AIM: To retrospectively review the results of over-thescope clip (OTSC) use in our hospital and to examine the feasibility of using the OTSC to treat perforations after endoscopic submucosal dissection (ESD). METHODS:...AIM: To retrospectively review the results of over-thescope clip (OTSC) use in our hospital and to examine the feasibility of using the OTSC to treat perforations after endoscopic submucosal dissection (ESD). METHODS: We enrolled 23 patients who presented with gastrointestinal (GI) bleeding, fistulae and perforations and were treated with OTSCs (Ovesco Endoscopy GmbH, Tuebingen, Germany) between November 2011 and September 2012. Maximum lesion size was defined as lesion diameter. The number of OTSCs to be used per patient was not decided until the lesion was completely closed. We used a twin grasper (Ovesco Endoscopy GmbH, Tuebingen, Germany) as a grasping device for all the patients. A 9 mm OTSC was chosen for use in the esophagus and colon, and a 10 mm device was used for the stomach, duodenum and rectum. The overall success rate and complications were evaluated, with a particular emphasis on patients who had undergone ESD due to adenocarcinoma. In technical successful cases we included not only complete closing by using OTSCs, but also partial closing where complete closure with OTSCs is almost difficult. In overall clinical successful cases we included only complete closing by using only OTSCs perfectly. All the OTSCs were placed by 2 experienced endoscopists. The sites closed after ESD included not only the perforation site but also all defective ulcers sites.RESULTS: A total of 23 patients [mean age 77 years (range 64-98 years)] underwent OTSC placement during the study period. The indications for OTSC placement were GI bleeding (n = 9), perforation (n = 10), fistula (n = 4) and the prevention of post-ESD duodenal artificial ulcer perforation (n = 1). One patient had a perforation caused by a glycerin enema, after which a fistula formed. Lesion closure using the OTSC alone was successful in 19 out of 23 patients, and overall success rate was 82.6%. A large lesion size (greater than 20 mm) and a delayed diagnosis (more than 1 wk) were the major contributing factors for the overall unsuccessful clinical cases. The location of the unsuccessful lesion was in the stomach. The median operation time in the successful cases was 18 min, and the average observation time was 67 d. During the observation period, none of the patients experienced any complications associated with OTSC placement. In addition, we successfully used the OTSC to close the perforation site after ESD in 6 patients. This was a single-center, retrospective study with a small sample size. CONCLUSION: The OTSC is effective for treating GI bleeding, fistulae as well as perforations, and the OTSC technique proofed effective treatment for perforation after ESD.展开更多
The incidence of colonic diverticulosis with or without diverticulitis has increased in the Japanese population due to the modernization of food and aging.The rate of diverticulitis in colon diverticulosis ranges from...The incidence of colonic diverticulosis with or without diverticulitis has increased in the Japanese population due to the modernization of food and aging.The rate of diverticulitis in colon diverticulosis ranges from 8.1% to 9.6%.However,few cases of stenosis due to diverticulitis have been reported.These reports suggest that the differentiation between sigmoid diverticulitis and colon cancer is difficult.This report describes two cases of colon stenosis due to diverticulitis that were difficult to differentiate from colon cancer.Case 1 was a 70-year-old woman with narrowed stools for 1 month who underwent colonofiberscopy (CFS).CFS revealed a diverticulum and circumferential stenosis in the sigmoid colon.Barium enema revealed a marked,hourglassshaped,2-cm circumferential stenosis in the sigmoid colon.Fluorodeoxyglucose (FDG)-positron emission tomography computed tomography (CT) revealed an increased FDG uptake at the affected portion of the sigmoid colon.Sigmoid colon cancer was suspected,and laparoscopic sigmoidectomy was performed.Pathological examination demonstrated active inflammation with no evidence of malignancy.Case 2 was a 50-yearold man who presented to a nearby clinic with reduced stool output despite the urge to defecate.CFS detected severe stenosis in the sigmoid colon approximately 25 cm from the dentate line.Contrast-enhanced abdominal CT revealed multiple diverticula,wall thickening,and swelling of the lymph nodes around the peritoneal aorta and the inferior mesenteric artery.A partial sigmoidectomy was performed.Pathological examination of the resected specimen revealed no changes in the mucosal epithelial surface,but a marked infiltration of inflammatory cells was observed.展开更多
