During colonoscopy, estimation of the depth of invasion in early colorectal lesions is crucial for an adequate therapeutic management and for such task, magnifying chromoendoscopy (MCE) has been ...proposed as the best in vivo method. However, validation in large-scale studies is lacking. The aim of this prospective study was to clarify the effectiveness of MCE in the diagnosis of the depth of invasion of early colorectal neoplasms in a large series.
A total of 4,215 neoplastic lesions were evaluated using MCE from October 1998 to September 2005 at the National Cancer Center Hospital, Tokyo, Japan. Lesions were prospectively classified according to the clinical classification of the pit pattern: invasive pattern or non-invasive pattern. All lesions were histopathologically evaluated.
There were 3,371 adenomas, 612 intramucosal cancers (m-ca), 232 submucosal cancers (sm-ca): 52 sm superficial (sm1) and 180 sm deep cancers (sm 2-3). Among lesions diagnosed as invasive pattern, 154 out of 178 (86.5%) were sm2-3, while among lesions diagnosed as non-invasive pattern, 4,011 out of 4,037 (99.4%) were adenomas, m-ca, or sm1. Sensitivity, specificity and diagnostic accuracy of the invasive pattern to differentiate m-ca or sm1 (< 1000 microm) from sm2-3 (> or = 1000 microm) were 85.6%, 99.4%, and 98.8%, respectively.
The determination of invasive or non-invasive pattern by MCE is a highly effective in vivo method to predict the depth of invasion of colorectal neoplasms.
Background
Differentiating sessile serrated adenoma/polyp (SSA/P) from hyperplastic polyp (HP) is clinically important in determining the necessity of endoscopic resection or recommending appropriate ...surveillance. There are few reports of characterization of SSA/P using narrowband imaging and chromoendoscopy with and without magnification. We aimed to establish imaging criteria to aid real-time diagnosis of SSA/P.
Methods
Patients with pale sessile or flat lesions of 6 mm or greater were prospectively enrolled in this multicenter trial. Nine endoscopic criteria, determined in real time, were investigated for possible association with SSA/P. Endoscopic mucosal resection was performed; specimens were retrieved and analyzed by histopathological examination.
Results
In 63 patients, 89 lesions were detected, including 41 HP, 38 SSA/P, five mixed polyps, and five other lesions. Right-side colon location, lesion size of 10 mm or greater, excessive mucus, the presence of a varicose microvascular vessel (VMV) noted with high-magnification narrowband imaging, and type III
H
pit pattern were each commonly associated with SSA/P compared with HP. Multivariate analysis substantiated three independent endoscopic criteria for SSA/P: the presence of VMV (
p
= 0.001), lesion size of 10 mm or greater (
p
= 0.0017), and right-side location (
p
= 0.0041), with odds ratios of 8.2, 7.2, and 6.1, respectively. The presence of VMV had a significantly higher specificity (87.8 %) than the other two independent endoscopic criteria (
p
= 0.0007 and
p
= 0.0008, respectively), but a lower sensitivity (57.9 %), whereas a combination of the three criteria (two or more positive) increased the sensitivity significantly (89.5 % and
p
= 0.0033) and had a higher degree of accuracy (82.3 %).
Conclusions
Three endoscopic criteria individually and in combination were effective in predicting a diagnosis of SSA/P without the need for chromoendoscopy.
A 70-year-old man with multicentric Castleman disease (MCD) was admitted to our hospital with jaundice and ascites. Elevations in his bilirubin and interleukin-6 levels were noted, and computed ...tomography revealed hepatic atrophy and portal vein and bile duct disorders. Steroid therapy was started for MCD, but he died of hepatic failure. An autopsy revealed that the MCD activity was mild, but advanced fibrosis and cholestasis were observed in the liver. Mild infiltration of interleukin-6-positive plasma cells was noted in the highly fibrotic area of the liver. Although rare, liver and biliary tract damage may be also considered organ disorders of MCD.
Objective
A prior study using porcine colon demonstrated the feasibility of a novel injectable, temperature?responsive, and biodegradable collagen sol (ICS) that transforms from a liquid to a gel ...state in response to body temperature for endoscopic closure of perforation during endoscopic resection (ER). This study aims to report the acute and survival outcomes of ICS for gastric perforations during ER.
Methods
In two experiments using nine live pigs under general anesthesia, four and six perforations (3‐5\xA0mm) were created using an electrosurgical knife in acute and survival experiments, respectively. ICS was delivered to the perforations using an endoscopic catheter. In Experiment 1, a leak test and histopathology were performed on all explanted stomachs after euthanization. In Experiment 2, perforation sites were assessed by gastroscopy and histopathology 7, 14 and 28\xA0days post?procedure.
