Background
We investigated the presence of occult pancreaticobiliary reflux in patients with a morphologically normal pancreaticobiliary ductal arrangement by measuring biliary amylase levels and ...compared histopathological findings of the gallbladder between groups with high and low biliary amylase levels.
Methods
In 178 patients with a normal pancreaticobiliary ductal arrangement who had undergone endoscopic retrograde cholangiopancreatography (ERCP), we sampled bile from the bile duct and measured amylase levels. Then we compared clinical features and histological findings of the gallbladder between high (HALG) and low amylase level groups (LALG).
Results
A high biliary amylase level was observed in 25.8% (46/178) of the patients. The prevalence of a high biliary amylase level was high in patients with gallbladder carcinoma (40%) and in those with choledocholithiasis (28.4%). The level of amylase in bile was high in patients with gallbladder carcinoma, adenomyomatosis of the gallbladder, and chronic cholecystitis. A strong correlation between the levels of amylase and lipase in bile and the dominance of amylase of pancreatic origin in bile were confirmed by isozyme analysis. Thickening of the gallbladder mucosa was a significant manifestation in HALG. Histological examination of the gallbladder mucosa showed that incidences of metaplastic change and atypical epithelium and Ki67-LI in were higher in HALG than in LALG.
Conclusions
Occult pancreaticobiliary reflux is observed in a considerable number of ERCP candidates. Those who show an extremely high biliary amylase level, at least, may be at high risk for biliary malignancies.
Aim: Endoscopic diagnosis of the lateral extension of Barrett's cancer under the squamous epithelium (BCUS) is sometimes difficult because the cancer is unobservable in the esophageal lumen. The aim ...of the present study was to clarify the endoscopic features of the extension of BCUS and verify the usefulness of the acetic acid‐spraying method (AAS) for diagnosis.
Methods: A total of 25 patients with Barrett's cancer who had undergone endoscopic resection were included in this study. Histological examination of patients' resected specimens was performed to identify the presence of BCUS. Then, the endoscopic images of the BCUS cases were reviewed to summarize the findings and to evaluate the feasibility of diagnosing the extent of BCUS with each imaging technique.
Results: Of the 25 patients, 10 (40%) had BCUS. With white‐light imaging, subtle reddish change was observed in the area of BCUS in 80% of the patients, and a flat elevated lesion was recognized in 30%. With narrow band imaging, slight brownish change was observed in the area of BCUS in 86% of the patients. Slight white changes were visualized in all cases with AAS. The extension of BCUS was correctly diagnosed by white‐light imaging, narrow band imaging and AAS in 50%, 43% and 100% of the cases, respectively. Histology verified the opening of cancerous glands, which extended under the squamous epithelium, into the esophagus in the area showing slight white changes by AAS.
Conclusion: AAS can be useful for diagnosing the extension of BCUS.
Objective The purpose of this study was to review cases of early gastric cancer associated with Endocrine cell micronests (ECM) and investigate the incidence and characteristics of these lesions. ...Methods A total of 482 patients who had undergone endoscopic or surgical resection for gastric epithelial neoplasms from April 2008 to March 2010 were enrolled in this study. After detection of ECM in the lamina propria mucosa by histological examination of the resected specimens with hematoxilin-eosin staining, immunostaining was also performed. Clinical manifestation and endoscopic findings, as well as histological findings, were examined. Results Among the 482 patients, 5 (1.0%) had ECM. The histological type of gastric epithelial cancers associated with ECM was tubular adenocarcinoma and carcinoma in situ (Tis) in the WHO classification in all 5 cases. ECM were round to oval or trabecular and located within the area of the early gastric cancer in all the 5 cases. The background gastric mucosa was Type A gastritis in 2 patients and ordinary atrophic gastritis in 2 patients. In the other case, it was difficult to determine the type of gastritis. Conclusion ECM developed not only from the background of Type A gastritis but also from ordinary atrophic gastritis. ECM coexistent with gastric cancer were present in 1.0% of resectable gastric epithelial neoplasms.
Aim
The aim of the present study was to investigate the efficacy and safety of a newly available enteral WallFlex stent for malignant gastric outlet obstruction (GOO).
Methods
Twenty‐one consecutive ...patients with symptomatic (unable to take solids) malignant GOO treated by a WallFlex stent from April 2010 to February 2012 were included and analyzed retrospectively. Main outcome measurements were technical success, early complications, clinical response (elimination of the need for nasogastric tube drainage), clinical success (improvement of oral intake to a GOO score of 2 or 3), and duration of sustaining a GOO score of 2 or 3 after clinical success (median duration until reworsening of GOO score to <2 by the Kaplan–Meier method). A four‐point GOO scoring system (0–3) was used for estimation of oral intake.