Endoscopic hemostasis performed in the emergency room is difficult due to the presence of blood clots and food residue that makes obtaining a clear view of the bleeding vessel difficult. We experienced the efficacy of...Endoscopic hemostasis performed in the emergency room is difficult due to the presence of blood clots and food residue that makes obtaining a clear view of the bleeding vessel difficult. We experienced the efficacy of a newly developed inverted overtube to shorten the hemostatic time and obtain a clear endoscopic view with upper gastrointestinal bleeding patient who were transferred by ambulance car and required emergency endoscopy. The technique improved the endoscopic views and enabled us to perform the hemostatic procedures from the conventional standing position while freely and easily changing the patient's position. The presence of blood clots and food residue in the gastric fornix or upper gastric body makes identifying a bleeding exposed vessel impossible. This set-up significantly shortened the procedure time. The inverted overtube helped us obtain a clear view in patients who were laid in the right lateral position. Rapid identification of ex-posed vessels resulted in success of hemostasis.展开更多
Endoscopic submucosal dissection(ESD) of large gastric lesions often leads to severe gastric strictures, especially in cases of large ESD in the antrum of the stomach. It has recently been reported that balloon dilati...Endoscopic submucosal dissection(ESD) of large gastric lesions often leads to severe gastric strictures, especially in cases of large ESD in the antrum of the stomach. It has recently been reported that balloon dilation, mucosal incision, and local steroid injections can successfully treat gastric strictures. However, there are some complications with existing methods and decreasing the quality of life. We have developed a novel method to prevent severe gastric strictures that does not involve balloon dilation, mucosal incision, or steroid injections after circumferential ESD. Our original method involves the submucosal injection of a mixed solution composed of triamcinolone acetonide and a general solution of glycerol, hyaluronic acid, and a small amount of indigo carmine and epinephrine dur-ing the ESD procedure; this mixture is called a mixed solution of triamcinolone(MST). According to standard ESD procedures, several milliliters of MST are injected into the submucosal layer for the purpose of elevating the submucosa during ESD resulting in prevention of severe strictures. Our method using MST take several advantages such as MST method suppress inflammation in ulcer from initial phase, prevention of stricture without obstructive symptoms, and does not require several ballooning. Therefore, MST method is safe and gentle, shorten the hospitalization duration. Here, we described two cases in which we prevented severe strictures of the gastric antrum after completing a circumferential ESD using MST without any complications.展开更多
The local injection of triamcinolone acetonide(TA) is effective in preventing pyloric stenosis and deformity following large endoscopic submucosal dissection(ESD).However,because of its long-acting nature,TA can induc...The local injection of triamcinolone acetonide(TA) is effective in preventing pyloric stenosis and deformity following large endoscopic submucosal dissection(ESD).However,because of its long-acting nature,TA can induce long-term local immunosuppression and subsequent adverse events.We report a case of a cytomegalovirus(CMV) ulcer that formed only at the TA local injection site.A 68-year-old man underwent ESD to treat early gastric cancer that formed over the pylorus.The lesion extended to the duodenum,and an artificial ulcer covered more than two-thirds of the circumference of the pylorus.To prevent pyloric stenosis,TA was locally injected into the ulcer floor.On day 12,a deeper ulcer 10 mm in diameter was discovered in the center of the post-ESD ulcer.Biopsies revealed large cells with intranuclear inclusion bodies,which stained positive for the anti-CMV antibody.Local TA injections are useful,however,CMV ulcer might occur as adverse events.展开更多
To treat Barrett's esophagus(BE),radiofrequency ablation or cryotherapy are effective treatments for eradicating BE with dysplasia and intestinal metaplasia,and reduce the rates of Barrett's esophageal adenoca...To treat Barrett's esophagus(BE),radiofrequency ablation or cryotherapy are effective treatments for eradicating BE with dysplasia and intestinal metaplasia,and reduce the rates of Barrett's esophageal adenocarcinoma(BAC).However,patients with BE and dysplasia or early cancer who achieved complete eradication of intestinal metaplasia,BE recurred in 5% within a year,requiring expensive endoscopic surveillances.We performed endoscopic submucosal dissection as complete radically curable treatment procedure for BE with dysplasia,intestinal metaplasia and BAC.展开更多
