Masayuki Sawaguchi

Salvage endoscopic submucosal dissection for the esophagus-localized recurrence of esophageal squamous cell cancer after definitive chemoradiotherapy

1. Kawai K, Akasaka Y, Murakami I, et al. Endoscopic sphincterotomy of the ampulla of Vater. Gastrointest Endosc 1974;20:148-51. 2. Classen M, Demling L. Endoskopische sphincterotomie der papilla vateri und steinextraktion aus dem ductus choledochus [In German]. Dtsch Med Wochenschr 1974;99:469-76. 3. Geenen JE, Vennes JA, Silvis SE. Resume of a seminar on endoscopic retrograde sphincterotomy (ERS). Gastrointest Endosc 1981;27:31-8. 4. Soehendra N, Grimm H, Berger B, et al. Endoskopische behandlungsmogglichkeiten [In German]. 1988;1:2-9. 5. Cotton PB. Nonoperative removal of bile duct stones by duodenoscopic sphincterotomy. Br J Surg 1980;67:1. 6. Sievert CE, Silvis SE. Evaluation of electrohydraulic lithotripsy on human gallstones. Am J Gastroenterol 1985;80:854. 7. Leung JWC, Chung SSC. Electrohydraulic lithotripsy with peroral choledochoscopy. Br J Med 1989;299:595-8. 8. Siegel JH, Ben Zvi JS, Pullano WE. Electrohydraulic lithotripsy. Gastrointest Endosc 1990;36:134-6. 9. Kozarek RA, Low DE, Ball TJ. Tunable dye laser lithtripsy: in vitro studies and in vivo treatment of choledocholithiasis. Gastrointest Endosc 1988;34:418-21. 10. Ell C, Lux G, Hochberger J, et al. Laserlithotripsy of common bile duct stones. Gut 1988;29:746-51. 11. Cotton PB, Kozarek RA, Shapiro RH, et al. Endoscopic laser lithotripsy of large bile duct stones. Gastroenterology 1990;99:1128-33. 12. Ponchon T, Gagnon P, Valette PJ, et al. Pulsed dye laser lithotripsy of bile duct stones. Gastroenterology 1991;100:1730-6.

Advanced feasibility of endoscopic submucosal dissection for the treatment of gastric tube cancer after esophagectomy

The incidence of esophageal cancer is increasing worldwide. However, progress in surgical techniques and the development of novel therapeutic modalities such as adjuvant chemoradiation therapy combined with surgery have improved the postoperative survival up to 34% to 51% at 5 years. Therefore, long-term survival cases are no longer rare. Generally, gastric tubes are substituted for the reconstitution after the esophagectomy for the treatment of esophageal cancer. In association with the increase in the number of long-term follow-up cases after esophagectomy, the occurrence of secondary malignancies such as adenocarcinoma arising in gastric tubes has been reported. Until a decade ago, repeat surgery was considered for the treatment of adenocarcinoma in gastric tubes. However, this did not achieve satisfactory clinical outcomes because of its high operative risks. Recently, the use of EMR has been emphasized for treatment in patients with superficial lesions. Although the clinical risks of EMR associated with gastric tube cancer (GTC) treatment are significantly lower than those associated with surgery, EMR cannot always be used to resect GTC completely because of its technical limitations regarding the tumor sizes. Therefore, endoscopic submucosal dissection (ESD) is currently used as a therapeutic option for treating GTC. However, ESD for GTC also carries limitations with respect to the anatomical features of gastric tubes, particularly the suture line and staples with the possibility of fibrosis. We therefore investigated the feasibility of

The feasibility of endoscopic submucosal dissection for superficial esophageal cancer in patients with cirrhosis (with video)

Endoscopic submucosal dissection (ESD) was initially developed for gastric cancer and is currently accepted as an established procedure for superficial cancer of the esophagus. The most important advantage of ESD compared with EMR is that it can provide a high en bloc resection rate and precise histologic assessment even for large lesions. On the other hand, the disadvantage of ESD is a higher risk of bleeding and perforation than for EMR. Previous reports described that esophageal ESDrelated adverse events, such as postoperative bleeding and perforation, are considerably serious risks. However, ESD for patients with cirrhosis may carry a higher risk of these adverse events because of the low platelet count, coagulopathy, and portal hypertensive gastroenteropathy, including esophageal varices, in these patients. As a result, endoscopists have been hesitant to apply ESD for the treatment of esophageal cancer in patients with cirrhosis.

Proper muscle layer damage affects ulcer healing after gastric endoscopic submucosal dissection.

Endoscopic submucosal dissection (ESD) is the established therapy for superficial gastrointestinal neoplasms. However, management of the artificial ulcers associated with ESD has become important and the relationship between ulcer healing factors and treatment is still unclear. We aimed to evaluate ESD‐related artificial ulcer reduction ratio at 4 weeks to assess factors associating with ulcer healing after ESD that may lead to optimal treatment.

True Primary Enterolith Treated by Balloon-assisted Enteroscopy

Primary enterolith is a rare condition that can induce ileus and intestinal perforation. We report the first case of a true primary enterolith treated by balloon-assisted enteroscopy. The patient presented with a small intestinal ileus. After its improvement following the insertion of an ileus tube, radiography with amidotrizoate sodium meglumine detected a round, movable defect in the ileum measuring 42 mm diameter. The patient was diagnosed with a primary enterolith based on her past history. The enterolith was fractured and removed using balloon-assisted enteroscopy. This case suggests that balloon-assisted enteroscopy may be an effective non-invasive treatment option for enteroliths.

