Toshiki Yamaguchi

Predicting the clinical response to cytapheresis in steroid-refractory or -dependent ulcerative colitis using contrast-enhanced ultrasonography

Objective. To evaluate the usefulness of transabominal ultrasound (US), including contrast-enhanced ultrasonography (CEUS), in predicting the response to cytapheresis therapy in patients with steroid-refractory or -dependent ulcerative colitis (UC). Material and methods. Between January 2005 and June 2008, 26 consecutive patients with steroid-refractory or -dependent UC were treated with granulocyte and monocyte adsorption apheresis (GCAP) or leukocytapheresis (LCAP) at our institute. The clinical activity of UC was evaluated by patients’ C-reactive protein (CRP) levels and clinical activity index (CAI) scores. All patients were evaluated by grey-scale US, power Doppler US (PDUS), and CEUS. In CEUS, the color signal patterns were classified as 1 of 2 patterns. In pattern 1, color signals were partially detected in the bowel wall (excluding muscularis propria, the outer thin layer of the bowel wall), whereas in pattern 2, color signals were detected in the entire bowel wall (excluding muscularis propria). Differences between remission or clinical response (group R) and no response (group N) were ascertained for clinical features, clinical activities, and US findings. Results. Differences between the two groups were not considered significant for the clinical features, clinical activities, and grey-scale US and PDUS findings. Using CEUS, 4 patients in group R showed pattern 2 (21%), while in group N, all patients showed this pattern, indicating a significant difference between the two groups (p<0.01). Conclusion. CEUS findings may be helpful in predicting the clinical response to cytapheresis for steroid-refractory or -dependent UC.

Small-Intestinal Peutz-Jeghers Polyps Resected by Endoscopic Polypectomy with Double-Balloon Enteroscopy and Removal Confirmed by Ultrasonography

Ultrasonography (US) is easy to use and noninvasive, and there are many reports of its usefulness for diagnosing various gastrointestinal diseases [1]. The “multiple concentric ring sign” is the most typical US sign of intussusception [2]. The most common causes of small-intestinal intussusception in adults are cancer, Meckel diverticulum, and Peutz-Jeghers syndrome (PJS) polyps [3], and US is useful for detecting intussusception due to these conditions [4]. Two new technological developments, capsule enteroscopy (CE) and double-balloon enteroscopy (DBE), have revolutionized small intestinal endoscopy [5]. DBE in particular makes possible not only examination of the whole small bowel but also treatment of the disease detected. We report herein the case of a patient with PJS who underwent resection of two polyps by means of interventional DBE at one procedure. In addition, US was useful for screening intussusception in this patient and confirming whether the polyps had been removed completely.

Famotidine prevents canine gastric blood flow reduction by NSAIDs

Aim : To investigate the effect of famotidine on gastric blood flow reduction induced by diclofenac sodium, a common non‐steroidal anti‐inflammatory drug in Japan, using laser Doppler flowmetry in the canine stomach.

The usefulness of transabdominal ultrasound for the diagnosis of lower gastrointestinal bleeding

Background  Lower gastrointestinal bleeding is a frequent cause of hospitalization, but diagnostic methods for this condition are not fully established. Transabdominal ultrasound is a widely accepted diagnostic tool in bowel diseases.

Endoscopic submucosal dissection of early colorectal neoplasms with a monopolar scissor-type knife: short- to long-term outcomes

Background and study aims Endoscopic submucosal dissection (ESD) for colorectal neoplasms remains challenging because of technical issues imposed by the complex anatomical features of the large intestine. We evaluated the feasibility, and the short- and long-term clinical outcomes of ESD for early colorectal neoplasms performed using the Stag-beetle Knife Jr. (SB Knife Jr.) Patients and methods We retrospectively assessed 228 patients who underwent ESD for 247 colorectal lesions with the SB Knife Jr. Clinicopathological characteristics of the neoplasms, complications, and various short- and long-term outcomes were evaluated. Results Mean tumor size was 34.3 mm and median procedure time was 76 minutes. The SB Knife Jr. achieved 98.4 % en bloc resection, 93.9 % complete resection, and 85.4 % curative resection. No perforations occurred during the procedure, and a delayed bleeding rate of 2.4 % was observed. Long-term outcomes were favorable with no distant recurrence, 1.1 % local recurrence, a 5-year overall survival rate of 94.1 % and 5-year tumor-specific survival rate of 98.6 % in patients with cancer. Conclusions ESD using the SB Knife Jr. is technically efficient and safe in treating early colorectal neoplasms and is associated with favorable short- and long-term outcomes.

