Minoru Kizu

Manometric endoscopic retrograde pancreatocholangiography. Technique, significance, and evaluation.

A manometer has been developed to permit measurement and control of the injection pressure of the contrast medium in endoscopic pancreatocholangiography (EPCG). Using this method we have retained the precision of the investigation but have avoided pancreatic damage caused by excessive pressure. The findings of pancreatic carcinoma in EPCG were characterized by stenosis and obstruction of the main pancreatic duct and, sometimes, by a peripheral filling defect. Obstructed type, stenosed type, pancreatic-field-defect type, and mixed type were encountered in that order of frequency. 28 of 29 proved cases of pancreatic carcinoma were correctly diagnosed preoperatively by EPCG. There were two possible false positive diagnoses. Chronic pancreatitis was classified into three groups: minimal, moderate, and advanced pancreatitis, according to a grading of findings in EPCG. The main findings of minimal and moderate pancreatitis were “pancreatectasis.” There was a close correlation between histological and EPCG grading of chronic pancreatitis. EPCG is now one of the most reliable procedures for the detection of diseases of the pancreatic and biliary systems.

A case of gastic antral vascular ectasia—increase of neuroendocrine cells in the antrum

We report an 82-year-old woman with severe iron deficiency anemia who was found to have gastric antral vascular ectasia (GAVE). As the required repeated blood transfusion for the anemia and did not respond to various medical treatments, she was referred for antrectomy. The pathogenesis of GAVE is still obscure and may involve many factors. In our patient, immunohistochemical studies of the resected stomach disclosed a marked increase of neuroendocrine cells. The majority of these hyperplastic neuroendocrine cells, furthermore, showed immunoreactivity for 5-hydroxytryptamine (serotonin). These findings suggest that neuroendocrine mediators, serotonin in particular, may have been responsible for the local vasodilatation.

Endoscopic electromyography of the sphincter of ODDI

SummaryEndoscopie electromyography of the human sphincter ofODDI has provided useful information for the patho-physiological studies on the choledocho-duodenal junction. The pattern and rhythm of the electromyogram observed on the sphincter ofODDI were different from those of the duodenum recorded simultaneously in basal tracings of our initial four cases. In the half of other ten cases with consecutive tracings, the different pattern and rhythm of electromyograms between the sphincter ofODDI and the duodenum were also confirmed.It was possible, from our results, to speculate that the functional independence of the sphincter ofODDI from the duodenal wall muscles was in existance.

A Case of a “Vanishing Submucosal Tumor” of the Stomach Which was Suspected of being a Gastric Wall Abscess

We report on a case of a “vanishing submucosal tumor” of the stomach in a 76‐year‐old woman who was admitted to our hospital with severe abdominal pain. Laboratory tests revealed marked inflammation. Various radiological, ultrasonographical, and endoscopic findings in addition to the clinical symptoms were compatible with a diagnosis of gastric wall abscess. The tumor vanished before an endoscopic puncture could be performed. We speculate that the disappearance of the tumor and subsequent improvement of the patients clinical symptoms were the result of spontaneous drainage into the gastric lumen. The findings in this case suggest that there is a spontaneous healing mechanism in this disease.

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.

Symposium (III): Clinical aspects of the duodenal diverticula

bu t not remaks, 12 months after biopsy done, adenocarc inoma tubu ia re was indicated, it is I I a type early cancer. Next we showed a few cases of confusable benign pro t ruding type lesions in the prepyloric portion. Case 3 is a gastritis verccosa, case 4 was a benign ulcer of near the rings, bu t looks like Bor rman I I type cancer, as the h igh land walls, case 5 was abe r r an t pancreas, case 6 was benign mul t ip le cysts in the submucosa and last case was adul t pylorusring muscle hyper t rophy. W e are conclusive in this studies, it is more i m p o r t a n t biopsy study to diagnosis or different ia t ion I I a and inf lammatory changes of prepyloric portion, and so necesary to examine by duodenoscope to observe in details,

1) Diagnosis of benign papillary lesions by cholangiography and biliary pressure study

Diagnosis of benign papillary lesions including organic and functional changes is significant clinically because of a close relationship of the lesions and the diseases of the liver, biliary tract and pancreas 1). The X-ray study was made by PTC and to analyse videotaped images. The pressure study was done by using Microt ip Catheter Transducer that was inserted through T tube into the common duct. From the pressure curve, the value of the closing and opening pressure were found. The histological study was made to investigate the specimens obtained by papilloplasty and by autopsy as the control materials~L The results are as follows : 1) The pathologic findings of the papilla of Vater were divided into 3 types; inflammation type (I), glandular and/or fibrous proliferation type (II) and adenosis (adenomyosis) type (III) . 2) The pathologic findings of cholangiograms are rigidity and stenosis. The former was histopathologically based on the type I and the latter was chiefly based on the type I I or I I I . The cholangiograms of the lower end of the common bile duct were divided into 4 types; normal type, fingertip type, funnel type and sclerosed-tapering type. The fingertip type was seemed to be chracteristic of primary papillary stenosis. 3) The findings of the biliary pressure were divided into 3 types based on the level of the opening pressure; hypertensive, hypotensive and normotensive types. In cases with the hypertensive type with high level of the closing pressure, functional disturbance ot the papilla may be considered, whereas organic changes may be present in cases with low level of the closing pressure. References 1) Hess, W.: Surgery of the biliary passages and tile pancreas. D. Van fflostrand Company, Inc. 1965. 2) Tanabe, T.: Pathological study of papilla of Vater including the relationship between the biliary tract and the pancreas. Japanese Journal of Gastroenterology 71: 973-988.