1
|
|
2
|
Clinical and endoscopic characteristics of acute haemorrhagic rectal ulcer, and endoscopic haemostatic treatment: a retrospective study of 95 patients. Colorectal Dis 2010; 12:e320-5. [PMID: 19863598 DOI: 10.1111/j.1463-1318.2009.02091.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM Acute haemorrhagic rectal ulcer (AHRU) is characterized by sudden onset of painless and massive rectal bleeding in elderly bedridden patients who have serious illness. Endoscopic diagnosis and management of AHRU is, however, still controversial. We retrospectively investigated 95 AHRU patients to elucidate the clinical characteristics, endoscopic findings and haemostatic strategies. METHOD Between January 1999 and March 2007, 95 patients were diagnosed with AHRU in our hospital. Medical records and colonoscopy files were reviewed. Clinical features, colonoscopic findings, haemostatic treatment and outcome of the patients were evaluated. RESULTS Eighty per cent of the patients were bedridden at the onset. The most frequent underlying disorder was cerebrovascular disease (36.8%). Hypoalbuminaemia (< 3.5 g/dl) was seen in 92.6% of the patients. Endoscopic findings of AHRU were classified as circumferential ulcer (41.1%), linear or nearly round small ulcer(s) (44.2%), circumferential and small ulcer(s) (7.4%) and Dieulafoy-like ulcer (7.4%). Primary endoscopic haemostatic treatment was performed in 45.3% of cases. Recurrent bleeding occurred in 24.2% of patients. Permanent haemostasis was achieved by secondary endoscopic treatment in 82.6% of re-bleeding patients. CONCLUSION Understanding the typical clinical and endoscopic findings and careful endoscopic examination are important for the accurate diagnosis of AHRU, and endoscopic haemostatic therapy may be effective for bleeding patients.
Collapse
|
3
|
Diagnosis of a small splenic artery aneurysm mimicking a gastric submucosal tumor on endoscopic ultrasound. Endoscopy 2010; 42 Suppl 2:E107-8. [PMID: 20306394 DOI: 10.1055/s-0029-1243940] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
4
|
Endoscopic submucosal dissection of early colorectal tumors using a grasping-type scissors forceps: a preliminary clinical study. Endoscopy 2010; 42:419-22. [PMID: 20340070 DOI: 10.1055/s-0029-1243973] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
To reduce the risk of complications related to endoscopic submucosal dissection (ESD), we developed a new grasping-type scissors forceps (GSF), which can grasp and incise the targeted tissue using an electrosurgical current. We prospectively evaluated the efficacy and safety of ESD using GSF for the removal of colorectal tumors in 10 consecutive patients. After the submucosa had been injected with a solution, the lesion was separated from the surrounding normal mucosa by complete incision around the lesion using the GSF. A piece of submucosal tissue was grasped and cut with the GSF using an electrosurgical current to achieve submucosal excision. All lesions were treated easily and safely with no unexpected incisions. No delayed hemorrhage or perforation occurred. En bloc resection was obtained in all cases. The tumor-free lateral/basal margins were obtained in eight out of 10 patients. ESD using GSF appears to be an easy, safe, and technically efficient method for resecting early colorectal tumors.
Collapse
|
5
|
Capsule endoscopic detection of bleeding Meckel's diverticulum, with capsule retention in the diverticulum. Endoscopy 2010; 42 Suppl 2:E199-200. [PMID: 20845270 DOI: 10.1055/s-0030-1255696] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
6
|
Endoscopic resection of a large pedunculated duodenal polyp using a grasping type scissors forceps. Endoscopy 2008; 40 Suppl 2:E74-5. [PMID: 18633904 DOI: 10.1055/s-2007-995524] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|
7
|
Endosonographic detection of dumbbell-shaped jejunal GIST using double balloon enteroscopy. Endoscopy 2008; 40 Suppl 2:E38-9. [PMID: 18300201 DOI: 10.1055/s-2007-966828] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
|
8
|
Abstract
Endoscopic submucosal dissection (ESD) with a knife is a technically demanding procedure that is associated with a high complication rate. The shortcoming of this method is the difficulty in fixing the knife to the target lesion. This difficulty can lead to unexpected incision, resulting in major complications such as perforation and bleeding. To reduce the risk of complications related to ESD, we developed a new grasping type scissors forceps (GSF), which can grasp and incise the targeted tissue using an electrosurgical current. The ESD procedure using the GSF was carried out in an animal model (resected porcine stomachs in vitro). After marking the lesion and injecting a solution into the submucosa, the lesion was separated from the surrounding normal mucosa following complete incision around the lesion using the GSF. A piece of submucosal tissue was grasped and cut with the GSF using an electrosurgical current to achieve submucosal exfoliation. ESD using the GSF was carried out safely and easily without unintentional incision. ESD using GSF appears to be an easy, safe, and technically efficient method for resecting gastrointestinal neoplasms.