Previously, we reported the efficacy of a newly developed inverted overtube in shortening the hemostatic time and obtaining a clear endoscopic view in emergency endoscopic hemostasis. This device also helped us to per...Previously, we reported the efficacy of a newly developed inverted overtube in shortening the hemostatic time and obtaining a clear endoscopic view in emergency endoscopic hemostasis. This device also helped us to perform gastric endoscopic submucosal dissection(ESD) more safely by changing the direction of gravity in the right lateral position. To perform a safe ESD, it is important to make an appropriate angle and distance between the electric knife and the gastric mucosa. In this position, the distance to gastric mucosa is reduced, and the angle of the electric knife changes from vertical to somewhat oblique, facilitating safer cutting.展开更多
文摘AIM: To retrospectively review the results of over-thescope clip (OTSC) use in our hospital and to examine the feasibility of using the OTSC to treat perforations after endoscopic submucosal dissection (ESD). METHODS: We enrolled 23 patients who presented with gastrointestinal (GI) bleeding, fistulae and perforations and were treated with OTSCs (Ovesco Endoscopy GmbH, Tuebingen, Germany) between November 2011 and September 2012. Maximum lesion size was defined as lesion diameter. The number of OTSCs to be used per patient was not decided until the lesion was completely closed. We used a twin grasper (Ovesco Endoscopy GmbH, Tuebingen, Germany) as a grasping device for all the patients. A 9 mm OTSC was chosen for use in the esophagus and colon, and a 10 mm device was used for the stomach, duodenum and rectum. The overall success rate and complications were evaluated, with a particular emphasis on patients who had undergone ESD due to adenocarcinoma. In technical successful cases we included not only complete closing by using OTSCs, but also partial closing where complete closure with OTSCs is almost difficult. In overall clinical successful cases we included only complete closing by using only OTSCs perfectly. All the OTSCs were placed by 2 experienced endoscopists. The sites closed after ESD included not only the perforation site but also all defective ulcers sites.RESULTS: A total of 23 patients [mean age 77 years (range 64-98 years)] underwent OTSC placement during the study period. The indications for OTSC placement were GI bleeding (n = 9), perforation (n = 10), fistula (n = 4) and the prevention of post-ESD duodenal artificial ulcer perforation (n = 1). One patient had a perforation caused by a glycerin enema, after which a fistula formed. Lesion closure using the OTSC alone was successful in 19 out of 23 patients, and overall success rate was 82.6%. A large lesion size (greater than 20 mm) and a delayed diagnosis (more than 1 wk) were the major contributing factors for the overall unsuccessful clinical cases. The location of the unsuccessful lesion was in the stomach. The median operation time in the successful cases was 18 min, and the average observation time was 67 d. During the observation period, none of the patients experienced any complications associated with OTSC placement. In addition, we successfully used the OTSC to close the perforation site after ESD in 6 patients. This was a single-center, retrospective study with a small sample size. CONCLUSION: The OTSC is effective for treating GI bleeding, fistulae as well as perforations, and the OTSC technique proofed effective treatment for perforation after ESD.
文摘The incidence of colonic diverticulosis with or without diverticulitis has increased in the Japanese population due to the modernization of food and aging.The rate of diverticulitis in colon diverticulosis ranges from 8.1% to 9.6%.However,few cases of stenosis due to diverticulitis have been reported.These reports suggest that the differentiation between sigmoid diverticulitis and colon cancer is difficult.This report describes two cases of colon stenosis due to diverticulitis that were difficult to differentiate from colon cancer.Case 1 was a 70-year-old woman with narrowed stools for 1 month who underwent colonofiberscopy (CFS).CFS revealed a diverticulum and circumferential stenosis in the sigmoid colon.Barium enema revealed a marked,hourglassshaped,2-cm circumferential stenosis in the sigmoid colon.Fluorodeoxyglucose (FDG)-positron emission tomography computed tomography (CT) revealed an increased FDG uptake at the affected portion of the sigmoid colon.Sigmoid colon cancer was suspected,and laparoscopic sigmoidectomy was performed.Pathological examination demonstrated active inflammation with no evidence of malignancy.Case 2 was a 50-yearold man who presented to a nearby clinic with reduced stool output despite the urge to defecate.CFS detected severe stenosis in the sigmoid colon approximately 25 cm from the dentate line.Contrast-enhanced abdominal CT revealed multiple diverticula,wall thickening,and swelling of the lymph nodes around the peritoneal aorta and the inferior mesenteric artery.A partial sigmoidectomy was performed.Pathological examination of the resected specimen revealed no changes in the mucosal epithelial surface,but a marked infiltration of inflammatory cells was observed.
