Soichi Ichikawa

VASCULAR ECTASIA OF THE COLON TREATED BY ARGON PLASMA COAGULATION : REPORT OF A CASE

A 72‐year‐old woman presented with hematochezia. Colonoscopy revealed branch‐like vasodilation in the ascending colon and chronic hemorrhage from vascular ectasia of the colon was suspected. Argon plasma coagulation was performed. After treatment, epithelialization of the lesion site was noted and her anemia improved. Vascular ectasia of the colon is recognized as the etiology of lower gastrointestinal bleeding with increasing frequency. Infrared ray electronic endoscopy is useful for determining the extent of disease and argon plasma coagulation, a new hemostatic technique, is suitable for treatment of this condition.

Usefulness and Limitations of Endoscopic Ultrasonography in Diagnosis of Adenomyomatosis of the Gallbladder

Abstract: Although endoscopic ultrasonography (EUS) is commonly used to examine lesions in the gallbladder, its ability to accurately diagnose adenomyomatosis (ADM) has not been evaluated. We compared the accuracy of EUS and various other imaging techniques in the diagnosis of ADM. Thirty‐one patients undergoing cholecystectomy after elevated lesions were found in the gallbladder by various imaging techniques were studied retrospectively. Based on histopathologic examination, the sensitivity and specificity of EUS were evaluated in ADM. The sensitivity of abdominal ultrasonography, CT and ERCP in ADM were also evaluated. Of the 11 patients diagnosed with ADM by EUS, 9 cases were confirmed histologically (81.8%). Of the 11 patients with histologic diagnosis of ADM, 9 were accurately diagnosed preoperatively by EUS (81.8%). EUS proved more reliable for diagnosis of ADM than the other imaging techniques. Important diagnostic features include preservation of the three‐layered structure of the gallbladder, wall‐thickening exceeding 3 mm, and 2 or more Rokitansky‐Aschoff sinuses occurring within a 1 cm area of the gallbladder.

Evaluation of solitary and scattered esophageal varices according to infrared endoscopy and endoscopic ultrasonography

Background and Aim:  The aim of this study was to clarify the etiology and clinical significance of solitary and scattered esophageal varices by evaluating their hemodynamics and other characteristics using infrared endoscopy and endoscopic ultrasonography.

7172 Endoscopic ultrasonography for the diagnosis of gallbladder lesions in patients with gallstones.

Purpose: Gallstones are generally considered a risk factor for gallbladder cancer. Since gallbladder cancer has a poor prognosis, accurate qualitative diagnosis of elevated lesions in the gallbladder is needed, even in the presence of gallstones. In this study, the ability of endoscopic ultrasonography (EUS) to detect gallbladder lesions in patients with gallstones was assessed. Patients and Methods: Between April 1992 and September 1999, 62 patients underwent cholecystectomy for an elevated lesion or thickening of the gallbladder wall identified by imaging techniques including EUS. EUS was performed using the Olympus GF-UM20 (7.5MHz) system. The accuracy of EUS was analyzed in relation to the presence or absence of gallstones, the size and number of stones, and presence or absence of acoustic shadowing.The EUS results were compared with histopathologic results. Significance was tested using the chi-square test and the Students t test. Results: The accuracy of EUS was 70.8% in the gallstone group and 89.5% in the gallstone-free group (NS). The diagnostic accuracy was 75.0% in the patients with stones smaller than 5 mm, 33.3% in the patients with stones between 6 and 10 mm in size, and 77.8% in the patients with stones larger than 11 mm (NS). The accuracy was 66.7% in the patients with 1 to 5 stones, and 83.3% in the patients with 6 or more stones (NS). Acoustic shadowing did not affect the diagnostic accuracy of EUS. Conclusions: Gallstones do not affect the diagnostic accuracy of EUS for gallbladder lesions. However, more diagnostic criteria must be established, and new devices need to be introduced that can provide more information about the lesions.

3560 Evaluation of solitary and scattered esophageal varices by infrared-ray endoscopy and endoscopic ultrasonography.

Objective: Solitary esophageal varices (SoV) sporadically develop in the upper and middle esophagus, while scattered esophageal varices (ScV) consist of more than two variceal lesions. It is considered that both SoV and ScV differ from portal hypertensive esophageal varices or so-called down hill varices. However, the etiology and clinical significance of SoV and ScV remain unclear. In the present study, using both IRE and EUS, we evaluated the internal characteristics and hemodynamics of SoV and ScV. Subjects and Methods: The subjects consisted of 44 lesions in 28 patients in whom SoV or ScV were detected by visible ray endoscopy (VRE). These lesions were evaluated by IRE and EUS. During IRE, the intensity of blueblack color was evaluated using GIF-Q200IR (Olympus Co., Ltd.). Subsequently, 2 mg/kg of ICG was rapidly injected intravenously to evaluate the degree of stainability by three stages. During EUS, the major location and echo patterns of SoV and ScV were observed using an ultrasonic miniprobe. Echo patterns were classified as follows: homogeneous low echo, mixed echoes, and homogeneous high echo. Results: When the relationship between the size of SoV or ScV and the degree of stainability during IRE was evaluated in densely stained lesions, the diameter of SoV or ScV was significantly smaller in lesions that showed stronger stainability than in those that showed weaker stainability. When the relationship between the size of SoV or ScV and echo patterns observed by EUS was evaluated, the diameter was significantly smaller in lesions that showed homogeneous low echo than in those that showed mixed echoes. When the relationship between echo patterns observed by EUS and the degree of stainability during IRE was evaluated, lesions that showed homogeneous high echo showed the weakest stainability, followed by lesions that showed mixed echoes and those that showed homogeneous low echo in ascending order. Conclusion: Concomitant i.v. injection of ICG was useful for observing hemodynamics of SoV and ScV during IRE, as well as observing the major location or morphology of these variceal lesions during EUS. SoV and ScV with larger diameters were stained later when hemodynamics were evaluated by IRE, and showed a mixture of low and high echo areas when the morphology was evaluated by EUS. These observations suggested that internal blood flow of SoV or ScV was arrested, and the severity of extravasation of blood increased with the diameter of variceal lesions.