Torahiko Terui

NEW ENDOSCOPIC TECHNIQUE TO CLOSE LARGE MUCOSAL DEFECTS AFTER ENDOSCOPIC MUCOSAL RESECTION IN PATIENTS WITH GASTRIC MUCOSAL TUMORS

Endoscopic mucosal resection has been recognized as a standard method for treating mucosal tumors of the stomach in Japan. In our department, we have treated mucosal defects after this procedure by using metallic clips to prevent and manage complications related to endoscopic mucosal resection. In the present study, we explain the new technique, the ‘loop‐and‐clips’ method, which uses clips and a detachable snare to close large mucosal defects after endoscopic mucosal resection.

Pleuropericarditis and Disseminated Intravascular Coagulation in Ulcerative Colitis

We report a 30-year-old woman with pleuropericarditis, cardiac tamponade, and disseminated intravascular coagulation complicating active ulcerative colitis (UC). Other autoimmune diseases were not present. She responded to pulsed steroid therapy and anticoagulant with resolution of the complication and UC. We reviewed the literature and found 27 cases of pleuropericarditis associated with idiopathic inflammatory bowel disease (IBD). It has been reported that pleuropericarditis associated with IBD responds well to nonsteroidal antiinflammatory drugs, as well as steroids. The causes of cardiac involvement in IBD remain unclear, but the pleuropericarditis must be recognized as a potential extraintestinal manifestation of IBD.

Administration of additional analgesics can decrease the incidence of paradoxical reactions in patients under benzodiazepine‐induced sedation during endoscopic transpapillary procedures: Prospective randomized controlled trial

The aim of the present study was to evaluate the efficacy and safety of giving pentazocine as an analgesic with benzodiazepine during endoscopic retrograde cholangiopancreatography (ERCP).

Endoscopic closure of mucosal defects with metallic clips after endoscopic mucosal resection in patients with intramural tumors of the stomach: A retrospective study

Background:  Representative complications of endoscopic mucosal resection to treat intramural gastric tumors include bleeding and perforation. The purpose of the present study was to clarify whether endoscopic closure of mucosal defects using metallic clips decreases the incidence of delayed bleeding following endoscopic mucosal resection.

The study of the local immunity in Helicobacter pylori-infective gastric mucosa

A 32 year old white male with an eight year medical history of Crohns disease but no surgical history came to the ER after fainting in the shower. He complained of light headedness and multiple black tarry stools that had gradually progressed to bright red, bloody diarrhea over the course of four days. There were no accompanying abdominal cramps, nausea, vomitting or hemetemesis. While in house patient continued to bleed requiring a total of ten units of blood. Patient underwent EGD which showed candidiasis and no active bleeding. Colonoscopy was performed in which terminal ileum was entered and biopsies taken. It only showed melenic stools and no active bleeding. Biopsy from terminal ileum suggested Crohns disease. Patient continued to drop his H&H and RBC-tagged bleeding scan was done which showed bleeding in the right mid-upper abdomen. Patient underwent angiography of the superior mesenteric artery with urokinase challenge that led to identification of brisk bleeding from an arterial branch to the mid ileum. Patient was taken into surgery and bleeding site was identified with methylane blue injection through the angiography catheter. Fifteen centimeters of the diseased terminal ileum was resected sparing the last five centimeters and the ileal cecal valve. Post-operative recovery went well and the patient was discharged on post-operative day number six. Conclusion: Massive bleeding from the ileum is extremely rare in purely ileal Crohns disease. Only about I% to 2% of patients with Crohns bleed so massively and those usually have some colonic involvement. This case is unusual in the very fact that such heavy ileal bleeding occurred when this is a complication more commonly associated with colonic Crohns.