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ABSTRACT: Ulcerative colitis is a chronic inflammatory bowel disease with repeated remission and relapse, although the occurrence of relapse is difficult to predict. We performed a prospective study to determine whether there is a relationship in ulcerative colitis between the inflammatory changes identified by endoscopic ultrasonography (EUS) and relapse.
Participants were 23 ulcerative colitis patients who had not suffered a relapse for 1 month, with a Seo activity index less-than-or-equal 150 and Baron grade 1 at colonoscopy. The thickness of the first to the third layer of the rectal wall in these patients was measured by EUS at the start of the study. They were subsequently followed up for 1 year to record any relapses, defined as having a Seo activity index > 150 and Baron grade greater-than-or-equal 2 at colonoscopy.
Relapse occurred in eight patients. The mean activity index of the relapsed patients was 187.3 (95 % confidence interval (CI), 166.4 - 208.2) at the end of the study. The thickness of the first to the third layer of the rectal wall, as evaluated by EUS at the beginning of the study, was significantly larger in the relapse group (mean 2.73 mm, 95 % CI 2.13 - 3.33 mm) than in the non-relapse group (1.79 mm; 1.56 - 1.99 mm; P = 0.0001).
Catheter probe-assisted endoluminal ultrasonography may predict the occurrence of relapse of ulcerative colitis.
Endoscopy 04/2002; 34(3):212-9. · 5.21 Impact Factor
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ABSTRACT: The objective of three-dimensional (3-D) endoscopic ultrasonography (EUS) is to recognize lesions stereoscopically.
We investigated a total of 43 lesions in the upper gastrointestinal (GI) tract by regenerating 3-D images in eight cases of oesophageal cancer, two cases of oesophageal submucosal tumour, two oesophageal varices, two cases of achalasia, 27 gastric cancers, one gastric carcinoid, and one duodenal submucosal tumour. Using a prototype system (Fujinon, Omiya, Japan), we reconstructed 3-D images from conventional EUS images taken by a thin ultrasound probe (Sonoprobe, SP-701, Fujinon) having a radial-linear scanning mode. The basic 3-D images could be obtained in a short period during EUS performed using the conventional thin-ultrasound probe. The acceptable quality level of the reconstructed 3-D images was 37% (57% in the oesophagus, 25% in the stomach and 100% in the duodenum). Deterioration of 3-D images was due to a wobbling of linear scanning mainly caused by peristalsis of the GI tract, cardiac impulses, and respiration.
Our study has proved that the simple and speedy 3-D display system built using the existing linear-radial switchable probe is easily applicable to clinical cases.
Journal of Gastroenterology and Hepatology 01/2000; 14(12):1212-8. · 2.87 Impact Factor
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ABSTRACT: The metaplastic polyp of the colon is a non-neoplastic lesion that is generally identified as white, flat and having a smooth surface. In general, this polyp is small, is less than 5 mm in diameter but is occasionally larger than 5 mm in diameter, and forms a swelling. The aims of the present study were to clarify the factors that determine the morphology of protruding metaplastic polyps. More specifically, we investigated whether the metaplastic polyp forms as a result of an abnormality in cell proliferation or inflammation of the region.
We examined 15 endoscopically resected metaplastic polyps of the colon having a longitudinal diameter of more than 5 mm. To study aspects of cell proliferation, we used proliferating-cell nuclear antigen (PCNA) staining. For examination of histological changes caused by inflammation, we used alpha-smooth muscle actin (alphaSMA) staining, in which myofibroblasts are specifically stained.
Metaplastic polyps showed significantly higher expression of PCNA, not only in the deep layer, but also in the intermediate and superficial layers, compared with the normal mucosa of the colon. In the protruding metaplastic polyps, anti-alphaSMA staining revealed bundle-like myofibroblasts in the interstitium.
The factors responsible for the formation of non-neoplastic metaplastic polyps larger than 5 mm with a protruding morphology are: an increased number of epithelial cells due to the movement of these cells toward the ductal epithelium in the proliferating zone; and expansion of interstitial tissues due to infiltration of myofibroblasts and other inflammatory cells in response to inflammation.
Journal of Gastroenterology and Hepatology 08/1999; 14(7):709-14. · 2.87 Impact Factor
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ABSTRACT: Cyanoacrylate injection is highly effective and is regarded as the treatment of choice in bleeding gastric varices in Europe, but intravenous injection of cyanoacrylate is not allowed in the USA and Japan because it may cause embolisms in other organs. Accordingly, we developed a new endoscopic combined treatment of endoscopic management of gastric varices using a detachable snare (EVLs) and simultaneous endoscopic sclerotherapy and O-ring ligation (EISL) (i.e. EVLs + EISL), and we prospectively evaluated its efficacy and safety.