Results
In Experiment 1, gastroscopy confirmed complete closure of the perforations with ICS and no evidence of leak. Subsequent histopathology revealed a fixation of collagen gel (CG) as a sealant agent at the perforation sites. There were no adverse effects related with ESD or the use of ICS. In Experiment 2, histopathology revealed a fixation of CG as a sealant agent, replacement with granulation tissue and no CG; and fibrotic tissue at 7, 14 and 28\xA0days, respectively.
Conclusions
This study presents a novel method using ICS, demonstrating promising efficacy and safety profile for endoscopic closure of perforations during ER. Further studies are necessary before translating to clinical use.
PuraStatⓇ—a self-assembling peptide solution—has been recently approved and marketed in Japan as a hemostatic agent for gastrointestinal endoscopy. It is an artificial synthetic peptide consisting of ...three amino acids: arginine (R), alanine (A), and aspartic acid (D). After coming in contact with body fluids, the peptides change from acidic to neutral, self-assembling into gel aggregates and acting as a medical device for pressure hemostasis of bleeding points. PuraStatⓇ is ineffective against spurting bleeding and can only be used for oozing. However, compared with the conventional hemostatic agents, PuraStatⓇ has the following advantages: stays as a gel for a long time at the application site; is a transparent substance easily removable by washing, and therefore, does not interfere with subsequent procedures after application; and has a low risk of infection. PuraStatⓇ can help with hemostasis of intraoperative bleeding in ESD, prevent postoperative bleeding, promote wound healing, and act as a hemostatic agent for gastrointestinal bleeding. This article outlines an endoscopic hemostatic technique using PuraStatⓇ.
Background
The values of the parameters in the Chicago classification measured by a high-resolution manometry (HRM) system with the Unisensor catheter (Starlet) are significantly different from those ...measured by the ManoScan. The contraction vigor is categorized by values of the distal contractile integral (DCI) in the Chicago classification v3.0; however, reference values of the DCI in the Starlet and the clinical impact of the different reference values in the Starlet and ManoScan on diagnosing esophageal motility disorders are not known.
Methods
We evaluated data from a previous report in which ManoScan and Starlet were compared in the same subjects. The DCI values in each system were compared and reference DCI values were calculated. Moreover, diagnoses assessed by Starlet using reference values in ManoScan were compared with those using calculated reference values and those assessed by ManoScan.
Results
There was a significant positive correlation between the DCI values measured by ManoScan and those measured by Starlet (
r
= 0.80,
p
< 0.01). Based on a linear functional relationship considering measurement errors, the reference DCI values for diagnosing failed, weak and hypercontractile contraction vigor were calculated as 590.6, 1011.3 and 10,085.8 mmHg-s-cm, respectively, in the Starlet. Therefore, the proposed reference values in the Starlet were 500, 1000 and 10,000 mmHg-s-cm, respectively. When the reference values in the ManoScan were used in the Starlet data, approximately 30% of subjects were diagnosed inappropriately. This issue was resolved using the proposed reference values in the Starlet.
Conclusion
Recognizing systemic differences in HRM systems is important.
Background Surgical gastrojejunostomy is associated with relatively high morbidity and mortality rates. However, current experimental EUS-guided gastrojejunostomy information is limited. Objective To ...evaluate a novel EUS-guided gastrojejunostomy technique using a new enteric balloon and lumen-apposing metal stent. Design Animal experiment. Setting Animal laboratory at a referral center. Subjects and Interventions In 5 pigs, gastrojejunostomies were created under EUS guidance. Fully covered lumen-apposing stents were placed between the stomach and the jejunum. Main Outcome Measurements Technical success and adverse events of EUS-guided gastrojejunostomy. Results All stents, with 1 exception, were successfully deployed without any adverse events. The mean time to stent placement was 44.2 minutes (range 28-64 minutes). All animals showed normal eating behavior without signs of infection for 1 month after the procedure. Endoscopic imaging of the stomach site showed the stent to be patent and stable, without dislodgment, in all of the pigs. Necropsy showed complete adhesion between the stomach and the jejunum wall. Limitations Pilot study. Conclusions Creation of an EUS-guided gastrojejunostomy by using a novel enteric balloon and metal stent appears to be promising as a minimally invasive treatment.
Cholangiolocellular carcinoma (CoCC) is a rare primary liver cancer that is difficult diagnose due to a lack of specific imaging findings. We herein report a case of CoCC accompanied by severe ...alcoholic cirrhosis. Dynamic computed tomography showed a low-density tumor with a faint surrounding enhancement. Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging revealed iso-intensity in the hepatobiliary phase and a maximum tumor diameter of 53 mm. 18F-fluoro-2-deoxyglucose position-emission tomography was moderately positive (maximum standardized uptake value: 4.3). CoCC was diagnosed based on the pathological findings, including immunohistochemistry. We discuss the diagnostic imaging findings and review previous reports.
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