Results
Technical success rate was 100%. Bleeding and perforation after stent placement and stent dislocation/migration in the follow‐up period did not occur in any patients, whereas one patient (5%) developed moderate post‐procedural pancreatitis. Clinical response and clinical success was achieved in all patients and in 81% (17/21), respectively. In 17 patients whose GOO score had improved to 2 or 3 after stent placement, eight (47%) developed reworsening of the GOO score to <2 with a median time of 148 days (95% confidence interval CI, 0–328; Kaplan–Meier method). Median survival time after the initial intervention was 61 days (95% CI, 40–82).
Conclusion
Placement of an enteral WallFlex stent in patients with malignant GOO is safe and effective.
Aim: We evaluated the diagnostic efficacy of transpapillary intraductal ultrasonography before biliary drainage (IDUS‐BD) and transpapillary biopsy (TPB) for the assessment of the longitudinal ...extent of bile duct cancer.
Methods: Between November 1999 and January 2005, we performed IDUS‐BD and TPB preoperatively in 27 patients with carcinoma of the extrahepatic bile duct. Following IDUS‐BD, TPB was performed under fluoroscopic guidance immediately after endoscopic sphincterotomy. The diagnostic efficacy of IDUS‐BD and TPB for the longitudinal extent of the cancer and the complications which accompanied the procedure were evaluated.
Results: The overall success rate of sampling and the diagnostic accuracy of bile duct cancer by TPB were 85.3% (192/225) and 85% (23/27), respectively. The sensitivity, specificity and accuracy of the assessment of the longitudinal extent of cancer on the hepatic and duodenal sides by IDUS‐BD were 82%, 70%, 78% and 85%, 43%, 70%, respectively. Those by a combination of IDUS‐BD and TPB were 88%, 80%, 85% and 77%, 86%, 80%, respectively. Overestimation of the longitudinal extent of BD cancer by IDUS‐BD was mainly due to inflammation and obscure images, especially resulting from collapse of the bile duct on the duodenal side of the tumor, and was corrected by TPB in four of five patients. No serious complications occurred following the combination of IDUS‐BD and TPB.
Conclusions: TPB is useful for preoperative histological diagnosis of bile duct cancer. The combination of IDUS‐BD and TPB is practical for evaluation of its longitudinal extent; basically, IDUS‐BD is sufficient on the hepatic side of the tumor, but concomitant TPB is recommended on the duodenal side.
Background
Cystic duct cancer fulfilling Farrar’s criteria is relatively rare, but tumors whose origin is estimated to be in the cystic duct exist. The clinical features of such “broadly defined” ...cystic duct cancer have not been clarified.
Methods
The endoscopic retrograde cholangiography (ERC) findings, intraductal ultrasonography (IDUS) findings, histological findings, and prognoses of 11 cases of cystic duct cancers resected at our institution (group C) were retrospectively analyzed. As a control group, 55 cases of middle or lower bile duct cancer (group B) were used (in 20 of the 55 cases of group B, tumors extended to the cystic duct intraluminally (group B-C (+)).
Results
(1) ERC findings of group C as compared with those of group B-C (+) were as follows: (a) unilateral bile duct narrowing (spoon-like appearance): 55% versus 5% (
P
< 0.01); (b) bilateral bile duct narrowing (apple-core-like appearance): 27% versus 95% (
P
< 0.001). (2) IDUS was unable to visualize the cysticocholedochal junction (negative “confluence sign”) more often in group C (67%) than in group B-C (+) (13%) (
P
< 0.01). (3) Histologically, tumors extended to the gallbladder and the bile duct in 36% and 91% of the cases in group C, respectively. (4) The median survival time of the two groups was 21 and 28 months, respectively.
Conclusions
Cystic duct cancers frequently extended to the bile duct. The spoon-like appearance by ERC and the negative confluence sign by IDUS were characteristic findings.
The aim of this study was to evaluate histopathologically the frequency, direction, and length of intraductal spread (IS) along the main pancreatic duct from the main tumor of small pancreatic ...cancer.
Resected specimens from 20 cases of pTS1 (histologically 2 cm or less in diameter) pancreatic cancer (September 1983 to December 2005) were examined histopathologically. As controls, 40 resected specimens from cases of pTS2 (more than 2 cm and less than 4 cm in diameter) or larger sized pancreatic cancer (pTS2<or=) were examined in the same manner. The specimens were evaluated histopathologically as to (1) the prevalence of IS, (2) the direction and length of IS, and (3) the positive rates of transpapillary cytology of pure pancreatic juice (TPC) and biopsy of the main pancreatic duct (TPB), performed preoperatively.