Collapse
|
9
|
Endoscopic band ligation therapy for upper gastrointestinal bleeding related to Mallory-Weiss syndrome. Surg Endosc 2006; 20:1431-4. [PMID: 16703428 DOI: 10.1007/s00464-005-0608-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2005] [Accepted: 01/05/2006] [Indexed: 01/12/2023]
Abstract
BACKGROUND No consensus exists as to the best endoscopic treatment for Mallory-Weiss syndrome. Endoscopic band ligation is a readily available and easily learned technique. This prospective study evaluated the efficacy and safety of endoscopic band ligation therapy for Mallory-Weiss syndrome. METHODS From August 1998 to June 2005, a clinical trial assessed 37 patients with a diagnosis of Mallory-Weiss syndrome who had active bleeding, exposed vessels, or both. Their lesions were treated using endoscopic band ligation. RESULTS Endoscopic band ligation was successful in 36 of 37 cases, with a follow-up period ranging from 1 to 24 months. The remaining patient had severe liver failure and disseminated intravascular coagulation. The patient bled again at 12 h and subsequently died. Except for this case, no recurrent bleeding, perforation, or other complications occurred. CONCLUSIONS The study results suggest that endoscopic band ligation is an effective, safe, and easily learned procedure for treating upper gastrointestinal bleeding related to Mallory-Weiss syndrome.
Collapse
|
10
|
Abstract
Colonic muco-submucosal elongated polyp is a new clinical entity first reported in 1998. The purpose of this report is to determine the value of endoscopic ultrasound in the diagnosis of this condition. We reviewed the endosonographic and histological findings of seven colonic muco-submucosal elongated polyps that were removed completely by endoscopic resection or surgery. The lesions appeared as pedunculated submucosal tumours, measuring 1-4 cm in maximal diameter. Endosonographically, all lesions consisted of mucosal and submucosal layers, and microcystic components were found in the submucosal layer. There were no echogenic masses or muscularis propria within the polyps. These endosonographic features corresponded to histological findings of this type of polyp which was covered with normal mucosa and composed of submucosal layer alone. The submucosal layer consisted of oedematous, loose, connective tissue and/or fibrous tissue, accompanied by dilated blood vessels and lymphatics. Endoscopic ultrasound enabled differentiation of colonic muco-submucosal elongated polyp from other submucosal lesions.
Collapse
|
11
|
|
12
|
EUS-guided endoscopic resection using band ligation of oesophageal granular cell tumour: report of a case. Acta Gastroenterol Belg 2005; 68:272-5. [PMID: 16013651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
A 60-year-old Japanese man was referred for treatment of a polypoid oesophageal tumour. Radiographic examination of the upper gastrointestinal tract disclosed a nodule with central depression in the lower esophagus. By endoscopy the nodule was yellowish and appeared submucosal. Endoscopic ultrasonography demonstrated a hypoechoic solid tumour limited in submucosa without lymph node involvement. Endoscopic resection using band ligation was performed under guidance by endoscopic ultrasonography. By histologic examination the tumour consisted of large cells arranged in nests. These cells had abundant granular cytoplasm and small round nuclei. They expressed S-100 protein and were CD68, and periodic acid-Schiff positive. No expression of alpha-smooth muscle actin was noted. The tumour was limited in submucosa. Findings were consistent with complete endoscopic resection. This report may be the first concerning an oesophageal granular cell tumour successfully treated with EUS-guided endoscopic resection using band ligation.
Collapse
|
13
|
|
14
|
|
15
|
Duplication of 15q11.2-q14, including the P gene, in a woman with generalized skin hyperpigmentation. AMERICAN JOURNAL OF MEDICAL GENETICS 2001; 104:299-302. [PMID: 11754064 DOI: 10.1002/ajmg.10095] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We describe a woman with 15q11.2-q14 duplication who had clinical manifestations of proximal 15q trisomy and hyperpigmentation. Within this region, the P gene, located at chromosome segment 15q11.2-q12, is associated with oculocutaneous albinism type II (OCA2) and with hypopigmentation in the Prader-Willi and Angelman chromosome 15q deletion syndromes. We therefore hypothesized that in this woman skin hyperpigmentation might result from a duplication of the P gene. We carried out chromosomal and interphase fluorescence in situ hybridization (I-FISH) analyses, and determined that the P gene is duplicated in this woman. Our findings demonstrate that trisomy of the P gene can be associated with skin hyperpigmentation.
Collapse
|
16
|
Abstract
The objective of this study was to examine the accuracy of a 12 MHz ultrasound catheter probe in the pre-operative staging of colorectal cancer by assessing the depth of tumour infiltration and involvement of pericolonic lymph nodes. 159 patients with colorectal cancer who underwent ultrasound examination with a 12 MHz catheter probe were studied prospectively. The results of this imaging procedure were compared with the histological findings of the resected specimens. The accuracy of the 12 MHz ultrasound catheter probe for depth of invasion (T category) was 85% (131/154) for all tumours, 87% (46/53) for pT1 tumours, 60% (9/15) for pT2 tumours, 89% (74/83) for pT3 tumours and 67% (2/3) for pT4 tumours. The accuracy for tumours of the rectum and colon was 81% and 89%, respectively. The accuracy of the probe for nodal staging (N category) was 67% (76/114) overall. The sensitivity was 70% (33/47), the specificity 64% (43/67), the positive predictive value 58% (33/57) and the negative predictive value 75% (43/57). Endoscopic ultrasound using a 12 MHz catheter probe accurately assessed tumour stage, although nodal staging remained suboptimal. This method may aid in the selection of treatment for patients with colorectal cancer.
