Sarcoidosis is a multi‐systemic disease of unknown etiology that results in the development of non‐caseating epithelioid granulomas. The liver is the third most frequently involved organ after the ...lymph nodes and the lungs. Most cases of liver sarcoidosis do not present with symptoms and involve minimal liver dysfunction, but some cases display progression to portal hypertension and liver cirrhosis, and finally to liver failure. The mechanism and the risk of progression in liver sarcoidosis are still unknown because of the diagnostic difficulty associated with this condition, and because follow‐up examinations can only be done in an invasive manner. Here, we present an informative case of liver sarcoidosis with rapid progression of esophagogastric varices. Four months prior to the definitive diagnosis, no signs of varices were observed on endoscopy, and developmentof esophagogastric varices, rapid progression, and eventual rupture occurred in a short period of time. A liver biopsy, carried out after endoscopic sclerotherapy, revealed that granulomas primarily affected the portal area without fibrotic and cirrhotic changes, which is considered a primary cause of portal hypertension and esophagogastric varices. Following the liver biopsy, the patient was given systemic steroids and is currently receiving outpatient care. Thus, we should consider the possibility that liver sarcoidosis, even in the absence of cirrhotic changes, can cause serious events such as esophagogastric variceal rupture following rapid progression as a result of portal hypertension.
A 75-year-old man underwent endoscopic hemostatic therapy for hemorrhagic gastric ulcer in September 2002. After healing of the gastric ulcer, he underwent Helicobacter pylori eradication therapy in ...February 2003. In August 2007, an irregular tumor was detected in the lower esophagus at annual checkup for gastric cancer screening using X-ray. Endoscopic examination showed that the lower margin of the tumor almost coincided with the esophagogastric junction and that a short segment of Barrett’s epithelium existed near the tumor. Biopsies of the tumor showed moderately to poorly differentiated adenocarcinoma. Mild reflux esophagitis and minor hiatal hernia was also observed, and the previously treated gastric ulcer was not recurrent. Absence of H. pylori was confirmed by serum antibody and urea breath test. Surgical resection of the lower esophagus and proximal stomach was performed. The tumor invaded into the muscularis propria of the esophageal wall but had no evidence of lymph node metastasis. Based on macroscopic and pathological findings, the tumor was recognized as esophageal adenocarcinoma. Previous endoscopic examination did not detect any apparent signs of tumor in the esophagogastric junction. As far as we know, this is the first report documenting a newly developed esophageal adenocarcinoma after the successful eradication of H. pylori.
Although many cases of solid cystic tumor of the pancreas (SCT) have been reported, its nature and histogenesis remain controversial. We herein report six cases of SCT, including three cases of ...noncystic type. A review of 22 cases of noncystic type SCT, including our 3 cases, was carried out to compare their features with those of 173 cases of classic SCT reported in Japan. Noncystic type SCTs tend to occur in male patients and are smaller in size and less frequently symptomatic, although they show histological characteristics similar to those of classic SCTs. The developmental process might be a cause of cyst formation. The accumulation and analysis of many, at present, "atypical" cases for clarification of its nature, will, it is hoped, lead to a new nomenclature for this condition that adequately describes its biological origin.
Background: Biopsy diagnosis of gastric mucinous carcinoma (GMC) is sometimes difficult. Endoscopic ultrasonography (EUS) can visualize the change in the gastric wall in detail. We reviewed the EUS ...images and histological findings of cases of GMC and evaluated the correlation between them to identify the characteristic findings of GMC on EUS.
Methods: Thirty‐one GMC patients who had undergone both preoperative EUS and surgery were studied. The EUS images of these patients and the histological findings were compared with those for other histological types of gastric cancer (OGC).
Results: The tumor echo showed high echoic in GMC cases more frequently than that in OGC. The frequency of visualization of the layer structure above the tumor was higher compared with OGC. Histology verified the presence of fine septa composed of thin fibrotic tissue and floating cancer cells in the mucus lake. The mucus lake was often located in the submucosa and the tumor was covered with cancerous mucosa of other histological types with preserved lamina muscularis mucosae.
Conclusions: The EUS findings of GMC are characteristic and reflect its histological changes well, and would complement the preoperative diagnosis of this tumor.
We conducted this study to clarify the effectiveness of aspiration endoscopic mucosal resection (EMR) using a cap‐fitted scope for early gastric cancer in the C and M regions of the stomach. EMR was ...performed in 111 early gastric cancer patients with 123 lesions in the C and M regions. The patients were divided into three groups. The EMR‐1CS group consisted of patients who had undergone EMR with a one‐channeled scope, the EMR‐2CS group those who had received EMR in which a two‐channeled scope was utilized. The EMRC group consisted of patients who had undergone aspiration EMR with a cap‐fitted scope.