Gastric varices were ligated with the loop of a detachable snare that opened to a diameter of 4 cm (EVLs). Then the residual varices around the ligated portion were sclerosed by ethanolamine oleate and the injected vessel was ligated using a pneumo-activated EVL device (EISL). The EVLs + EISL was performed in 35 patients: on an emergency basis in eight patients, on an elective basis in six patients and as primary prophylaxis in 21 patients. Liver function was classified as Child-Pugh class A in 12 patients, class B in 12 patients and class C in 11 patients.
Endoscopic disappearance of gastric varices was obtained in 97.1% of the patients and they regressed in all patients. Haemostasis was achieved in all eight emergency cases. The 2-year cumulative non-recurrence rate was 85%, the 2-year cumulative non-bleeding rate was 92% and the 2-year cumulative survival was 80%. No patients died of bleeding from gastric varices. There were no serious short-term complications, such as haemorrhage, gastro-oesophageal perforation, ileus, or renal impairment.
Combined EVLs + EISL appears to be a useful treatment for gastric varices due to its safety and good clinical outcome.
Journal of Gastroenterology and Hepatology 08/1999; 14(7):730-5. · 2.87 Impact Factor
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ABSTRACT: Endoscopic variceal ligation (EVL) using 'O' rings is widely accepted as a treatment of oesophageal varices that is at least as effective as endoscopic injection sclerotherapy but which produces fewer complications. Endoscopic variceal ligation using detachable snares has attracted attention as a safe and easy method of endoscopic treatment for gastric varices. Nineteen patients with acute bleeding from oesophageal or gastric varices were treated in the present study. Of these, 14 patients were treated with EVL using 'O' rings and five patients were treated with EVL using detachable snares and the treatment results were evaluated. Haemostasis was achieved in all patients. No serious complications of the procedures were observed. However, recurrences and rebleeding were observed in some patients during the maximum follow-up period of 24 months. Endoscopic variceal ligation using 'O' rings and detachable snares is useful for achieving haemostasis in cases of acute bleeding from oesophageal or gastric varices. However, additional endoscopic sclerotherapy may be needed to eliminate the variceal feeding vessels to further improve the long-term prognosis of these patients.
Journal of Gastroenterology and Hepatology 05/1997; 12(4):331-5. · 2.87 Impact Factor
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ABSTRACT: Detailed information on the depth of invasion of superficial esophageal cancer is required for endoscopic mucosal resection. As a pretherapeutic diagnostic procedure, endoscopic ultrasonography using conventional 7.5 MHz systems has been ineffective at providing sufficient details. A newly developed, thin ultrasound probe system provides both radial and linear scanning for evaluation of superficial esophageal cancer.
Endoscopic ultrasonography was performed in 16 patients using a switchable probe driven at 20 MHz. Seventeen lesions of superficial esophageal cancer were evaluated for depth of invasion to discriminate mucosal from submucosal penetration.
The overall accuracy of staging was 64.7%. In all six errors, mucosal cancers were overstaged as submucosal invasion. The diagnostic accuracy was 80% when the muscularis mucosae was visualized.
A 20 MHz linear-radial switchable probe is a useful new method in the staging of superficial esophageal cancer.
Gastrointestinal Endoscopy 12/1996; 44(5):578-82. · 4.88 Impact Factor
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Journal of Gastroenterology and Hepatology 02/1989; 4 Suppl 1:173-5. · 2.87 Impact Factor
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ABSTRACT: Tissue adhesive agents, such as the cyanoacrylates, have been used as an alternative to conventional sclerotherapy to treat gastric varices, but the long-term efficacy of this approach has not been determined. We evaluated the efficacy and long-term outcome of injection sclerotherapy with n-butyl-2-cyanoacrylate and ethanolamine oleate in 16 patients with gastric varices.
We evaluated the effect of injection sclerotherapy in 16 Japanese patients with gastric varices. Injection sclerotherapy was performed on an emergency basis in 6 patients, an elective basis in 5 patients, and as prophylaxis in 5 patients.
No bleeding was observed in the 7 patients in whom gastric varices disappeared during the 51 month follow-up period. The non-bleeding rate after treatment was significantly higher in this group than in the 9 patients in whom gastric varices did not disappear (p<0.05). Acute bleeding was stopped in 5 (83.3%) of 6 patients. The single failure was a patient in whom the sclerosant could not be injected into the gastric varices. No serious complications, such as emboli in other organs, were observed.
The results suggest that this therapy is a safe and useful treatment for gastric varices and that the goal of injection sclerotherapy should be the disappearance of gastric varices.