Collapse
|
17
|
Woman with UV hypersensitivity and a de novo unbalanced chromosome translocation. AMERICAN JOURNAL OF MEDICAL GENETICS 2001; 101:153-7. [PMID: 11391659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
We report a Japanese woman with de novo 6p monosomy and 10q trisomy [46,XX,der(6)t(6;10)(p25.1;q25.2)] whose clinical manifestations resemble those of xeroderma pigmentosum (XP) and Cockayne syndrome (CS), known as premature aging syndromes. She had a history of easy sunburning and presented a number of freckles and hypopigmented spots on her face as those of XP. Magnetic resonance imaging and computed tomography scanning demonstrated intracranial abnormalities like those seen in CS. DNA repair studies using the patient's fibroblasts demonstrated hypersensitive responses to ultraviolet (UV). XP, CS, and UV-sensitive syndromes with photosensitivity disturbances have been known as DNA repair abnormalities. However, an association of 6p monosomy with these diseases has not been reported so far. Molecular analysis of the patient we described may contribute to the identification of novel DNA-repair-related gene(s) and/or to the senile mechanism.
Collapse
|
18
|
A comparison of an open and laparoscopic appendectomy for patients with liver cirrhosis. Surg Laparosc Endosc Percutan Tech 2001; 11:189-94. [PMID: 11444750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Liver cirrhosis is a critical factor contributing to morbidity and mortality in abdominal surgery, because patients with cirrhosis have a particularly high risk of developing bleeding, infection, and ascites. Laparoscopic appendectomy (LA) recently has gained a lot of attention around the world; however, comparisons between the benefits of LA and those of conventional open appendectomy (OA) for patients with liver cirrhosis have yet to be sufficiently compiled. In the present retrospective study, 40 patients with liver cirrhosis who were diagnosed with acute appendicitis before surgery underwent an appendectomy (OA in 25 patients and LA in 15 patients). This study focused on the operative time, amount of postoperative pain, use of analgesics, the restart of a normal diet, number of complications, length of hospital stay, and cost-effectiveness of the procedure in such patients. The amount of postoperative pain and the length of hospital stay were significantly smaller in the LA group. The mean values of the serum C-reactive protein on postoperative days 1, 3, and 7 were significantly less in the LA group. The number of wound infections and wound bleeding was also less in the LA group. The difference in the total cost of hospitalization was not significant. The cost of the operation was greater in the LA group than in the OA group, whereas the hospitalization cost in the LA group was less than that in the OA group. The results of this study suggest that LA may be superior to OA for the treatment of postoperative pain and postoperative complications for patients with liver cirrhosis. Long-term follow-up studies are still necessary, however, to determine any possible decrease in the number of late complications.
Collapse
|
19
|
Endosonography probe-guided endoscopic resection of small flat rectal carcinoid tumor using band ligation technique. Endoscopy 2001; 33:471. [PMID: 11396774 DOI: 10.1055/s-2001-14270] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
|
20
|
Intraductal papillary-mucinous tumors of the pancreas: differential diagnosis between benign and malignant tumors by endoscopic ultrasonography. Am J Gastroenterol 2001; 96:1429-34. [PMID: 11374678 DOI: 10.1111/j.1572-0241.2001.03794.x] [Citation(s) in RCA: 127] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Recently, intraductal papillary-mucinous tumor (IPMT) of the pancreas has increasingly been recognized. However, differential diagnosis between benign and malignant IPMT is often difficult using conventional imaging modalities. The purpose of this study was to retrospectively investigate the value of endoscopic ultrasonography (EUS) for differentiating malignant from benign IPMT. METHODS A total of 51 patients with IPMT were preoperatively examined by EUS. The endosonograhic findings were compared with histopathological findings of the resected specimens. RESULTS In main duct type IPMT, the diameter of the main pancreatic duct (MPD) was > or =10 mm in seven of the eight malignant tumors, compared with two of the seven benign tumors (p < 0.05). In branch duct type IPMT, three of the four large tumors (>40 mm) with irregular thick septa were malignant lesions. In both main duct type IPMT and branch duct IPMT, eight patients had large mural nodules (>10 mm); seven of the eight tumors were malignant and one of the eight tumors was benign. When the tumor was diagnosed as malignant according to above three findings, EUS was able to differentiate between malignant and benign IPMT with an accuracy of 86%. CONCLUSIONS Main duct type tumors with > or =10 mm dilated MPD, branch duct type tumors (>40 mm) with irregular septa, and large mural nodules (>10 mm) strongly suggest malignancy on EUS. EUS would be a useful modality for differentiating between benign and malignant IPMT.
