Shunichi Saeki

Endoscopic features of lymphoid follicles in Helicobacter pylori-associated chronic gastritis

Small, round, yellowish‐white nodules (YWN) are frequently observed in Helicobacter pylori‐associated gastritis. The aim of the present study was to investigate the clinical significance of these YWN.

ENDOSCOPIC MICROVASCULAR ARCHITECTURE OF THE PORTAL HYPERTENSIVE GASTRIC MUCOSA ON NARROW BAND IMAGING

Background:  We evaluated the endoscopic microvascular architecture of the gastric mucosa in portal hypertension patients using the prototype of narrow band imaging (NBI).

GASTRIC FUNDIC VARICES: HEMODYNAMICS AND NON-SURGICAL TREATMENT

The hemodynamics and non‐surgical treatment of gastric fundic varices (FV) are reviewed. FV are more frequently supplied by the short and posterior gastric veins than esophageal varices (EV), and are formed mostly by large spontaneous shunts in which the gastric or splenic vein is continuous with the left renal vein via the inferior phrenic veins and the suprarenal vein (so‐called gastric‐renal shunt). Concomitant collaterals such as EV, para‐esophageal vein, and para‐umbilical vein were also observed in nearly 60% of FV. Endoscopic injection sclerotherapy (EIS) with Histoacryl is thought to be the most approved treatment for hemorrhage from FV, but repeated treatment for residual FV and care for ensuing hepatic failure are required. Balloon‐occluded retrograde transvenous obliteration (B‐RTO) is a notable interventional radiological procedure specially developed for the elective or prophylactic treatment of FV. If the procedure is technically successful, long‐term eradication of treated FV is found in most patients without recurrence. B‐RTO includes another significance, obliteration of the unified portal‐systemic shunt. Follow‐up abdominal CT scan revealed a high incidence of long‐term obliteration of the gastric‐renal shunt after B‐RTO. Benefits such as elevation of serum albumin, improvement in 15‐min retention rate of indocyanine green, decrease in blood ammonia levels, and improvement of encephalopathy are sometimes observed.

A case of a large cholangiolocellular carcinoma.

Cholangiolocellular carcinoma (CoCC) is a rare malignant primary liver tumor that is considered to originate from the canals of Hering, where hepatic progenitor cells are located. CoCC has various clinicopathological findings, therefore it is difficult to describe a clear diagnostic criteria for CoCC. Reported is a case of a large CoCC in a 45-year-old Japanese woman, which could not be preoperatively diagnosed as CoCC. The final diagnosis of CoCC was determined by pathological observation. Since both the biological behavior and diagnostic criteria of CoCC remain unclear, it is necessary to accumulate more information on CoCCs in order to elucidate these characteristic findings.

Risk Factors of Hepatocellular Carcinoma in Chronic Hepatitis C and Cirrhosis: Special Reference to Laparoscopic Findings

Abstract: It remains unclear whether the hepatitis C virus genotype is associated with the severity and outcome of HCV‐related liver disease. The aim of this study was to determine whether hepatitis C virus genotype influenced the risk of developing hepatocelMar carcinoma. Two hundred and sixty nine patients who had chronic hepatitis C and cirrhosis without hepatocellular carcinoma were studied. The stage and activity of hepatitis were determined at laparoscopy and patients were followed up until the development of hepatocellular carcinoma or for a maximum of 16 years. Hepatitis C virus genotypes were determined by a genotyping enzyme‐linked immunosorbent assay. A cross‐sectional study revealed that the prevalence of hepatitis C virus genotype 1 increased and that of genotype 2 decreased with the progression of liver disease (pc 0.01). A follow‐up study using the Kaplan‐Meier method showed that hepatocellular carcinoma occurred more frequently in patients with hepatitis C virus genotype 1 (p<0.01), patients with a more advanced disease stage (p<0.01), and patients with reddish markings (p<0.05). Cox multivariate proportional hazards analysis confirmed that these three risk factors were independent. Hepatocellular carcinoma developed more frequently in patients with hepatitis C virus genotype 1 and pre‐cirrhosis (stage 3 chronic hepatitis with nodules) or liver cirrhosis, in whom hepatitis showed continued activity and progression. (Dig Endosc 1999; 11: 24–31)