Hepato-gastroenterology 45(22):1155-8. · 0.66 Impact Factor
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ABSTRACT: Bleeding Meckel's diverticulum tends to be a complication of ectopic gastric mucosa. It has been known that the gastric acid and digestive fluid produced from the ectopic gastric mucosa cause peptic ulcer, which leads to bleeding. When the ectopic gastric mucosa is entirely formed by the pyloric gland, however, ulcer formation may result from factors other than gastric acid and digestive fluid. This is a report of an adult case of bleeding Meckel's diverticulum with ectopic gastric mucosa in whom mechanical stimulation was suggested as a cause of the erosion and ulceration, resulting in bleeding.
Hepato-gastroenterology 48(42):1628-30. · 0.66 Impact Factor
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ABSTRACT: Endoscopic injection sclerotherapy with ligation is a technique by which endoscopic injection sclerotherapy is first carried out for a target esophageal varix using an endoscope equipped with a device for endoscopic variceal ligation, and subsequently, endoscopic variceal ligation is performed for the varix together with the injection site of the sclerosing agent. The aim of this prospective, randomized trial was to compare endoscopic injection sclerotherapy with ligation with endoscopic injection sclerotherapy techniques in utility for patients with esophageal varices.
Twenty-four patients with esophageal varices who were to undergo either an elective treatment of bleeding esophageal varices or a prophylactic treatment of non-bleeding esophageal varices underwent endoscopic injection sclerotherapy with ligation (n = 12) or without ligation (n = 12). The patients were followed for a mean of 19.9 +/- 8.1 months in the endoscopic injection sclerotherapy with ligation (EISL) group and 19.5 +/- 5.4 months in the Endoscopic injection sclerotherapy (EIS) group.
The red color sign disappeared in 10 patients in the EISL group and 3 in the EIS group (P = 0.004) after initial treatment. The length of time required for initial treatment was 16.3 +/- 4.7 min for the EISL group and 27.2 +/- 6.2 min for the EIS group (P = 0.0003). For treatment-related complications, no significant difference was noted between the 2 groups and no serious complication were noted in the 2 groups. The total quantity of ethanolamine oleate used to attain the endpoint was 17.3 +/- 7.9 mL for the EISL group and 25.2 +/- 9.7 mL for the EIS group (P < 0.05). The cumulative non-relapse rate for 2 years following attainment of the endpoint [F1, RC(-)] was 81.5% for the EISL group and 47.5% for the EIS group, producing no significant difference between the 2 groups. The cumulative non-bleeding and survival rates were 100% in the 2 groups.
Endoscopic injection sclerotherapy with ligation is more useful for esophageal varices than endoscopic injection sclerotherapy alone.
Hepato-gastroenterology 47(33):733-7. · 0.66 Impact Factor
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ABSTRACT: Advances in diagnostic technology have led to increased detection of early esophageal cancer, which is suitable for endoscopic treatment. We performed endoscopic esophageal mucosal resection of such cancer and dysplasia using the endoscopic esophageal mucosal resection tube and evaluated the clinical benefit of this technique.
Twenty-nine patients with esophageal mucosal cancer (27 cases with 33 lesions) or dysplasia (2 cases with 2 lesions) diagnosed between September 1992 and March 1998 were assessed endoscopically for the depth and extent of invasion by double staining with toluidine blue and iodine. Endoscopic ultrasonography was also performed to assess the depth of invasion in 22 cases with 22 lesions.
The 35 esophageal lesions comprised 27 esophageal carcinomas and 8 areas of dysplasia. Twenty of the 35 lesions were resected en bloc and 15 were resected piecemeal. Subsequent surgery was performed for 5 cases with 7 lesions out of 10 cases with 15 lesions that were histopathologically diagnosed as m3 or more invasive. No recurrence has been detected in 24 evaluable cases (including 1 who died of another disease, 2 in whom surgery could not be performed due to complications, and 3 who refused subsequent surgery). No patients died of esophageal cancer after a mean follow-up period of 30.9 +/- 18.9 months. The 4-year survival rate was 100% in the m2 or less invasive group of 19 cases with 20 lesions, 75% in the m3 or higher invasive group of 5 cases with 8 lesions and 100% in the surgery group of 5 cases with 7 lesions (NS). No serious complications occurred except for 1 patient. Circumferential mucosal resection was done in this patient, resulting in esophageal stenosis, which responded to esophageal dilation.
Esophageal mucosal resection using the endoscopic esophageal mucosal resection tube is safe and beneficial for early esophageal cancer and dysplasia.
Hepato-gastroenterology 48(38):453-7. · 0.66 Impact Factor
