Shigeharu Senoo

Histological study of gallbladder and bile duct epithelia in patients with anomalous arrangement of the pancreaticobiliary ductal system: comparison between those with and without a dilated common bile duct

BackgroundWe histologically evaluated the epithelia of the gallbladder (GB) and bile duct (BD) in patients with anomalous arrangement of the pancreaticobiliary ductal system (AAPB), with regard to the shape of the common BD (CBD).MethodsThe GB and BD were studied histologically using surgical materials from 44 patients with AAPB: 27 with a dilated CBD (D-type) and 17 with a nondilated CBD (N-type).ResultsGB cancer and BD cancer were found in 11.1% and 3.7% of D-type and 17.6% and 0% of N-type respectively. Hyperplastic epithelium and atypical epithelium of the GB were frequently seen in both D-type (46%, 46%) and N-type (82%, 70%), while such epithelia of the BD were only seen in D-type (10%, 35%). The Ki67 labeling index of the nonneoplastic epithelium of the GB was high in both D-type (13.0%) and N-type (9.7%), though that of the BD was high in D-type (12.5%) but low in N-type (1.8%). The prevalences of pyloric gland metaplasia, intestinal metaplasia, and p53 protein overexpression of the nonneoplastic epithelium did not show any significant differences between D-type and N-type.ConclusionsIt is suggested that the BD epithelium of N-type probably has a lower potential for developing malignancy than that of D-type, while the GB epithelia of both D-type and N-type have a high potential for developing malignancy. This might support the selection of simple cholecystectomy as the treatment of choice in AAPB patients of N-type, although further investigation of the BD epithelium is required in a larger number of such patients.

Handmade outer flushing channel for safe endoscopic submucosal dissection

Endoscopic submucosal dissection (ESD) is rapidly becoming widespread as an excellent method for the treatment of intramucosal tumors, especially the superficially spreading type, of the digestive tract. In contrast, of great concern are the complications that may arise when the procedure is prolonged due to such factors as bleeding during mucosal cutting and submucosal dissection. To realize safe performance of ESD, we have developed and have been using a handmade outer channel for flushing with excellent results. Mounting the outer channel for flushing provides an effective flushing function without costly investment and contributes to maintaining a clear endoscopic view during the procedure. This device enables some extended indications for endoscopic procedures, including hemostasis of hemorrhagic peptic ulcers and rupture of esophagogastric varices.

DIAGNOSIS OF GASTRIC MUCINOUS CARCINOMA BY ENDOSCOPIC ULTRASONOGRAPHY

Background:  Biopsy diagnosis of gastric mucinous carcinoma (GMC) is sometimes difficult. Endoscopic ultrasonography (EUS) can visualize the change in the gastric wall in detail. We reviewed the EUS images and histological findings of cases of GMC and evaluated the correlation between them to identify the characteristic findings of GMC on EUS.