Phlegmonous Gastritis: A Report of Three Cases with Clinical and Imaging Features

Phlegmonous gastritis is a rare but often fatal acute pyogenic infection of the stomach. We herein report three cases of phlegmonous gastritis with different causes: the long-term placement of a nasogastric feeding tube, bacteremia associated with cellulitis in a diabetic patient, and an adverse reaction to paclitaxel/carboplatin chemotherapy for cancer of unknown primary cause, which were classified as primary, secondary, and idiopathic types, respectively. Coping with the increasing morbidity rate associated with the diverse background of such patients requires a thorough understanding of the clinical features and image findings associated with this entity.

Successful treatment with infliximab for refractory para-ileostomal ulceration in a patient with Behҫet’s disease

Behҫet’s disease (BD) is a chronic disorder involving multiple organ systems including the small and large intestines. A 46-year-old female diagnosed with intestinal BD presented with ileocecal perforation and diffuse peritonitis and subsequently underwent ileocolic resection with ileostomy. After surgery, she suffered from refractory para-ileostomal ulceration associated with BD. Most importantly, however, treatment with infliximab was significantly effective in healing the ulceration. This is the first report of para-ileostomal ulceration associated with BD successfully treated with infliximab, suggesting the possible use of infliximab as a therapeutic option for para-stomal ulcers related to BD.

A case of esophageal actinomycosis with a unique morphology presenting as a refractory ulcer

A 60-year-old man presented with odynophagia after bronchial artery infusion chemotherapy for pulmonary metastasis of hepatocellular carcinoma. Esophagogastroduodenoscopy (EGD) revealed an esophageal ulcer in the middle thoracic esophagus. An esophageal biopsy demonstrated no malignancy. However, the symptoms had not improved after a month. EGD was performed again and showed a white cord lump at the bottom of the same esophageal ulcer identified before, showing no improving tendency. A repeated biopsy of the lump revealed actinomycosis, and the symptoms were improved by the oral administration of ampicillin. We herein report a case in which esophageal actinomycosis with a unique morphology of refractory esophageal ulcer was rapidly improved by the administration of antibiotics.

Mesenteric lymph node abscess due to Yersinia enterocolitica : case report and review of the literature

Abstract We describe the case of a 74-year-old female with a mesenteric lymph node abscess caused by a Yersinia enterocolitica infection. She had been administered an immunosuppressive drug and was admitted to the hospital due to a high fever, right lower abdominal pain and advanced leukocytosis. We initially diagnosed her with lymphadenitis based on the symptoms and the imaging studies. However, conservative treatment with antibiotics did not yield any improvement, and abscess formation was suspected. Surgical treatment was performed, and the culture from the drainage fluid grew Y. enterocolitica. The histological findings suggested that an ulcerative lesion of the terminal ileum was the entry port of Y. enterocolitica. The pathogen infected the mesenteric lymph nodes and spread along the ileocecal lymphatic vessels, resulting in the formation of an abscess. We also provide a review of the previously published literature on lymph node abscesses due to Y. enterocolitica infections.

Su1819 Evaluation of the Expanded Indication of Endoscopic Submucosal Dissection for Superficial Esophageal Squamous Cell Neoplasms

[Background and Aim] Since the technical advance and the development of new devices, endoscopic submucosal dissection (ESD) is widely utilized for the treatment of superficial esophageal squamous cell neoplasms (ESCNs). In the treatment of ESCNs without nodal metastasis, ESD achieves the similar clinical outcomes to those of esophagectomy and chemoradioherapy and is much less invasive than them. The intensive studies of histopathological analysis of surgically resected ESCNs have proven that the cases of non-invasive carcinoma (EP, carcinoma in situ) and intra-mucosal invasive carcinoma limited to the lamina propria mucosae (LPM) had an extremely low risks of lymph node and distant metastasis. Based on these findings, the Japanese guideline for the treatment of esophageal cancer states that both EP and LPM cases are suitable for ESD. On the other hand, the lymph node metastasis rate of ESCNs invading to the muscularis mucosae (MM) including both with and without lymphovascular invasion has been reported as 7-10 %. Thus, ESD treatment had not been positively recommended for MM cases. However, it is assumed that MM cases without lymphovascular invasion have no lymph node metastasis. Thus, there exists the possibility that MM cases without lymphovascular invasion can be suitable for ESD. In this study, therefore, we evaluated expanded ESD indication to the MM cases without lymphovascular invasion, by analyzing surgically resected specimens histopathologically and investigating the clinical outcomes both after surgery and ESD of MM cases without lymphovascular invasion. [Methods] MM cases without lymphovascular invasion surgically treated between January 2001 and December 2010 (11 cases) and those treated with ESD between January 2006 and August 2012 (30 cases) at Akita University Hospital were enrolled in this study. [Results] In the detailed histopathological analysis of the surgically resected specimens of 11 MM cases without lymphovascular invasion, no lymph node metastasis was detected. No recurrence or metastasis developed in any of these 11 cases until today. In the analysis of the ESD-treated, 30 MM cases were proven to have no lymphovascular invasion by the histopathological examination of the specimens endoscopically resectd en bloc. Then, no additional therapy such as chemoradiotherapy was performed for these cases. However, all of the 30 cases are still alive without recurrence or metastasis during the followup period (4-81 months, average 33.8 months). [Conclusion] Our current study elucidated that MM cases without lymphovascular invasion has no risk of lymph node metastasis, and clinical outcomes of the ESD-treated MM cases without lymphovascular invasion are extremely satisfactory. These data suggest that ESD indication for superficial ESCNs treatment can be expanded to the MM cases without lymphovascular invasion.