The rate of complete resection improved to a statistically significant degree in the EMRC group in comparison with that in the EMR‐1CS group. In type lie, a statistically significant improvement was achieved in the EMRC group in comparison with the EMR‐2CS group. In the M region or in lesions 10 mm or less in diameter, the rate of complete resection improved in the EMRC group as compared with that in the EMR‐2CS group. Our results suggest that EMRC is useful for lesions of early gastric cancer in the C and M regions.
Aims: To evaluate the efficacy and limitations of endoscopic placement of self-expandable metallic stents (EMS) in cases of malignant gastroduodenal stenosis. Methods : Fourteen patients who ...underwent endoscopic placement of EMS for unresectable malignant gastroduodenal stricture were reviewed. Comparison of pre-and post-stenting conditions and evaluation of clinical efficacy were carried out. Results : All procedures were successful. As for food ingestion, 50.0% of the cases showed improvement and the mean dysphagia score changed from 3.5 to 2.6. In 66.7% of the cases that had a stenosis in the upper stomach, improvement of peroral food intake was achieved. However, such intake did not improve even after stenting in all but one patient with stenosis of the distal stomach or proximal duodenum. Conclusions : Use of EMS for unresectable malignant gastroduodenal stenosis is effective in patients with proximal lesions. However, physical patency of the stenosed alimentary tract by stenting is not likely to alleviate the limitation of peroral food intake in patients with distal gastric or proximal duodenal stenosis.
Aim: To evaluate the effectiveness of the scratch-stick-method for endoscopic mucosal resection (EMR) of colorectal tumors (superficial type and nodule aggregating type) 20mm or more in size. ...Material and methods: Twenty lesions which were resected by the scratch-stick-method were reviewed as to the following points: 1) number of resections, 2) histological condition of the horizontal and vertical cut ends of resected specimens, 3) residue/recurrence of neoplasms at the site of resection, and 4) complications. Thirty-four lesions, resected by ordinary EMR, were also reviewed as a control. The scratch-stick-method is carried out as follows. First, a scratch is made by electrocautery in the normal mucosa oral to the lesion. After the tip of a snare has been stuck into the scratch to stabilize the snare, EMR is performed. Results: Complete resection in one session was achieved in 65% of the lesions which underwent EMR with the scratch-stick-method and in 35% of the lesions which underwent ordinary EMR. Neoplastic cells were observed at the horizontal cut end of the lesions in 5% of the group which underwent EMR with the scratch-stick-method and in 26% of the control group. No recurrence at the site of EMR was seen in the group which underwent EMR with the scratch-stick-method. No severe complications were observed in either group. Conclusion: The scratch-stick-method is a useful technique when performing EMR for large colorectal tumors.
Massive blood clots and food debris sometimes hamper emergency EGD for upper gastrointestinal hemorrhage by preventing clear endoscopic view resulting in difficulty in identification of the source of ...bleeding. Handling the difficulty with standard endoscopes by adjuvant techniques is often time consuming. We had an opportunity to use a new wide-channel endoscope (GIF XT-30, Olympus, Tokyo). GIF XT-30 has a wide forceps-channel with a diameter of 6 mm. The outer diameter at the distal end is 13.7 mm. A three-way stopcock connected to the channel enables the use of a double suction system with this scope. To clarify the efficacy and feasibility, we measured the time for suction of 500ml of distilled water and 100ml of plain yogurt with GIF XT-30 and GIF Q240 having a channel 2.8 mm in diameter (Olympus, Tokyo). The times required for sucking water and yogurt were signifficantly shorter by GIF XT-30 than those by GIF Q240. In clinical practice during six months period, GIF XT-30 was applied for 22 cases (11.3%) among 194 emergency EGDs. Suction of massive blood clots and food debris was successful and optimal endoscopic view was obtained in 19 of 22 cases. We conclued that GIF XT-30 is excellent in sucking massive clots and food debris and shortens the time of emergency EGD. This endoscope is an indispensable item for major endoscopic centers perfoming large volume emergency endoscopy.
A 50-year-old man with a chief complaint of abdominal distension admitted to ourdepartment for further examination. Endoscopic study revealed a hemisphered submucosaltumor 10mm in diameter with a ...central pit in the descending colon and a similar lesion 6mm indiameter covered with nomal mucosa in the cecum. Intraluminal ultrasonography with a 20MHz micro-scanner revealed a mass in the decending colon having heterogenous hypoechoic pattern with patchy internal hyperechoic and anechoic areas in the 3rd layer of the wall, and the other mass in the cecum showing a homogenous hypoechoic pettern in the 3rd layer of the wall. Based on the findings, endoscopic resection was successfully performed. Histological examination showed that the tumor in the descending colon was glomus tumor in the submucosal layer, and the other in the cecum was neurofibroma in the same layer.
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