IS was observed in 45% of pTS1 and 13% of pTS2<or= cases. In 88% of cases of pTS1, IS was observed in the direction of the ampullary side. In 40% of cases of pTS2<or=, IS toward the ampullary side was seen. The mean length of IS in pTS1 and pTS2<or= cases was 11.8 mm and 7.2 mm, respectively. Positive rates of TPC and TPB in pTS1 cases were 70% and 75%, respectively, and in pTS2<or= cases, 50% and 44%, respectively.
The frequency of IS was high in pTS1 cases, which suggests there is potential for improvement in establishing the histocytological diagnosis of small pancreatic cancer via the transpapillary approach with the development of adequate tools.
Background It is often difficult to insert a long intestinal tube in the small bowel of patients with bowel obstruction, and it often results in long procedure time and severe patient distress. ...Objective To assess the usefulness of the ropeway method by using a guidewire placed with the assistance of transnasal ultrathin endoscopy in long-tube insertion for patients with bowel obstruction. Design Prospective, randomized, controlled, single-center study. Patients and Interventions Thirty-four consecutive patients with bowel obstruction requiring decompression participated in the study and were randomized to the insertion of a long tube with the ropeway method (ILTR) group (ie, insertion along an endoscopically placed guidewire that was passed through only the distal 4 cm of the tube) or insertion by a conventional method group (C group). Main Outcome Measurements The time required for the procedure (main), success rate, x-ray exposure time, and intensity of patient distress measured with a visual analog scale of 1 to 5 (better to worse). Results The mean (± standard deviation) duration of the procedure in the successful cases in the ILTR group and the C group was 16.1 ± 5.6 minutes and 26.4 ± 13.8 minutes, respectively ( P = .010). The success rate was 100% in the ILTR group and 88% in the C group ( P = .48). The mean (± standard deviation) x-ray exposure time and intensity of patient distress were, respectively, 16.4 ± 8.7 minutes and 33.2 ± 12.3 minutes ( P < .001) and 2.6 ± 0.7 and 3.7 ± 1.2 ( P = .016). Limitations Single-center study and small sample size to evaluate overall safety. Conclusions Long-tube insertion for bowel obstruction with the ropeway method facilitated by transnasal ultrathin endoscopy was superior to conventional fluoroscopic placement with regard to overall procedure success, time required, and patient comfort.
Background: Endoscopic papillectomy for adenomas of the ampulla of Vater has been reported and is gaining acceptance as an alternative to surgery in the treatment of early ampullary cancer. However, ...whether endoscopic treatment is justified as a treatment of choice for early ampullary cancer remains controversial. The aim of the present study was to elucidate the possibility of endoscopic papillectomy as a treatment of early ampullary cancer from the review of pathology of cases treated by surgical resection.
Patients and methods: Twenty‐three cases of early ampullary cancer (m—tumor limited to the mucosa of the ampulla 14; od—tumor that invades Oddi's sphincter, 9) treated by surgical resection from January 1984 to March 2003 were investigated as to the following: (i) macroscopic type, maximum size, and histological type of tumor; (ii) main location and extension of tumor; (iii) prevalence of extension into the lower bile duct or pancreatic duct, and relationship between ductal infiltration and macroscopic type, maximum size, main location, or depth of invasion of tumor; (iv) lymphatic permeation, vascular invasion, and lymph node metastasis; and (v) prognosis.
Results: All cases were classified macroscopically as exposed‐tumor type or non‐exposed‐tumor type without ulceration. Extension into the lower bile duct or the pancreatic duct was observed in 43% of the cases. There was no correlation between ductal infiltration and macroscopic type, maximum tumor size, main tumor location, or tumor depth. No lymphatic permeation, vascular invasion, or lymph node metastasis were proven in cases with ampullary cancer confined to the mucosa. In the nine cases with involvement of Oddi's sphincter, lymphatic permeation and lymph node metastasis were observed in two cases and one case, respectively.
Conclusion: Endoscopic treatment for early ampullary cancer confined to the mucosa without spread to the bile duct or pancreatic duct is justified as a treatment of choice if detailed histological examination of the resected specimen indicated no invasion beyond its margin.
We describe 25-Gb/s error-free transmission over multi-mode fiber (MMF) by using a transmitter based on a 1.3-µm lens-integrated surface-emitting laser (LISEL) and a CMOS laser-diode driver (LDD). It ...demonstrates 25-Gb/s error-free transmission over 30-m MMF under the overfilled-launch condition and over 150-m MMF with a power penalty less than 1.0dB under the underfilled-launch condition.
PDF
