Tatsuzo Kasugai

Endoscopic and biopsy criteria for the diagnosis of esophagitis with a fiberoptic esophagoscope.

Endoscopic and biopsy criteria for the diagnosis of esophagitis with a fiberoptic esophagoscope were introduced and a good correlation between them was reported. Erosion and ulceration were reliable endoscopic signs of esophagitis, with histological confirmation in every case. An endoscopic finding of erythema alone was of less value. A pronounced ingrowth of the lamina propria with associated capillaries into the squamous epithelium represents esophagitis and is often associated with an erythematous mucosal change on endoscopy. It has been emphasized that this may be demonstrated even without the whole of the lamina propria in the biopsy specimen. A histological diagnosis of esophagitis was made in 90% of the patients with endoscopic esophagitis. Thus the criteria introduced here seem to be acceptable for the diagnosis of esophagitis from endoscopic biopsy specimens.

Manometric endoscopic retrograde pancreatocholangiography. Technique, significance, and evaluation.

A manometer has been developed to permit measurement and control of the injection pressure of the contrast medium in endoscopic pancreatocholangiography (EPCG). Using this method we have retained the precision of the investigation but have avoided pancreatic damage caused by excessive pressure. The findings of pancreatic carcinoma in EPCG were characterized by stenosis and obstruction of the main pancreatic duct and, sometimes, by a peripheral filling defect. Obstructed type, stenosed type, pancreatic-field-defect type, and mixed type were encountered in that order of frequency. 28 of 29 proved cases of pancreatic carcinoma were correctly diagnosed preoperatively by EPCG. There were two possible false positive diagnoses. Chronic pancreatitis was classified into three groups: minimal, moderate, and advanced pancreatitis, according to a grading of findings in EPCG. The main findings of minimal and moderate pancreatitis were “pancreatectasis.” There was a close correlation between histological and EPCG grading of chronic pancreatitis. EPCG is now one of the most reliable procedures for the detection of diseases of the pancreatic and biliary systems.

Fiberduodenoscopy: analysis of 353 examinations

Endoscopic examination of the duodenum was successful in 95.7% of 353 cases enploying the Machida FDS-L and the Olympus JF instruments. In the duodenal bulb, active ulcer crater and scar were differentiated. Biopsy specimens were readily obtained, including that from an early carcinoma of the papilla. Pancreatography was accomplished in 12 cases.

Endoscopic follow-up of gastric polyps.

The authors describe protracted observation of gastric polyps in 118 cases. Only 4 instances of eventual adenocarcinoma, suspected of being malignant change, were found. In 7 cases polyps increased in size, while in 4 cases polyps diminished. A majority of gastric polyps remained static.

Changes in serum dipeptidyl-aminopeptidase IV (glycylprolyl dipeptidyl-aminopeptidase) activity of patients with gastric carcinoma after surgical excision and the enzyme activity in the carcinoma tissue.

Abstract Serum dipeptidyl-aminopeptidase IV (glycylprolyl dipeptidyl-aminopeptidase, GP-DAP) activity was found to be significantly decreased in patients with gastric carcinoma. The patients with advanced carcinoma showed more significant reduction of serum enzyme activity. After successful surgical removal of gastric carcinoma, serum enzyme activity tended to return to the normal level. In cases of recurring carcinoma serum activity decreased progressively. When hepatitis or liver metastasis was complicated, serum activity was significantly increased. Gastric carcinoma tissue itself had lower GP-DAP activity than normal gastric tissue of the same patients.

Selective use of brushing cytology in gastrointestinal strictures.

Endoscopic brushing has yielded cytologic material of specific diagnostic quality in 80% of carcinomas of the esophagus, stomach, and colon. Brushing at the time of endoscopy is of particular value in lesions where proximal stenosis precludes direct biopsy of the neoplastic tissue.

Endoscopic diagnosis of gastric non-epithelial tumors

Benign non-epithelial tumors of the stomach characteristically are observed endoscopically as circumscribed masses. Ulcerated or infiltrative lesions connote malignancy and may be confused with carcinoma. Gastroscopy supplemented by biopsy and cytology can lead to an accurate diagnosis in a majority of these cases.

Early colonic cancer presenting as a pedunculated polyp: Application of fibercolonoscopy for its detection

The authors report 4 cases of solitary pedunculated polypoid lesions in the colon. In each case, the radiographic and colonoscopic appearance was that of benign adenoma. Endoscopic biopsies and subsequent sections of resected specimens were interpreted as early colon cancer.