Collapse
|
21
|
Abstract
BACKGROUND AND STUDY AIMS Recently, it was reported that focal submucosal invasive colorectal cancer could be treated by polypectomy or endoscopic mucosal resection (EMR) because of the rarity of lymph-node metastasis. Our objective was to examine the accuracy and efficacy of a 15-MHz ultrasound miniprobe in the preoperative evaluation of the degree of submucosal invasion in colorectal cancer. PATIENTS AND METHODS A total of 35 patients with submucosal invasive colorectal cancer who underwent ultrasonography with a miniprobe were studied prospectively. The results of this imaging were compared with the histologic findings in resected specimens. RESULTS Although the accuracy of the miniprobe in categorizing submucosal invasion into three subclasses (SM1, invasion limited to the upper third; SM2, limited to the middle third; SM3, limited to the lower third) was low (37.1%; 13/35), the accuracy in differentiation between < or = SMI (M and SMI) and > or = SM2 (SM2, SM3, MP, and S) was 85.7 % (30/35). CONCLUSIONS The miniprobe can be useful for therapeutic decision-making in submucosal invasive colorectal cancer.
Collapse
|
22
|
Abstract
A 56-year-old man and a 70-year-old woman, with histories of left colectomy and appendectomy respectively, were admitted to our hospital. In both cases, colonoscopy showed a pedunculated colonic polyp in the ascending colon, and a silk suture became visible in the stalk during polypectomy. The histological diagnosis was adenoma. These two cases constitute the first report of colonic adenomatous polyps accompanied by suture migration.
Collapse
|
23
|
The therapeutic strategies in performing emergency surgery for gastroduodenal ulcer perforation in 130 patients over 70 years of age. HEPATO-GASTROENTEROLOGY 2001; 48:156-62. [PMID: 11268955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND/AIMS Gastroduodenal ulcer is a very common illness in Japan. As the number of elderly persons in Japan increases the same as in Europe and America, the number of such patients requiring a gastroduodenal emergency operation has also increased. Regarding the complications of peptic ulcer, a perforation remains the most important fatal complication. The aim of this study is to investigate the operative risk factors and the long-term recurrence rates and to define the optimal surgical procedures in emergency situations in elderly patients. METHODOLOGY From April 1988 through March 1997, 130 patients over 70 years of age with a perforated gastroduodenal ulcer (a duodenal ulcer perforation in 50 patients and a gastric ulcer perforation in 80 patients) were operated on in an emergency situation in our clinic. We investigated the following items; medical illness, preoperative risk factor, optimal surgical procedure, postoperative organ failure and the cumulative recurrence-free rates after surgical treatment. RESULTS A significant correlation with mortality was observed in patients with established comorbidity in the following organs: lung (P = 0.03), heart (P = 0.02), kidney (P = 0.04), and diabetes (P = 0.03). The highest postoperative mortality rate was recorded in patients who underwent a simple closure of a duodenal ulcer perforation (4 patients; 26.7%), while the lowest postoperative mortality rate was recorded in patients who underwent a simple closure and vagotomy of a duodenal ulcer perforation (3 patients; 12.5%). In gastric ulcers, the mortality rate in patients with a gastrectomy was significantly higher than in patients with a simple closure. The practical application of the three risk factors (preoperative shock, delay to surgery over 24 hours, and medical illness) was shown by the progressive rise in the mortality rate with the increasing number of risk factors. Based on the 5 postoperative years after treating a perforated duodenal ulcer, the cumulative recurrence rate after a simple closure (63.6%) was significantly higher than that after a simple closure and vagotomy (38.1%) (n = 0.02) or after gastrectomy (0%) (P < 0.001). At 5 years postoperatively, the cumulative recurrence rate after a simple closure (41.2%) was significantly higher than that after a gastrectomy (15.9%) (P < 0.01). CONCLUSIONS In conclusion, in an emergency situation, elderly patients are in a highly unfavorable prognostic condition due to their advanced age, and comorbidity, which thus leads to poorer results, not only worldwide, but also in Japan. Based on our findings, in duodenal ulcer cases, a simple closure and vagotomy is recommended because of its low mortality and minimal stress, except for cases with a giant perforation measuring over 20 mm in diameter at the perforation hole or with severe duodenal stenosis. In stomach ulcer cases, a gastrectomy may be recommended because of its low recurrence rate.
Collapse
|
24
|
Abstract
BACKGROUND Conventional echoendoscopes have disadvantages when used for staging colorectal cancer including the inability to pass the instrument through tight stenosis and limited maneuverability. This study evaluated the preoperative use of a newly developed 7.5 MHz front-loading ultrasound probe (FLUP) for local staging of rectal cancer. METHODS A 7.5 MHz FLUP, diameter 7.3 mm, was used in this study. The mechanical shaft portion of the probe can be passed in retrograde fashion through the accessory channel of a standard colonoscope. Thirty-nine patients with rectal cancer underwent ultrasonography with this probe. The tumors were staged using the TNM system, and the results were compared with the histologic findings of the resected specimens. RESULTS The FLUP proved to be satisfactory, with respect to maneuverability, for traversing stenosis and accurate recognition of small tumors under direct endoscopic control. The accuracy of the FLUP for T staging was 82% (32 of 39) for all tumors, 90% in pT1, and 79% in pT2 to pT4 tumors. The accuracy of the FLUP for N staging was 72% (23 of 32) overall. The sensitivity was 83%, the specificity was 65%, the positive predictive value was 59%, and the negative predictive value was 87%. CONCLUSIONS The 7.5 MHz FLUP appears to be useful for preoperative local staging of rectal cancer. This system makes it technically easier to image small cancers as well as advanced rectal cancers.
