大澤 博之

BACKGROUND: The diagnostic accuracy of conventional endoscopy for small colonic polyps is not satisfactory. Optimal band imaging (OBI) enhances the contrast of the mucosal surface without the use of dye. OBJECTIVE: To evaluate the diagnostic accuracy for the differentiation of neoplastic and non-neoplastic colorectal polyps by using magnified OBI colonoscopy. DESIGN: An open prospective study. SETTING: Jichi Medical University, Japan. PATIENTS: A total of 133 colonoscopy cases. MAIN OUTCOME MEASUREMENT: A comparative study of the overall accuracy, sensitivity, and specificity for the differentiation of neoplastic and non-neoplastic colorectal polyps < or =5 mm in size by capillary-pattern diagnosis by using conventional colonoscopy, capillary-pattern diagnosis in OBI, and pit-pattern diagnosis in chromoendoscopy with low magnification. RESULTS: A total of 107 polyps, composed of 80 neoplastic and 27 non-neoplastic polyps, were evaluated. OBI clearly showed the capillary network of the surface mucosa of neoplastic polyps at low magnification, whereas the surface mucosa of non-neoplastic polyps showed up as a pale lesion. The capillary pattern in conventional colonoscopy had 74% accuracy, 71% sensitivity, and 81% specificity for neoplastic polyps. The accuracy and sensitivity were significantly lower than those that used the capillary pattern in OBI (accuracy 87% and sensitivity 93%) and the pit pattern in chromoendoscopy (accuracy 86% and sensitivity 90%). There were no significant differences in specificity (OBI 70% and chromoendoscopy 74%). The kappa analysis indicated good agreement in both OBI and chromoendoscopy. CONCLUSIONS: Capillary-pattern diagnosis in OBI is superior to that in conventional endoscopy and is not significantly different from pit-pattern diagnosis for predicting the histology of small colorectal polyps.

A 74-year-old man with diabetic nephropathy developed epigastric pain and high fever after endoscopic submucosal dissection (ESD) for early gastric cancer. Gastroscopy, endoscopic ultrasonography and computed tomography showed ulceration with a purulent lake, thickened entire gastric mucosal layers suggesting focal abscess formation, leading to the diagnosis of phlegmonous gastritis. He underwent total gastrectomy as an emergency. Histological findings of the resected specimen showed severe inflammatory cell infiltration and multiple focal abscess formation spreading to the entire gastric wall. In patients with poorer general conditions, phlegmonous gastritis should be considered as a serious complication after ESD, indicating a requirement of antibiotic prophylaxis.

We report three patients with acute hemorrhagic rectal ulcer (AHRU) in our hospital.<br> Case 1 : A 61-years-old male with alcoholic liver damage and acute renal failure had massive fresh bloody stool. Colonogram showed AHRU. Local injection of hypertonic saline-epinephrine (HSE) and clip ligation failed to prevent rebleeding. Surgical ligation was done.<br> Case 2 : A 80-years-old male with congestive heart failure was admitted because of hematochezia. We could easily inject HSE and perfom clippig ligation by the colonoscopy capped with a transparent hood.<br> Case 3 : A 77-years-old female with congestive heart failure and toxic epidermalnecrolysis had hematochezia. Bleeding from AHRU was treated by clipping ligation.<br> It is important to perform colonoscopy considering AHRU, when we find that a patient have scarlet bloody stool without abdominal pain.

A 68-year-old man was admitted to our hospital with the chief complaint of hematemesis. Laboratory studies showed anemia and positive occult blood in the feces. Endoscopic examination revealed a bright red lesion, approximately 10mm in diameter, on the lesser curvature near the incisura angularis. Color Doppler endoscopic ultrasonography showed multiple capillary vessels and pulsatile flow in the lesion.<br> Since the gastrointestinal bleeding continued and anemia progressed, the lesion was endoscopically resected using an endoscopic variceal ligation device. Such procedure is useful for the treatment the bleeding in case of angiodysplasia of the stomach.

A 42-year-old male consulted us because of hiccups on eating, which was revealed to be caused by an esophageal cyst. Though it is confirmed to be one of congenital diseases, such matters of importance as clinical classification and indication for operation still remain controversial.<br> The therapeutic procedure we made was endoscopic ultrasonogram (EUS) -guided needle aspiration. The echoendoscope, Pentax FG32-UA, is a forward oblique-scanning fiberoptic scope with a convex type array ultrasonic transducer. The needle inserted through the instrumentation channel can be visualized both endoscopically and ultrasonically. This new method enabled us to puncture the esophageal cyst with accuracy and safety, and the lesion apparently decreased in size.<br> In general, cystic lesions of gastrointestinal tract may be treated the best by EUS-guided needle aspiration. It is certain that the modality will play a more important role in both diagnosis and treatment in the near future.