Endoscopic submucosal dissection with a scissors-type knife for post-EMR recurrence tumor involving the colon diverticulum

The advantages of endoscopic submucosal dissection (ESD) include the ability to control resection size and shape and permit en bloc resection of large and ulcerated lesions. However, even with ESD, endoscopic treatment is challenging for post-EMR recurrence of colorectal tumors because of severe fibrosis. Moreover, lesions involving the colon diverticulum are considered contraindicated for endoscopic treatment because of the risk of perforation in the absence of a muscle layer.

Endoscopic full-thickness resection for inverted Meckel’s diverticulum using double-balloon enteroscopy

Meckel’s diverticulum contains all layers of the small bowel wall and is usually treated by surgery [1, 2]. Inverted Meckel’s diverticulum is rare, with only two reports of endoscopic resection [3, 4]. As preoperative diagnosis of an inverted Meckel’s diverticulum is difficult [5], it was not diagnosed prior to resection in either case, and consequently perforation due to endoscopic resection was reported in one case [3]. In the current case, we diagnosed the condition preoperatively, and subsequently used two detachable snares prior to resection to prevent hemorrhage or perforation. We then safely treated the inverted Meckel’s diverticulum using endoscopic full-thickness resection with double-balloon enteroscopy (DBE). A 78-year-old man was admitted to our institution because of anemia and a positive fecal occult blood test. Abdominal ultrasound identified a hypoechoic polypoid lesion, with a hyperechoic head (▶Video1). A contrasted abdominal computed tomography scan also identified an elongated pedunculated polypoid lesion, with fat tissue in its center, in the distal ileum (▶Video1). Capsule endoscopy demonstrated a submucosal tumor-like lesion (▶Video1), and selective contrast-enhanced radiography indicated an elongated intraluminal polypoid lesion that was approximately 8 cm in size (▶Video1). Retrograde DBE indicated that the polypoid lesion exhibited intestinal villous mucosa on the surface at the head and typical mucosal features at the stalk of the antimesenteric attachment (▶Fig. 1). This indicated that the lesion was an inverted Meckel’s diverticulum, and endoscopic full-thickness resection with DBE was attempted. First, the stem of the polyp was closed with two detachable snares before resection to prevent hemorrhage or perforation. Then, conventional polypectomy with DBE was performed. The resection surface was closed with four clips after the polypectomy (▶Fig. 2, ▶Video1). Histopathological analysis revealed an 80×10mm inverted Meckel’s diverticulum without ectopic tissue (▶Video1). The patient was discharged 2 days later without adverse events. Endoscopy_UCTN_Code_TTT_1AP_2AD

Endoscopic submucosal dissection using a stag beetle knife for early esophageal cancer in lower esophageal diverticula

re 1. Esophageal ESD using the stag beetle (SB) knife. A single-channel endoscope (H260Z) and a high-frequency electric surgical unit (VIO 300D; Tübingen, Germany) were used. A, Visualization of the esophageal cancer (white arrows) in the lower esophageal diverticula. B, Circumferential sal cutting done with the SB knife. C, D, ESD performed directly grasping the submucosal layer with the SB knife. E,Mucosal defect after the ESD. F, cted lesion in a single piece. Histopathology confirmed a squamous cell carcinoma tumor confined to the lamina propria, with a negative lateral and margin.

Usefulness and safety of a scissors-type knife in endoscopic submucosal dissection for nonampullary duodenal epithelial tumors

4,5 Duodenal endoscopic submucosal dissection (ESD) is considered challenging because of poor endoscopic operability. Furthermore, the muscle layer of the duodenum is thinner than that of any other site in the GI tract, resulting in higher reported perforation rates of up to 30%. To prevent the risk of adverse events (especially perforations) associated with the use of a conventional knife in ESD for nonampullary duodenal epithelial tumors (NADETs), we used a scissors-type knife, a stag beetle (SB) Knife Jr (Sumitomo Bakelite Co, Tokyo, Japan), which maintains an adequate dissection layer and a controlled

Gastric and enteric anisakiasis successfully treated with Gastrografin therapy: A case report

We report a case of a 59-year-old woman who was diagnosed with gastric and small intestinal anisakiasis, which was successfully treated with endoscopic extraction and Gastrografin therapy. She was admitted to our hospital with epigastric pain and vomiting one day after eating raw fish. She exhibited tenderness in the epigastrium without obvious rebound tenderness or guarding. Computed tomography (CT) demonstrated segmental edema of the intestinal wall with proximal dilatation and a small number of ascites. Because enteric anisakiasis was suspected based on the patient’s history of recent raw fish consumption and abdominal CT, we performed gastroscopy and confirmed that nine Anisakis larvae were attached to the gastric mucosa. All of the Anisakis larvae were extracted via endoscopy, and the patient was diagnosed with gastric and enteric anisakiasis. Additionally, in the hospital, we performed ileography twice using Gastrografin, which led to shortened hospital stay. Based on the clinical results of this case, we suggest that Gastrografin therapy is a safe, convenient, and useful method to extract enteric Anisakis larvae.