摘要:

Abstract:Laser application in gastrointestinal endoscopy started with the development of flexible optical fibers in about 1970. Originally, non‐contact irradiation with high power Nd: YAG lasers of 100 watts (W) was used for gastrointestinal hemostasis. It was difficult to achieve safe and reliable irradiation with this method, the quarts fiber tips were susceptible to coagulation damage, and the cost was high. As a result local injections were recognized as an inexpensive and excellent method of producing hemostasis, and became the treatment of first choice. Therefore, the endoscopic use of lasers shifted from hemostasis to the topical treatment of tumors.In 1984 low‐power Nd: YAG laser irradiation at 1 to 30W became possible using a ceramic contact probe co‐developed by the authors and the Surgical Laser Technology Japan Co. This made photocoagulation, vaporization, cutting and local hyperthermia (Laserthermia) feasible. Improvements in laser irradiation efficiency led to the development of inexpensive equipment, costing less than one‐third of the price of conventional equipment. The application of low‐power contact lasers significantly improved the clinical efficacy of the treatment of minute cancers, but the technique has the same limitations as other endoscopic methods. Furthermore, because laserthermia is still being developed, the best technique has not yet been fully defined.In the future, treatments that can be used effectively in association with low‐power contact laser therapy need to be identified. Low‐power contact laserthermia, local hyperthermia with microwaves, and photodynamic therapy with excimer dye lasers all need to be studied further. This will contribute to the development of a minimum invasive therapy for gastrointes

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1992.tb00237.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Abstract:Endoscopic ultrasonography (EUS) reveals a variety of echo patterns in gastric carcinoma. We analysed the factors determining its echogenicity in 47 cases of advanced carcinoma. Echo levels were measured with a densitometer (Model PDM ‐5, Konishiroku, japan) on Polaroid films of ultrasonography. The echogenicity of a tumor (Et) was expressed as the value relative to those of the submucosal layer (EIII) and the proper muscle layer (EIV), (Et‐EIII)/(EIV‐EIII)=echogenicity index (EI). The amount of fiber was expressed as the ratio of the area of fibrosis measured with an image analyser (IBAS‐2000, Zeiss, Germany) on a preparation of Masson‐Trichrome staining. EI corresponded well to the echo levels graded by the conventional method of description and had a strong correlation with the amount of fiber (r =–0.621, p<0.001) except in two cases of mucinous carcinoma. Scirrhous carcinoma had a significantly smaller El than medullary and intermediate carcinomas. It also had a significantly greater amount of fiber than the others. No significant difference was found in terms of both the EI and amount of fiber when the carcinoma were grouped according to their degrees of differentiation (well, moderate and poor) or their modes of infiltration (α, β and γ). The tumors with short, wave‐shaped “curly fiber” showed a greater EI than those with fine networks of fibers or thick bundles of fibers. Mucinous carcinoma and two cases of intermediate type carcinoma were included in the former group and scirrhous carcinoma was included in the latter group.In conclusion, the echo levels of gastric carcinoma visualized by EUS are mostly determined by the amount of fiber in the tumor, but are also modified to some extent by the shape and arrangement of those fibers. Scirrhous carcinoma can be distinguished from the other types base

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1992.tb00238.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Abstract:We investigated the endoscopic and histopathological characteristics of 112 gastric polyps on the gastric body. According to the histopathological findings of the glands in the biopsy specimens, we classified the polyps into 6 categories; dense fundic gland type (group A), sparse fundic gland type (B), mixed fundic and pyloric gland type (C), pyloric gland type (D), complete atrophic gland type (E) and others (F).The grade of atrophic gastritis was defined by the fundic‐pyloric border type of the stomach, and was found to change from mild to severe respectively in groups A to E. The gastric area type of background fundic gland mucosa also changed from F0to F3in parallel with the order of the groups A to E. Thirty‐five of the 36 polyps in group A, all 19 in group B, 2 out of 3 in group C, 1 of 4 in group D, and the 1 in group E were located on the dye‐endoscopically defined fundic gland mucosal area. The gland type of biopsy specimens which were obtained from the mucosa adjacent to the polyps changed from fundic to fundic‐pyloric and to pyloric type in groups A to E respectively.In conclusion, the histopathological findings of polyps on the gastric body reflect the background mucosa, and in particular the extent of the atrophic change of the stomach. The majority of polyps, either fundic gland polyps (groups A and B) or hyperplastic polyps (groups C, D and E), on the gastric body were found to be the same gland type as their respective background mucosa. They thus seem to fall into the same category as hyperplastic polyps of background mucosal origin but are not the same as a hamartomatou