Collapse
|
25
|
Endosonographic features of solitary gastric hamartomatous polyp. Endoscopy 2000; 32:S39. [PMID: 10863932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
|
26
|
Abstract
BACKGROUND Endoscopic resection of pedunculated polyps with heads 1 cm or greater in diameter is technically complex. To facilitate removal of such polyps, we developed grasping forceps assisted endoscopic resection in which we use a detachable snare to prevent polypectomy-related bleeding and evaluated the usefulness and safety of the procedure. METHODS Ten patients with pedunculated polyps with heads 1 cm or greater in diameter were treated with this technique. A two-channel endoscope, grasping forceps, electrosurgical snare, and detachable snare are needed for the procedure. RESULTS All lesions were easily and safely resected. During this procedure, a two-channel endoscope with grasping forceps proved to be satisfactory for handling the detachable snare and the electrosurgical snare and for accurate recognition of the stalk under good visual control. No hemorrhage, perforation, or other complication occurred as a result of use of this new technique. CONCLUSIONS Grasping forceps assisted endoscopic resection of polyps with a detachable snare is an effective method for the prevention of polypectomy-associated bleeding. This technique makes it technically easier to resect large pedunculated polypoid lesions of the GI tract.
Collapse
|
27
|
Transanal endoscopic microsurgery for T1 rectal cancer in patients with synchronous colorectal cancer. Surg Endosc 1999; 13:710-2. [PMID: 10384080 DOI: 10.1007/s004649901078] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
We treated T1 rectal cancer in three patients with synchronous colorectal cancer by transanal endoscopic microsurgery (TEM) before performing a radical operation for the second lesion. On pathological examination, all rectal specimens resected by TEM showed cancer invasion within the submucosal layer, while the margins of the specimen were completely free of cancerous tissue. Few complications were encountered with either the TEM for the rectal lesions or the succeeding radical operation for the second lesions. When patients present with synchronous colorectal cancer, including T1 rectal cancer, local excision of the rectal lesion via TEM can help to improve the patient's quality of life without affecting the curability of the disease.
Collapse
|
28
|
Abstract
Ampullary carcinomas have a significantly higher resectability rate and better prognosis than other periampullary carcinomas, although the prognosis is poor with advanced disease. Accurate tumour staging is therefore important in surgical planning. Our objective was to evaluate the usefulness of, and problems associated with, endoscopic ultrasound (EUS) in the pre-operative staging of ampullary tumours. 35 patients with ampullary tumours were pre-operatively examined with EUS. The imaging results were compared with histopathological findings of the resected specimen according to the TNM staging classification. The overall accuracy of tumour (T) staging was 74% (26/35) for all tumours, and 67% (6/9), 71% (10/14) and 83% (10/12) respectively for T1, T2 and T3 tumours. The overall accuracy of nodal (N) staging was 63%. In diagnosing pancreatic invasion, EUS had an accuracy of 86% (30/35), a sensitivity of 83% (10/12), and a specificity of 87% (20/23). In conclusion, EUS provides an accurate method of evaluating the stage of ampullary tumours, especially infiltration into the pancreas. This modality is useful to surgeons in deciding on an appropriate therapeutic approach and in giving a prognosis.
Collapse
|
29
|
Abstract
A 74-year-old Japanese woman with early gastric cancer was successfully treated with uracil and tegafur (UFT). She was diagnosed by endoscopy (including endoscopic biopsy and endosonography) with an early gastric cancer, type IIa + IIc, on the greater curvature of the angulus. Surgical procedures or endoscopic therapy could not be performed because the patient had severe ischemic heart disease. Therefore, chemotherapy with UFT was administered at 300 mg/day for 15 months. Follow-up endoscopy, endosonography, and biopsy showed disappearance of the gastric cancer. To our knowledge, this is the first case report of the complete response of an early gastric cancer to UFT in the English-language literature.
Collapse
|
30
|
Abstract
BACKGROUND The usefulness of and problems associated with an ultrasound catheter probe in the pretreatment staging of endoscopically early gastric cancer remain unexplored. METHODS Endoscopic ultrasonography using a 15 MHz catheter probe of 2.6 mm diameter was performed in a prospective study to determine the pretherapy staging of endoscopically early gastric cancer in 78 patients. The results of the ultrasound images were compared with the histologic findings of the specimens obtained by endoscopic mucosal resection or surgical resection. RESULTS The accuracy of the catheter probe for depth of invasion of endoscopically early gastric cancers was 67% (52 of 78 patients). The accuracy in determining depth of invasion in relation to endoscopic type was significantly higher for the elevated type (91%) than for the depressed type of early cancer (56%) (p < 0.01). The staging accuracy classified by histologic type was significantly higher for differentiated (86%) than for undifferentiated (18%) cancer (p < 0.01). Staging accuracy decreased as tumor size increased. The accuracy, sensitivity, and specificity for nodal staging were 80%, 17%, and 90%, respectively. CONCLUSIONS A 15 MHz ultrasound catheter probe is most useful for determining depth of invasion when the tumor is histologically differentiated and endoscopically of the small elevated type early gastric cancer, but it is unreliable in the diagnosis of metastatic lymph nodes.
