Tomohiro Noda

Ease of early gastric cancer demarcation recognition: A comparison of four magnifying endoscopy methods

Background and Aim:  Various techniques using magnifying endoscopy (ME) have been developed to enhance images of early gastric cancer (EGC) demarcations, which are often obscure. We investigated four ME methods to determine which is most effective in enhancing the recognition of EGC demarcations: conventional ME (CME), ME with narrow band imaging (NBI‐ME), enhanced‐magnification endoscopy with acetic acid (EME), and ME with NBI and acetic acid (NBI‐EME).

Increased plasma levels of tissue factor pathway inhibitor‐activated factor X complex in patients with disseminated intravascular coagulation

Plasma levels of tissue factor pathway inhibitor (TFPI)–activated factor Xa (FXa) complex were measured in patients with disseminated intravascular coagulation (DIC), pre‐DIC, and DIC. Plasma levels of plasmin–plasmin inhibitor complex (PPIC), D‐dimer, and soluble fibrin monomer (SFM) were significantly higher in patients with DIC than in those with pre‐DIC or non‐DIC; the levels of these hemostatic markers were significantly higher in patients with pre‐DIC than in those with non‐DIC. Plasma levels of thrombin–antithrombin complex (TAT) were significantly higher in patients with DIC or pre‐DIC than in those with non‐DIC. Plasma levels of tissue factor (TF), total TFPI, free TFPI, and TFPI–Xa complex were significantly higher in patients with DIC than in those with non‐DIC. Plasma levels of TFPI–Xa complex were significantly increased in patients with pre‐DIC as compared to those with non‐DIC; however, plasma free TFPI levels were significantly decreased in patients with pre‐DIC as compared to those with non‐DIC. These findings suggest that free TFPI might be consumed in the pre‐DIC state, thereby confirming the activation of the extrinsic pathway. Plasma levels of TFPI–Xa complex were significantly correlated with TF, free TFPI, and total TFPI. Increased plasma TFPI–Xa complex levels might be useful for the diagnosis of DIC or pre‐DIC, particularly that occurring by activation of the extrinsic pathway of blood coagulation. Am. J. Hematol. 65:210–214, 2000.

Usefulness of endoscopic submucosal dissection for the treatment of rectal carcinoid tumors.

Background and aim Various techniques of endoscopy have been developed to treat rectal carcinoids. This retrospective study aimed to evaluate the feasibility and efficacy of endoscopic submucosal dissection for the treatment of rectal carcinoids smaller than 10 mm in diameter. Patients and methods A total of 18 consecutive patients were enrolled with 20 carcinoid tumors that had the following characteristics: the diagnosis of a rectal carcinoid smaller than 10 mm, no endoscopic evidence of muscularis propria invasion, and no evidence of lymph node or distant metastasis (11 men and seven women; median age, 69 years; median tumor size, 4 mm). Tumors were resected by endoscopic submucosal dissection with a needle knife and a hook knife. After marking, a one-third to one-half circumferential mucosal incision was made, and subsequently, the submucosa under the lesion was exfoliated. After the submucosa under the tumor was exfoliated, the residual mucosa was incised and the tumor was removed. Complete resection, complication rates, and operation time were evaluated. Results Complete resection was achieved in all cases (100%) without complications. The mean operation time was 34.2 min, which was acceptable in clinical practice. Conclusion Endoscopic submucosal dissection with the strategy described above is feasible and efficacious for selected patients with a rectal carcin-oid smaller than 10 mm.

ENDOSCOPIC SUBMUCOSAL DISSECTION FOR EARLY GASTRIC CANCER USING MAGNIFYING ENDOSCOPY WITH A COMBINATION OF NARROW BAND IMAGING AND ACETIC ACID INSTILLATION

Demarcation of early gastric cancers is sometimes unclear. Enhanced‐magnification endoscopy with acetic acid instillation and magnifying endoscopy with a narrow band imaging (NBI) system have been useful for recognition of demarcation of early gastric cancers. We report a patient with early gastric cancer who underwent a successful endoscopic submucosal dissection (ESD) by magnifying endoscopy with the combined use of NBI and acetic acid instillation. A 72‐year‐old man with early gastric cancer underwent ESD. Demarcation of the lesion was not clear, but magnifying endoscopy using the combination of NBI and acetic acid clearly revealed the demarcation. ESD was carried out after spots were marked circumferentially. We identified the positional relation between the demarcation and all markings. Resection of the lesion was on the outside of the markings. Histopathologically, the lesion was diagnosed as a well‐differentiated adenocarcinoma limited to the mucosa. The margins were carcinoma free. Magnifying endoscopy combining the use of NBI with acetic acid instillation is simple and helpful for identifying the demarcation of early gastric cancer. This method may be useful in increasing the rate of complete resection by ESD for early gastric cancer.