In our hospital, colonoscopic polypectomy was done 130 times in 103 patients (176lesions) since 1975. There are neither death nor operation cases resulted from the polypectomy in our series. In 18 ...cases, patient developed abdominal pain, bleeding, fever and so on after the polypectomy. In order to elucidate the causable factors of these complications, the 18 cases were analized. The following results were obtained.1) The frequency of complication was 13.8% of all polypectomy, and treatment was needed in 10 cases (7.7%).2) Abdominal pain was complained in 12 cases, four of which were accompanied by fever, 2 of urinary tenesmus and one of rebound tenderness.3) In the polypectomy of the sessile polyps, complication rate was significantly higher than in that of the other types of polyps.4) In the multiple polypectomy, frequency of complication was twice as many as in the single polypectomy. But in the multiple polypectomy, there was no relationship between the number of the polypectomized lesions and occurrence of complication.5) In the submucosal tumor and polypoid carcinoma, rather many complications were observed.6) Histologically, deep damage extended to the muscle layer was demonstrated in the polypectomized site.7) Significant changes of the laboratory examinations (WBC, ESR and CRP) was found in the cases with complications resulted from the polypectomy. We concluded that although there were no severe complications, the factors above mentioned might be important and valuable when actively performed the colonoscopic polypectomy.
In order to elusidate characteristics of mucosal patterns of gastric cancer, depressedgastric lesions such as cancer, ulcer, atypical epithelium and erosion were examined busing a magnifying ...endoscope GIF-HM. It was concluded that irregular nodule-like appearance and concomitant flattenedmucosal appearance were characteristic of gastric cancer (Figure 7). In the next place, to clear the diagnostic value in the case of carcinoma, 30 cases of thegastric cancers smaller than 20 mm (of wich 14 lesions smaller than 10 mm, 9 lesionssmaller than 5 mm) were examined (Table 3). In the case of minute cancers smaller than5 mm, the conventional endoscopy made a correct diagnosis in only 1 case. On the otherhand, the magnifying endoscopy made correct diagnosis in 5 cases. But even by themagnifying endoscopy, it was impossible to detect the lesion smaller than 2 mm anddistinguish the lesion smaller than 3 mm from other gastric lesions. Magnifying endoscopic findings were compared with stereomicroscopic and histologicalfindings in the lesions not correctly diagnosed by the magnifying endoscopy (Figure 10)
A high power up to 35 times magnifying colonoscope (CF-HM) has recently been de-vised and we have had an oppotunity to use this apparatus. We have performed 277 mag-nifying colonoscopic examinations ...in 207 cases during the past one year from July 1979 to June 1980. Among all cases investigated, we found 102 colon polyps in 65 cases. Through the intensive magnifying colonoscopic study and stereomicroscopic observation on the polypecto-mized materials, we classified adenoma into 5 types from the view point of minute surface structure. Type I is circular type, Type II is tubular type, Type III is grooved type, Type IV is gyral type and Type V is irregular type. Most of tubular adenomas were classified into the type I, II and III and we found a mixed type in 21% of tubular adenoma. All tubulo-villous adenomas were classified into type IV. The lesions classified to type V were regarded as carcinoma in adenoma. The adenomas with malignant potential were more frequently observed in type III and type IV than type I and II. More surface lobulations were seen in larger adenomas. Carcinoma in adenoma showed charactaristic findings, name-ly, irregularly distributed small pits, many irregular lobulations and disapperance of normal mucosal pattern. From the findings mentioned above, it was concluded that magnifying colonoscopy was a valuable method for evaluation of polyps and for early diagnosis of car-cinoma of the large intestine.
Recently, not a few endoscopists have been interested in magnifing endoscopic observation of the minute gastric mucosal lesions, and several magnifing fiberscopes have been developed successfully. ...This time, we have had a chance to use the newly developed magnif ing f iberscope (GIF-HM), which was devesed by Olympus Optical Company. We compared this newmodeled fiberscope with an upper gastrointestinal fiberscope GIF-D3 about the specific features of those two apparatus. Their capacities are expressed on Table I. The f ibererscope GIF-HM is a foward-viewing type similar to GIF-D3, but its maximal magnif ing rate is about thirty-five times. There is no need of changing a light guide and the object can be continuously magnified smoothly, when we make it close to the gastric mucosa. also we can use the zooming effect from 10 to 70 mm in distance. Using GIF-HM for the purpose of ordinary and magnif ing observation, we could easily observe the gastric angle, and there were no blind areas in the stomach. In addition, observation could be easily performed in the esophagus and duodenal bulb. Summarization was described on Table 4. We thought, magnifing fiberscope GIF-HM was useful not only for magnif ing observation, but also for ordinary observation through the upper gastrointestinal tract.
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