Endoscopic mucosal resection (EMR) is useful as a radical treatment for early gastric cancer. However, a difficulty of this technique depends on the sites of lesions. If the lesions are in the lesser ...curvature or the posterior wall of the M- or C-region, it is very difficult or even impossible to resect them. We carried out a clinical study to compare the results of EMR using a 2 channel scope (EMR-2CS, conventional method) with those of EMR using a cap-fitted panendoscope (EMRC, newly introduced method) for lesions at the abovementioned sites. Thirty-four patients with 35 lesions (17 lesions resected by EMR-2CS, 18 lesions resected by EMRC) located in the lesser curvature or the posterior wall of the Mor C-region were included in this study, and the results were as follows : 1) Rate of complete resection with EMR-2CS was 64.7% and that with EMRC was 77.8%. 2) Especially, for the lesions located in the lesser curvature or the posterior wall of the M-region, EMRC was very effective and the rate of complete resection reached 90%. On the other hand, the lesions in the lesser curvature or posterior wall of C-region were still difficult to resect even by EMRC, the rate of complete resection being 63%. 3) There were no major complications in EMR-2CS, but there were two patients with massive bleeding and two who suffered from perforation by EMRC. Specimens obtained by EMRC tended to be resected more deeply. Thus we conclude that EMRC is a useful treatment for early gastric cancer located in the lesser curvature or the posterior wall of the M-region.
In Japan, early esophageal cancer is now completely treated by endoscopy. Therefore, detection of Early Esophageal Cancer is very important. Dye endoscopy is useful for detection of early esophageal ...cancer. And the newest NBI (Narrow Band Imaging) method is very useful for detection of early esophageal cancer.
We developed a new pancreatoscope, XPF-22, with an outer diameter of 2.2 mm to perform peroral pancreatoscopy (POPS) in cases with normal papilla of Vater. To improve the maneuverability of the ...scope, the tip is equipped with a two-directional tip-bending system. POPS and peroral cholangioscopy with this scope were performed in 16 cases of pancreatic diseases and 14 cases of bliary disorders by the mother-baby scope method. Insertion of this scope into the target duct and up to the area of interest through the normal papilla of Vater was achieved in 80% of the cases. The endoscopic view was kept satisfactory with the use of the tip-bending function during the examination. Durability of the scope was sufficient for clinical use.
A 45 years old male with a chief complaint of epigastralgia was admitted to our hospital for further examination. Endoscopic examination revealed three irregular depres-sions surrounded by multiple ...cystic lesions. Histological diagunosis of biopsy specimens obtained from these depressive lesions were group V. Cystic lesions of Yamada's type I were covered with nomal gastric mucosa, and could be easily depressed by biopsy forceps. EUS revealed multiple hypoechoic masses in the 3rd layer of gastric wall. A diagunosis of submucosal heterotopia of gastric glands was made by these findings. Distal gastrectomy was performed. Histological examination of the resected specimen confirmed three lesions of early gastric cancers, moderately differentiated tubular adenocarcinomas. Submucosal heterotopia was localized in the so-called F line and its anal side. Histologically they consisted of retension cystlike glands in the superficial layer of submucosa. Smooth muscle fibers around them linked the muscularis mucosa. In addition, we could find retension cysts of gastric glands in the tunica mucosa, invasion of gastric glands to muscularis mucosa, thinness and breakdown of musclaris mucosa, and atrophic or meta-plastic change of superficial mucosa. Based on these findings, we suppose that chronic inflammation may induce submucosal heterotopia of gastric glands.
To evaluate the detectability of EUS in waking diagnosis of gastric myogenic tumor, 12 cases of leiomyoma and 13 cases of leiomyosarcoma evaluated by EUS were studied.The results were as follows; 1) ...EUS findings were corresponded precisely to the histological findings (Table 3). 2) Tumor of which internal echoic pattern was type B or the one larger than 40mmof which echoic pattern was type C was assigned for malignancy. According to this sign, accuracy rate was 760%. 3) The change of internal echoic pattern or the rapid growth followed by EUS wassuggested to be the sign of malignancy. 4) EUS was very useful for differentiating gastric leiomyosarcoma from leiomyoma.
We experienced 8 eases of esophageal granular cell tumor in the past 3 years; 7 were endoscopically resected and one has been frequently observed by endoscopy. We studied endoscopic appearance and ...EUS findings of these tumors. The results were as follows; 1) Endoscopically, yellowish white submuCasal tumors similar to molar tooth were characteristic in esophageal granular cell tumor. 2) No cases were diagnosed as granular cell tumor by endoscopic biopsy. 3) Esophageal granular cell tumors were imaged by EUS as homogenous hypoechoic mass with clear border and smooth margin. 4) EUS was useful to diagnose the depth and invasion of granular cell tumor. 5) Endoscopic resection should be taken into consideration as the first choice if the tumor is limited to the submucosal layer.
ENDOSCOPIC RESECTION OF EARLY GASTRIC CANCER CHONAN, Akimichi; MOCHIZUKI, Fukuji; YUKI, Toyohiko ...
GASTROENTEROLOGICAL ENDOSCOPY,
1994, Letnik:
36, Številka:
9
Journal Article
Recenzirano
Odprti dostop
Clinical study was done for 110 lesions of early gastric cancer in 103 cases which were treated endoscopically during past 13 years. And the results were as follows; 1) Indication for endoscopic ...resection was that histological type was differentiated adenocarcinoma, (2) diagnosis of depth of invasion was limited to mucosal layer, (3) cancer in hyperplastic polyps, type I or type IIa less than 2cm and type IIc not associated with ulceration less than 1cm. 2) Rate of complete resection was 43.8% in the former period (1981-1990), 77.2% in the latter period (1991-1993). 3) Rate of complete resection improved by using tripod type grasping forceps and unification of resection tecnique to EDSP method by Takekoshi. 4) It was difficult to resect completely type IIa more than 10mm and the lesion on the posterior wall of gastric body. 5) No recurrence was found in the cases resected completely. 6) Recurrent rate of the cases resected incompletely was 5.3%.
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