文摘Endoscopic hemostasis performed in the emergency room is difficult due to the presence of blood clots and food residue that makes obtaining a clear view of the bleeding vessel difficult. We experienced the efficacy of a newly developed inverted overtube to shorten the hemostatic time and obtain a clear endoscopic view with upper gastrointestinal bleeding patient who were transferred by ambulance car and required emergency endoscopy. The technique improved the endoscopic views and enabled us to perform the hemostatic procedures from the conventional standing position while freely and easily changing the patient's position. The presence of blood clots and food residue in the gastric fornix or upper gastric body makes identifying a bleeding exposed vessel impossible. This set-up significantly shortened the procedure time. The inverted overtube helped us obtain a clear view in patients who were laid in the right lateral position. Rapid identification of ex-posed vessels resulted in success of hemostasis.
文摘Endoscopic submucosal dissection(ESD) of large gastric lesions often leads to severe gastric strictures, especially in cases of large ESD in the antrum of the stomach. It has recently been reported that balloon dilation, mucosal incision, and local steroid injections can successfully treat gastric strictures. However, there are some complications with existing methods and decreasing the quality of life. We have developed a novel method to prevent severe gastric strictures that does not involve balloon dilation, mucosal incision, or steroid injections after circumferential ESD. Our original method involves the submucosal injection of a mixed solution composed of triamcinolone acetonide and a general solution of glycerol, hyaluronic acid, and a small amount of indigo carmine and epinephrine dur-ing the ESD procedure; this mixture is called a mixed solution of triamcinolone(MST). According to standard ESD procedures, several milliliters of MST are injected into the submucosal layer for the purpose of elevating the submucosa during ESD resulting in prevention of severe strictures. Our method using MST take several advantages such as MST method suppress inflammation in ulcer from initial phase, prevention of stricture without obstructive symptoms, and does not require several ballooning. Therefore, MST method is safe and gentle, shorten the hospitalization duration. Here, we described two cases in which we prevented severe strictures of the gastric antrum after completing a circumferential ESD using MST without any complications.
文摘The local injection of triamcinolone acetonide(TA) is effective in preventing pyloric stenosis and deformity following large endoscopic submucosal dissection(ESD).However,because of its long-acting nature,TA can induce long-term local immunosuppression and subsequent adverse events.We report a case of a cytomegalovirus(CMV) ulcer that formed only at the TA local injection site.A 68-year-old man underwent ESD to treat early gastric cancer that formed over the pylorus.The lesion extended to the duodenum,and an artificial ulcer covered more than two-thirds of the circumference of the pylorus.To prevent pyloric stenosis,TA was locally injected into the ulcer floor.On day 12,a deeper ulcer 10 mm in diameter was discovered in the center of the post-ESD ulcer.Biopsies revealed large cells with intranuclear inclusion bodies,which stained positive for the anti-CMV antibody.Local TA injections are useful,however,CMV ulcer might occur as adverse events.
文摘To treat Barrett's esophagus(BE),radiofrequency ablation or cryotherapy are effective treatments for eradicating BE with dysplasia and intestinal metaplasia,and reduce the rates of Barrett's esophageal adenocarcinoma(BAC).However,patients with BE and dysplasia or early cancer who achieved complete eradication of intestinal metaplasia,BE recurred in 5% within a year,requiring expensive endoscopic surveillances.We performed endoscopic submucosal dissection as complete radically curable treatment procedure for BE with dysplasia,intestinal metaplasia and BAC.
文摘Previously, we reported the efficacy of a newly developed inverted overtube in shortening the hemostatic time and obtaining a clear endoscopic view in emergency endoscopic hemostasis. This device also helped us to perform gastric endoscopic submucosal dissection(ESD) more safely by changing the direction of gravity in the right lateral position. To perform a safe ESD, it is important to make an appropriate angle and distance between the electric knife and the gastric mucosa. In this position, the distance to gastric mucosa is reduced, and the angle of the electric knife changes from vertical to somewhat oblique, facilitating safer cutting.