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ABSTRACT: Double-balloon enteroscope (DBE)-assisted endoscopic retrograde cholangiopancreatography (ERCP) is an effective endoscopic approach for pancreatobiliary disorders in patients with altered gastrointestinal anatomy. Endoscopic interventions via DBE in these postoperative settings remain difficult because of the lack of an elevator and the use of extra-long ERCP accessories. Here, we report the usefulness of direct cholangioscopy with an ultra-slim gastroscope during DBE-assisted ERCP. Three patients with choledocholithiasis in postoperative settings (two patients after Billroth II gastrojejunostomy and one patient after Roux-en-Y gastrojejunostomy) were treated. DBE was used to gain access to the papilla under carbon dioxide insufflation, and endoscopic sphincterotomy was performed with a conventional sphincterotome. For direct cholangioscopy, the enteroscope was exchanged for an ultra-slim gastroscope through an incision in the overtube, which was inserted directly into the bile duct. Direct cholangioscopy was used to extract retained bile duct stones in two cases and to confirm the complete clearance of stones in one case. Bile duct stones were eliminated with a 5-Fr basket catheter under direct visual control. No adverse events were noted in any of the three cases. Direct cholangioscopy with an ultra-slim gastroscope facilitates subsequent treatment within the bile duct. This procedure represents another potential option during DBE-assisted ERCP.
World Journal of Gastroenterology 07/2012; 18(28):3765-9. · 2.47 Impact Factor
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ABSTRACT: A 62-year-old woman presented with a markedly increased serum ALP level of skeletal origin during a regular follow-up of chronic hepatitis C. Serum calcium, phosphorus, and intact-PTH levels were normal and bone turnover markers were increased. Her generalized bone density was diffusely increased. These findings were consistent with hepatitis C-associated osteosclerosis (HCAO). She underwent cholecystectomy, as gallbladder cancer was suspected; however, histopathological findings demonstrated xanthogranulomatous cholecystitis. After cholecystectomy, serum ALP level and bone turnover markers were gradually decreased. This may indicate the existence of a novel osteogenic factor in the gallbladder in HCAO.
Internal Medicine 01/2011; 50(16):1703-8. · 0.94 Impact Factor
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Akiko Kuwahara,
Tatsuya Koshitani,
Shogo Matsuda,
Takaharu Takai,
Takayuki Motoyoshi,
Yasuhide Yamashita,
Toshihiko Kirishima,
Naomi Yoshinami, Hiroyuki Shintani,
Yoji Urata,
Yoshinori Katsuma,
Toshikazu Yoshikawa
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ABSTRACT: A 68-year-old man had been followed up since March, 1997 because of a cystic tumor of the pancreas head. The patient developed obstructive jaundice and was admitted to our hospital in June, 2007. The tumor size on CT scan had increased from 3.6 cm to 5.9 cm during the 10-year period. After endoscopic biliary drainage, pancreatoduodenectomy was performed. Pathological diagnosis of the resected specimen was serous cystadenoma. Serous cystadenoma of the pancreas is known as a benign tumor with indolent progression and is likely to be symptomatic if the tumor size exceeds 4 cm. However, biliary obstruction is a rare complication of serous cystadenoma. We report this rare case here with references to the literature.
Nippon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology 01/2011; 108(6):962-8.
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Toshihiko Kirishima,
Naomi Yoshinami,
Akiko Marui,
Shogo Matsuda,
Koji Takai,
Takayuki Motoyoshi,
Yasuhide Yamashita,
Junpei Takaaki, Hiroyuki Shintani,
Masami Mizumoto,
Toshikazu Yoshikawa
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ABSTRACT: A 65-year-old man was admitted because of epigastralgia and body weight loss. A 50-mm tumor found at the lesser curvature of the gastric antrum was histologically diagnosed as endocrine carcinoma. A computed tomography (CT) scan showed liver metastasis and multiple lymph node metastasis. We started chemotherapy with irinotecan and cisplatin every 4 week. After three courses of treatment, the primary lesion was estimated PR, the metastasis CR, and the synthesis PR. Then we performed distal gastrectomy with lymph node dissection. Histological findings revealed no cancer cells.
Nippon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology 11/2009; 106(11):1616-24.