Collapse
|
31
|
Diagnosis and staging of pancreatic cancer by endoscopic ultrasound. THE BRITISH JOURNAL OF RADIOLOGY 1998. [PMID: 9691893 DOI: 10.1259/br.71.845.9691893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The aim of this study was to evaluate the usefulness of and problems associated with endoscopic ultrasonography (EUS) in the diagnosis and pre-operative staging of pancreatic cancer. 96 patients suspected of having pancreatic cancer were pre-operatively examined with EUS. 37 of these 96 patients had pancreatic cancer. Results of the EUS imaging were compared with findings of histology and/or surgery, and the patient's clinical course. The sensitivity and specificity of EUS for diagnosing pancreatic cancer were 89% and 97%, respectively. EUS had excellent sensitivity regardless of tumour size or location. EUS was accurate (90%) in determining tumour size in pancreatic cancers less than 3 cm in maximum diameter, but not for tumours greater than 3 cm (30%). The accuracy of tumour (T) and nodal (N) staging were 64% and 50%, respectively. EUS is a promising method for the early diagnosis and pre-operative staging of pancreatic cancers, but requires further refinement.
Collapse
|
32
|
Case report: Endosonographic evaluation of colonic stenosis associated with chronic pancreatitis. Clin Radiol 1998; 53:532-4. [PMID: 9714396 DOI: 10.1016/s0009-9260(98)80176-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
33
|
|
34
|
|
35
|
|
36
|
Abstract
The aim of this study was to evaluate the usefulness of and problems associated with endoscopic ultrasonography (EUS) in the diagnosis and pre-operative staging of pancreatic cancer. 96 patients suspected of having pancreatic cancer were pre-operatively examined with EUS. 37 of these 96 patients had pancreatic cancer. Results of the EUS imaging were compared with findings of histology and/or surgery, and the patient's clinical course. The sensitivity and specificity of EUS for diagnosing pancreatic cancer were 89% and 97%, respectively. EUS had excellent sensitivity regardless of tumour size or location. EUS was accurate (90%) in determining tumour size in pancreatic cancers less than 3 cm in maximum diameter, but not for tumours greater than 3 cm (30%). The accuracy of tumour (T) and nodal (N) staging were 64% and 50%, respectively. EUS is a promising method for the early diagnosis and pre-operative staging of pancreatic cancers, but requires further refinement.
Collapse
|
37
|
Preoperative staging of colorectal cancer by a 15 MHz ultrasound miniprobe. Surgery 1998; 123:264-9. [PMID: 9526517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Our objective was to examine the accuracy of a 15 MHz ultrasound miniprobe in the pre-operative staging of colorectal cancer by assessing the depth of tumor infiltration and involvement of pericolonic lymph nodes. METHODS Thirty-three patients with colorectal cancer who underwent ultrasonography with a miniprobe were studied prospectively. The results of this imaging were compared with the histologic findings of the resected specimens. RESULTS The accuracy of the miniprobe for depth of invasion (T category) was 82% (27 of 33) for all tumors, 76% (13 of 17) in pT1 cases, and 88% (14 of 16) in pT2 to pT4 cases. The accuracy of the miniprobe for nodal staging (N category) was 87% (26 of 30) overall. The sensitivity was 63% (5 of 8), the specificity was 95% (21 of 22), the positive predictive value was 83% (5 of 6), and the negative predictive value was 88% (21 of 24). CONCLUSIONS The miniprobe is an accurate method for the preoperative TN staging of colorectal cancer. We recommend its preoperative use because the results may influence the surgical approach.
Collapse
|
38
|
|
39
|
Endoscopic ultrasonography: a promising method for assessing the prospects of endoscopic mucosal resection in early gastric cancer. Endoscopy 1997; 29:614-9. [PMID: 9360870 DOI: 10.1055/s-2007-1004266] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND STUDY AIMS A recent challenge that is increasingly being faced in endoscopy is the use of endoscopic mucosal resection (EMR) to treat differentiated intramucosal gastric cancers smaller than 2 cm. The usefulness of pretherapeutic endoscopic ultrasonography (EUS) in assessing whether this form of treatment is possible remains controversial. PATIENTS AND METHODS We retrospectively investigated the value of pretherapeutic EUS evaluation in 58 patients with macroscopically early gastric cancer that was histologically differentiated and less than 2 cm in diameter. The patients were classified as negative for endoscopic mucosal resection if EUS showed modifications of the third layer, and as positive if such modifications were not seen. All patients underwent radical surgery and the preoperative EUS findings were compared with the histological findings. RESULTS The prevalence of metastatic adenopathy was 3% (two of 58). In the lymph-node staging, endosonography had a sensitivity of 0% (neither of two cases), and a specificity of 93% (52 of 56). In assessing the indication for EMR, EUS had a sensitivity of 93% (27 of 29), and a specificity of 86% (25 of 29). CONCLUSIONS These results suggest that EUS is a promising method of evaluating the indication for endoscopic mucosal resection in early gastric cancer. EUS may improve pretherapeutic prediction of tumor curability by EMR, and may reduce the need for standard gastrectomy.
Collapse
|
40
|
Relationship between histological type and endosonographic detection of regional lymph node metastases in gastric cancer. Br J Radiol 1997; 70:697-702. [PMID: 9245881 DOI: 10.1259/bjr.70.835.9245881] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The aim of the study was to compare the ability of endoscopic ultrasonography (EUS) in detecting lymph node metastases in differentiated and undifferentiated gastric adenocarcinoma. EUS was performed in 149 patients with differentiated or undifferentiated gastric cancer. Histopathological findings were compared with pre-operative EUS findings in a total of 2961 resected lymph nodes. The EUS detection rates of metastasis to individual nodes in relation to node size, the ratio of the metastasized area to the cross-sectional area of the node and to the depth of primary tumour invasion, were also investigated. The accuracy and negative predictive values of EUS for detecting metastatic lymphadenopathy in each patient were significantly higher for differentiated (87%, 94%) than for undifferentiated (71%, 71%) tumours. The detection rate of individual node metastasis was higher for differentiated (31%) than for undifferentiated (21%) tumours. For differentiated lesions, EUS detected more small nodal metastases (< 5 mm in diameter) (p < 0.01) and more nodes involved with a relatively small proportion of the metastasized area to the cross-sectional area of the node (< 1/3 involvement) (p < 0.05). In relatively superficial lesions, such as pT1 and pT2, the pre-operative EUS detection rate of metastatic nodes was higher for differentiated than for undifferentiated tumours. In conclusion, the ability of EUS to detect nodal metastases is related to the histological type of gastric cancer.
Collapse
|
41
|
Abstract
The aim of the study was to evaluate the usefulness of and problems associated with a new endoscopically guided ultrasound miniprobe, used for pre-operative staging of gastric cancers. 59 cases of gastric cancer were prospectively examined with a 15 MHz ultrasound miniprobe. The results of the ultrasound imaging were compared with the histological findings of the resected specimens. The accuracy of the miniprobe for depth of invasion (T category) was 61% for all tumours, and 72% and 40%, respectively, for T1 and T2 to T4 lesions. If indeterminate cases due to ultrasound attenuation were excluded, the accuracy was improved to 82% for T1 and 57% for T2 to T4 tumours, respectively. The accuracy of the miniprobe for nodal staging (N category) was 69% overall, and 86%, 25% and 14% for stages N0, N1 and N2, respectively. In tumours classified on the basis of endoscopic types, the miniprobe staged early type gastric cancers (T category = 73%, N category = 80%) significantly (p < 0.01) more accurately than advanced ones (T category = 21%, N category = 36%). This study suggests that the miniprobe is indicated for pre-operative TN staging when endoscopy reveals an early gastric cancer.
Collapse
|
42
|
Endoscopic removal of a lymphangioma of the colon: case report of the diagnostic value of an endoscopic ultrasound probe. Endoscopy 1997; 29:S32-3. [PMID: 9270941 DOI: 10.1055/s-2007-1004242] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
43
|
Metastatic large-cell lung carcinoma presenting as gastrointestinal hemorrhage. Acta Gastroenterol Belg 1996; 59:217-9. [PMID: 9015935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A rare case of severe small bowel hemorrhage due to jejunal metastases from a large-cell type carcinoma of the lung is reported. A 69-yr-old Japanese woman presented with complaints of mild abdominal pain and liquid tarry stools 6 months following surgery for lung carcinoma. Gastroduodenoscopy and barium enema yielded unremarkable findings, although a subsequent small bowel enema revealed a large, 15-cm ulcerated mass in the jejunum. This tumor was resected and histology confirmed to be consistent with a metastasis from the primary undifferentiated large-cell carcinoma of the lung. The patient had an uneventful postoperative course and survived for 9 months. There have been only two prior case reports of major intestinal hemorrhage secondary to pulmonary carcinoma metastases in the English literature. Previous reports of such metastases of the small bowel have bowel have documented a very poor prognosis and our patient demonstrated the longest survival period to date. The clinical course of this patient suggests that the early diagnosis and palliative surgery for this complication provide a more favourable outcome.
Collapse
|
44
|
|
45
|
Diagnostic value of endoscopic ultrasonography in an unusual case of gastric cyst. Am J Gastroenterol 1995; 90:662-3. [PMID: 7717335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Using endoscopic ultrasonography, we diagnosed a gastric antral submucosal cyst with a papillous protrusion in a 71-yr-old woman, apparently the first such case to be detected by this method. Endoscopic ultrasonography demonstrated a well-marginated hypoechoic area with papillary tumor in the submucosal layer that did not extend to the muscularis propria. The lesion was diagnosed as a gastric submucosal cyst. CT and transabdominal ultrasound each failed to detect the intracystic papillary tumor. Follow-up endoscopic ultrasonography performed 6 months later revealed an increase in the diameter of the cyst and the papillary tumor. The patient then underwent a partial gastrectomy for a suspected malignancy. The resected specimen showed a cystic lesion with papillary tumor. Although no malignancy was present, examination of cross-sections of the resected specimen gave results consistent with the endoscopic ultrasonographic findings. Endoscopic ultrasonography is thus useful in assessing the nature of a submucosal gastric cyst in detail and in monitoring patients with this lesion.
