Naomi Mochizuki

Examination time as a quality indicator of screening upper gastrointestinal endoscopy for asymptomatic examinees

The significance of examination time of esophagogastroduodenoscopy (EGD) for asymptomatic examinees is yet to be established. We aimed to clarify whether endoscopists who allot more examination time can detect higher numbers of neoplastic lesions among asymptomatic examinees.

3467 Eus in the management of colorectal cancer: a comparative study with conventional colonocopy.

Background: The colorectal tumors limited within the mucosa or superficial submucosa(sm-small) can be completely treated endoscopically since the probability of lymph node metastasis is almost nil. Histologically, the depth of submucosal tumor invasion was regulated by equally divided three levels of the submucosa in the vertical direction. Tumors of sm-small were defined as those limited within the superficial 1/3 of the submucosa, tumors of sm-massive, extending from the middle 1/3 of the submucosal layer to the deeper portion near the muscularis propria. Therefore, pretherapeutic diagnosis whether the depth of tumor invasion is limited within sm-small or deeper than sm-massive is extremely important for the treatment strategy. Aims: To evaluate the usefulness of EUS in the diagnosis of depth of colorectal cancer invasion, and compare the ability of EUS with conventional colonoscopy in the diagnosis of submucosal cancer invasion. Methods: Between May 1985 and September 1999, EUS was performed in 563 patients with colorectal cancer. All of the tumors were resected and confirmed histologically. Especially, preoperative EUS diagnosis of submucosal cancer staging was investigated in comparison with conventional colonoscopy in 77 patients with colorectal submucosal cancer. EUS criteria for the depth of submucosal cancer invasion were defined as SM-small and SMmassive according to the deepest portion of the hypoechoic tumorous mass compared with the third hyperechoic layer in the vertical direction. Colonoscopic criteria for the SM-massive were based on the following findings; marginal submucosal elevation, erosion or ulceration on the tumor, marked elevation on the tumor and fold convergence. Results: EUS correctly diagnosed pTis in 98 of 118 patients, pT1 in 62 of 80 patients, pT2 in 42 of 84 patients, pT3 in 248 in 276, and pT4 in 5 of 5 patients. The overall accuracy rate of EUS was 81%(455/563) according to TNM classification. Pretherapeutic diagnosis was investigated whether the depth of tumor invasion was sm-small or sm-massive. The accuracy rates of EUS and colonoscopy were 23/31(74%) and 19/31(61%), respectively, in sm-small, and 41/46(89%) and 38/46(83%), respectively, in sm-massive. The overall accuracy rates with EUS and colonoscopy were 83%(64/77) and 74%(57/77), respectively. Conclusion: EUS is a useful diagnostic method for determining the depth of colorectal cancer invasion according to TNM classification and subclassification of submucosal cancer.

Endoscopic mucosal resection for large sessile polyps of the colon

ENDOSCOPIC MUCOSAL RESECTION FOR LARGE SESSILE POLYPS OF THE COLON E. Cho, N. Mochizuki, T. Ashihara, K. Yasuda and M. Nakajima, Department of Gastroenterology, Kyoto Second Red Coss Hospital, Kyoto, Japan With the advances of techniques and instruments, endoscopic electrosurgical polypectomy has become a fundamental procedure in the management of colorectal polypoid lesions. However, large sessile polyps can be technically difficult and sometimes dangerous to endoscopically resect. Recently, endoscopic mucosal resection(EMR) has been developed as a safer method for colorectal polyps. We assessed the usefulness of this technique for large sessile colorectal polyps. From September 1990 to November 1995, we have performed EMR in 32 patients with colorectal sessile polyps larger than 2 cm in size. The procedure was done in a similar fashion of standard snare polypectomy after injection of saline solution into the submucosa just underneath the target lesion. The maximum diameter of resected polyps ranged from 2.0 to 6.0 cm with a mean of 3.1 cm. The procedure was performed in Ii patients with single resection and 21 patients with piecemeal resection. The histological analysis of these lesions consisted of 3 with tubular adenoma, 5 with tubulovillous adenoma, i with villous adenoma, 20 with mucosal carcinoma and 3 with submueosal carcinoma. The complications after EMR occurred in 4 patlents(12.5%) including i patient with bleeding, 2 with transmural burn and i with perforation into the retroperitonetum, all of which required neither transfusion nor laparotomy. Twentyfive of 32 patients underwent colonoscopic management and surveillance. Locally reccurent or persistent neoplasia was discovered in 4 of 25 patients(16%). Three of these four patients subsequently underwent surgical resection. Endoscopic management was ultimately successful in 22 of 25 patients(88%). EMR is a safer and reliable therapeutic procedure for large sessile colorectal polyps. Close follow-up with colonoscopy is essential to evaluate this technique.

Factors associated with the presentation of erosive esophagitis symptoms in health checkup subjects: A prospective, multicenter cohort study

Background We aimed to clarify the factors associated with the presentation of erosive esophagitis (EE) symptoms in subjects undergoing health checkups. Methods We utilized baseline data from 7,552 subjects who underwent upper endoscopy for health screening in a prospective, multicenter cohort study. The subjects were asked to complete a questionnaire detailing their upper abdominal symptoms and lifestyle. Based on the heartburn and/or acid regurgitation frequency, the EE subjects were stratified into the following three groups: (1) at least one day a week (symptomatic EE [sEE]), (2) less than one day a week (mild symptomatic EE [msEE]), and (3) never (asymptomatic EE [aEE]). Postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS) were defined according to the Rome III criteria. Results Of the 1,262 (16.7%) subjects (male 83.8%, mean age 52.6 years) with EE, the proportions of sEE, msEE and aEE were 15.0%, 37.2% and 47.9%, respectively. The sEE group showed significant associations with overlapping EPS (OR: 58.4, 95% CI: 25.2–160.0), overlapping PDS (OR: 9.96, 95% CI: 3.91–26.8), severe hiatal hernia (OR: 2.43, 95% CI: 1.43–4.05), experiencing high levels of stress (OR: 2.20, 95% CI: 1.43–3.40), atrophic gastritis (OR: 1.57, 95% CI: 1.03–2.36) and Los Angeles (LA) grade B or worse (OR: 1.72, 95% CI: 1.12–2.60) in the multivariate analysis. Conclusions Approximately one-sixth of EE subjects were symptomatic. A multifactorial etiology, including factors unrelated to gastric acid secretion, was associated with the symptom presentation of EE subjects.