Tatsuyuki Watanabe

Endoscopic Measurement of Polyp Size Using a Novel Calibrated Hood

Background. Although the size of colon polyps is an important risk factor for colorectal cancer, a standardized measurement technique has yet to be determined. In clinical practice, most endoscopists estimate polyp size by uncertain visual estimation; however, colonoscopic polypectomy is indicated for adenomatous polyps more than 5 mm in diameter. We have therefore developed a novel calibrated hood that enables accurate measurement of polyp size during colonoscopy. Method. We compared prepolypectomy estimates using the calibrated hood against measurements of preformalin-fixed samples immediately after polypectomy. Results. Sixty-five polyps removed from 44 patients were included in the present study. The mean size of polyps was significantly larger at prepolypectomy (6.06 ± 1.23 mm) than after polypectomy (5.48 ± 1.31 mm, P < 0.05). Conclusion. Accurately measuring the size of polyps during colonoscopy is important, since polyps are shrunk by polypectomy. Attaching the calibrated hood appears useful in the measurement of polyp size to determine indications for polypectomy in patients with colon polyps.

A Case of Acute Superior Mesenteric Artery Occlusion Rescued by Thrombus Aspiration without Bowel Resection

Acute superior mesenteric artery (SMA) occlusion is rare and associated with high morbidity and mortality.One of the reasons is the difficulty to diagnose the disease soon after the abdominal pain initially occurs. A 79-year-old woman with atrial fibrillation was admitted because of progressive left abdominal pain and nausea. Two hours after the onset, computed tomography revealed an occlusion of the SMA. No signs of intestinal infarction were present. Abdominal angiography revealed complete obstruction from the distal portion of the SMA to the ileocolic artery, so we could have a diagnosis of SMA occlusion early. Continuous per-catheteric thrombus aspiration for the occlusion successfully removed the thrombus and led to complete revascularization laparotomy. We encountered a case of acute mesenteric ischemia due to SMA occlusion with atrial fibrillation. Early diagnosis is necessary to survive without bowel resection.

TRANSECTION OF METAL STENTS USING ARGON PLASMA COAGULATION

Background:  Placement of self‐expandable metallic stents has become the preferred palliative treatment for patients with unresectable malignant biliary obstruction. Metallic stents provide longer patency compared with plastic stents. Distal malposition or migration of metallic stents sometimes occurs, but it is often difficult to remove them. We evaluated the efficacy and safety of argon plasma coagulation (APC), and the optimum conditions for cutting metallic stents (Wallstent).

Recombinant Thrombomodulin Used to Successfully Treat Cronkhite-Canada Syndrome with Disseminated Intravascular Coagulation due to Sepsis in a Compromised Patient: A Case Report

Cronkhite-Canada syndrome (CCS) is a rare non-inherited disease characterized by gastrointestinal polyposis, chronic diarrhea, ectodermal dysplasia, skin hyperpigmentation, hair loss and nail atrophy. Although the efficacy of corticosteroid and immunomodulatory agents has been demonstrated, no standard therapy regimen has been established, and the prognosis of CCS is still poor due to various complications. We here in report a CCS patient complicated with severe sepsis and disseminated intravascular coagulation who was successfully treated by combined modality therapies, including recombinant human soluble thrombomodulin.

A Young Adult Patient with Nonalcoholic Steatohepatitis Developed Severe Gastroesophageal Varices Associated with Severe Obesity and Diabetes Mellitus

Obesity is a major contributor to insulin resistance and nonalcoholic fatty liver disease, which is the most common cause of chronic liver diseases. Nonalcoholic steatohepatitis (NASH) can progress to liver cirrhosis and end-stage liver diseases. Some cases already show severe liver fibrosis at the time of diagnosis. We present the case of a 44-year-old male with overt obesity who was admitted with hematemesis due to the rupture of gastric varices. We diagnosed him with NASH with severe liver fibrosis. This case shows that we should be concerned about the progression of liver fibrosis due to NASH associated with severe obesity even in young patients.