Collapse
|
46
|
Abstract
A patient with ulcerative colitis developed a sulfasalazine-induced skin allergy manifested by a urticaria rash. The patient underwent drug desensitization. The first desensitization, done according to Holdsworth's protocol, resulted in eruption with itching at a dose of 800 mg. The second desensitization, with Das's protocol, failed to reintroduce the drug because of urticarial eruptions. The third challenge, with a more gradual increase in sulfasalazine dose than that used in Holdsworth's protocol, successfully desensitized the patient. The relationship between the drug and various adverse reactions is reviewed and the desensitization to sulfasalazine is discussed.
Collapse
|
47
|
A case of combined primary biliary cirrhosis, ulcerative colitis and chronic myelocytic leukemia. GASTROENTEROLOGIA JAPONICA 1992; 27:252-7. [PMID: 1577231 DOI: 10.1007/bf02777731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A rare case of primary biliary cirrhosis, ulcerative colitis and chronic myelocytic leukemia is described in a 49-year-old Japanese diabetic woman. Primary biliary cirrhosis was diagnosed by characteristic liver histology and positive serum mitochondrial antibody test. Ulcerative colitis was diagnosed by typical findings of barium enema and colonoscopy, negative fecal test for pathogens and compatible rectal histology. Chronic myelocytic leukemia was determined by representative hematologic findings and positive result for Ph1 chromosome. This is the first case with combination of primary biliary cirrhosis, ulcerative colitis and chronic myelocytic leukemia.
Collapse
MESH Headings
- Colitis, Ulcerative/complications
- Colitis, Ulcerative/diagnosis
- Diabetes Complications
- Female
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Liver Cirrhosis, Biliary/complications
- Liver Cirrhosis, Biliary/diagnosis
- Middle Aged
Collapse
|
48
|
Abstract
Endoscopic ultrasound (EUS) was performed in 83 patients with gastric cancer to evaluate regional lymph node metastasis. Histopathologic findings were compared with preoperative EUS findings in a total of 1,519 resected lymph nodes. In lymph node staging, the prevalence of metastatic adenopathy was 31.3% (26 of 83 patients); EUS had an accuracy of 83.1% (69 of 83 patients), sensitivity of 53.8% (14 of 26 patients), specificity of 96.5% (55 of 57 patients), positive predictive value of 87.5% (14 of 16 patients), and negative predictive value of 82.1% (55 of 67 patients). The greater the maximum diameter of the node with metastasis, or the larger the ratio of the metastatic area to the cross-sectional area of the node, the higher the detection rate. In tumors classified on the basis of depth of invasion according to the 1987 TNM system, the rate of detection of metastasis in individual nodes was 0% in pT1 tumors (none of five nodes), 20% in pT2 tumors (17 of 85 nodes), 29% in pT3 tumors (20 of 70 nodes), and 10% in pT4 tumors (three of 31 nodes). It is concluded that the most important use of EUS will be in diagnosis of regional lymph node metastasis.
Collapse
|
49
|
Abstract
To differentiate scirrhous carcinoma from hypertrophic gastritis, 16 patients with scirrhous carcinoma of the stomach and seven patients with hypertrophic gastritis were examined with endoscopic ultrasonography (US) between August 1987 and October 1990. US images of the normal gastric walls of 16 patients with gastric ulcers served as controls. Characteristic features of scirrhous carcinoma included an irregular hypoechoic enlargement of the third (submucosa) and fourth (muscularis propria) layers. The mean thickness of the third and fourth layers was increased sixfold and threefold, respectively, compared with thickness in healthy subjects. In the patients with scirrhous carcinoma, the mucosal layer remained normal in appearance at US, and it was possible to distinguish the five-layer structure of the gastric wall. These findings were prospectively correlated with histopathologic findings in the resected specimens. In contrast, only the mucosal layer was thickened in cases of hypertrophic gastritis. Recognition of these patterns at US can aid in the differential diagnosis of scirrhous carcinoma and such benign diseases as hypertrophic gastritis with a thickened gastric wall.
Collapse
|
50
|
Abstract
The preoperative use of endoscopic ultrasound was evaluated in 74 patients with confirmed gastric cancer. It was used in diagnosing the depth of invasion in the gastric wall, the infiltration to the adjacent organs, and the involvement of the perigastric lymph nodes. Results were compared with histological findings in resected specimens. Accuracy in staging gastric cancer using the T grade of the 1987 TNM system was 81.1% (60 of 74 patients). Endoscopic ultrasound provided excellent results compared with computed tomography and conventional ultrasound, particularly in evaluating perigastric lymph node metastasis and direct infiltration to the adjacent organs. The success rate in detecting lymph node metastasis was 50% (11 of 22 patients); the accuracy in diagnosing direct infiltration to the adjacent organs was 60% (three of five patients). This technique is useful in diagnosing malignant invasion and lymph node metastasis of gastric carcinomas but requires further refinement for use in diagnosing the disease itself. Its preoperative use is recommended for establishing surgical and other treatment plans, as well as in predicting the prognosis of gastric cancer.
Collapse
|