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1992.tb00239.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Abstract:This study was undertaken to assess the diagnostic significance of the colon mucus test (CMT) by which the cancer‐associated carbohydrate antigen, β‐D‐Gal (1 ‐ 3)‐D‐GalNAc (T antigen) is measured in rectal mucus, chiefly in patients with various alimentary tract diseases. The incidence of a positive CMT was relatively high in colorectal cancer (69%) and gastric cancer (40%), and was similarly high in some benign colorectal diseases such as colonic diverticulum (42%) and colonic polyps (39%), and in gastric polyps (75%). On the other hand, the incidence of a positive CMT in other benign diseases or in healthy controls was less than 10%. A positive CMT was significantly more common in colorectal disease and in gastric tumors (cancer and polyps) than in the other diseases (p<0.001). Of 28 colonic polyp patients, 20 (71%) had negative fecal occult blood test results (FOBT), and nine of them (45%) had positive CMT results.These results suggest that the CMT may be a useful screening test for alimentary tract disease, particularly colorectal disease and gastric tumors, although its specificity for colorectal cancer is only moderate. Furthermore, a combination assay using FOBT plus CMT may help to improve the dia

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1992.tb00240.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Abstract:A new method of endoscopic therapy for esophageal varices using a clipping apparatus was devised and applied prophylactically in nine patients with esophageal varices which were not bleeding. Eighty two ligations were placed in 21 separate treatment sessions in this study. All the esophageal varices were eradicated or reduced in size and length within 2 months following treatment. No major complications such as massive bleeding, the development of deep esophageal ulcers, esophageal perforation, esophageal stenosis and pleural effusion developed. The follow‐up period ranged from 6 months to 18 months. Three patients (33%) were re‐treated by the same method because of the regrowth of esophageal varices during this period, but no bleeding occured in these patients. It seems that this newly developed method is a safe, simple and effective technique for the treatment of esophageal vari

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1992.tb00241.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Abstract:An EST was performed on 33 patients with choledocholithiasis and a previous Billroth II gastrectomy according to an alternative technique, using a cannula as a cutting guide. This seems to be an easy and safe technique which may be used in cases in which the deep cannulation of the common bile duct is possible.

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1992.tb00242.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Abstract:A case of depressed type mucosal cancer of the large intestine with converging mucosal folds is discussed.A 71‐year‐old female was admitted to our hospital with melena. A total colonoscopy revealed a type IIa + IIc lesion measuring 1. 5cm in diameter with converging mucosal folds in the transverse colon. An endoscopic biopsy revealed an adenocarcinoma. A diagnosis of submucosal carcinoma was made and a partial colectomy was performed. The resected specimen showed a type IIc + IIa cancer. Histologically, a well differentiated adenocarcinoma which was limited to the mucosa in association with fibrosis in the submucosa was revealed. The submucosal fibrosis was thought to be a cause of the converging mucosal fo

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1992.tb00243.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Abstract:A 67‐year‐old Japanese woman with duodenal Crohn's disease developed cholangitis. Radiographic and endoscopic examinations revealed a marked stenosis of the third portion and a dilatation of the second portion of the duodenum. The endoscopic and histopathological observations showed this disease affected the Vater's papilla. Duodenoscopic manometry indicated a reduced pressure of the phasic sphincter of Oddi, indicating ampullar insufficiency. E. coli was found in the bile culture as the infecting organism. The authors suggest that the cholangitis in this patient was caused by the reflux of duodenal contents into the biliary tr

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1992.tb00244.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Abstract:A 33‐year‐old male was admitted to our hospital with a seven months history of retrosternal pain and odynophagia. On admission the patient could take only liquid or soft diet. An endoscopic examination revealed a mid‐esophageal ulcer. The ulcer was intractable. No known etiological factor of esophagitis was found. A biopsy of the ulcer exacerbated the ulcer and symptoms. Biopsies of normal‐looking esophageal mucosa gave rise to new ulcers at the site of biopsy accompanied by an increase in the symptoms. While these newly formed ulcers healed within 6 weeks, it took an additional 6 months for the primary ulcer to completely disappear. The elimination of hard and hot foods, large boluses, condiments and alcohol from the patient's diet appeared to improve the condition of the ulcer and prevent recurrence. The esophageal mucosa of this patient may have an exaggerated potential to react to mechanical stimulation. Such intractable esophageal ulcers rarely appear in healthy young men and the mechanism of the abnormal reactivity of the esophageal mucosa needs to be cl

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1992.tb00245.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Abstract:This study reports on the case of a 71‐year‐old man who complained of repeated episodes of right lower abdominal pain. A barium enema and colonoscopy revealed a 20 times 20 times 15 mm smooth‐surfaced polypoid tumor (Yamada type III) located in the terminal ileum.An endoscopy showed that the lesion had a slightly yellowish surface and the cushion sign was observed, so the tumor was considered to be an intestinal lipoma. During colonoscopy, prolapse of the tumor occurred through the orifice of Bauhin's valve and the patient simultaneously complained of right lower abdominal pain. The tumor was removed endoscopically.After a colonoscopic polypectomy, the patient's right lower abdominal pain disappeared. A pathological examination of the specimen revealed a lipoma of the terminal ileum.In general, the correct preoperative diagnosis of intestinal lipoma is difficult. Furthermore, 80% of lipomas situated at the terminal ileum are complicated by acute intussusception.We suggest that a colonoscopic polypectomy is a useful procedure for confirming the diagnosis of intestinal lipoma and for the prophylaxis of intussusception when the tumor is located in the terminal

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1992.tb00246.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY