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Endoscopic hemostasis is widely performed for nonvariceal upper gastrointestinal (UGI) bleeding. As the aged Japanese population rapidly increases, the number of patients experiencing complications increases. The aim of this study was to evaluate the recent results of endoscopic hemostasis for nonvariceal UGI bleeding. A retrospective analysis of patients who underwent endoscopic procedures for nonvariceal UGI bleeding was performed. We performed 223 endoscopic procedures on 217 patients between January 1995 and July 2000, and 238 endoscopic procedures on 236 patients between January 2006 and September 2009 at the Kyoto Second Red Cross Hospital. We divided the patients into the 1995–2000 group and the 2006–2009 group. Patient characteristics, hemostasis methods chosen, rates of temporary hemostasis and rebleeding, and mortality were analyzed. There were many serious and actively bleeding cases in the 2006–2009 group ( P < 0.001). The endoclip method and intravenous proton pump inhibitor were mainly used in the 2006–2009 group compared with the drug-injection method and intravenous H2 receptor antagonist in the 1995–2000 group ( P < 0.001). Through these treatments, the two groups were able to obtain similar treatment outcomes. Through the progress of endoscopic management we obtained similar satisfactory results in the 2006–2009 group, which had multiple complicated cases, compared to the 1995–2000 group. [ABSTRACT FROM AUTHOR]

Background: Endoscopic ultrasonography (EUS) is widely accepted as a diagnostic tool for bilio-pancreatic and gastrointestinal tract diseases. Recently, an ultrasound endoscope with an electronic radial scan transducer has been developed. To evaluate the clinical usefulness of this system, its image quality, advantages and disadvantages were evaluated. Materials and methods: Ultrasound endoscope with electronic radial scan transducer and its monitor unit were used. The direction of the imaging plane was similar to that of the mechanical radial models. Color Doppler function and tissue harmonic imaging were feasible by this system. To evaluate this endoscope, we investigated the image quality and distance resolution by in-vitro study using thin papers, and 50 patients were examined by this system. Results: Comparison with the mechanical radial endoscope GF-UM2000 revealed that the image quality was almost equivalent. However, the ultrasound penetration of the electronic radial scanner was better and more satisfactory with less echoic reduction. In addition, the blood-flow signal could be obtained by using the color Doppler function. In contrast, the diameter of the new endoscope was bigger than the advanced mechanical radial models, the monitor unit was bigger than that of the mechanical radial system, and the operation of this unit was complicated. Conclusion: A prototype of the ultrasound endoscope with electronic radial scan showed satisfactory results regarding the image quality, ultrasound penetration, and clinical diagnosis. The blood flow could be investigated by using the color Doppler function, which is useful to diagnose lesions and detect involvement of the blood vessels in cancers. [ABSTRACT FROM AUTHOR]

A prototype electronic radial scan ultrasound endoscope has been developed by Olympus (Tokyo, Japan) for endoscopic ultrasound (EUS) study. The ultrasound view-angle of this model is 360° vertical to the scope. Though the diameter of the scanner and the shaft of the scope is bigger than those of the present mechanical radial scan model, clinical manipulation of the new scope is the same as that of the present model. Image quality of the ultrasound picture demonstrated by the electronic radial model was as clear as those provided by the mechanical radial scan model. Ultrasound penetration was better and satisfactory because of less echoic reduction compared to the mechanical radial model. The newly developed electronic radial model can be evaluated as an ultrasound endoscope for the next generation. The advantage of this system is to facilitate the clinical use of color Doppler function and tissue harmonic imaging, and this system can be operated by the same monitor unit as a convex model of ultrasound endoscope. [ABSTRACT FROM AUTHOR]

A prototype electronic radial scan ultrasound endoscope has been developed by Olympus (Tokyo, Japan) for endoscopic ultrasound (EUS) study. The ultrasound view-angle of this model is 360° vertical to the scope. Though the diameter of the scanner and the shaft of the scope is bigger than those of the present mechanical radial scan model, clinical manipulation of the new scope is the same as that of the present model. Image quality of the ultrasound picture demonstrated by the electronic radial model was as clear as those provided by the mechanical radial scan model. Ultrasound penetration was better and satisfactory because of less echoic reduction compared to the mechanical radial model. The newly developed electronic radial model can be evaluated as an ultrasound endoscope for the next generation. The advantage of this system is to facilitate the clinical use of color Doppler function and tissue harmonic imaging, and this system can be operated by the same monitor unit as a convex model of ultrasound endoscope. [ABSTRACT FROM AUTHOR]

The ultrasonograms of ulcerative colitis (UC) in active stage show hypoechoic changes of the colorectal wall from the mucosal layer to the deeper layers. These endoscopic ultrasound (EUS) changes of the wall recognized in active stage disappear or normalize in the stage of remission. When the stage of UC is exacerbated, the hypoechoic changes of the wall extend from the mucosal layer to the deeper layers with the increase of wall thickness. These EUS images of active UC are classified into the following types: UC-M, thickening of the whole wall with the structure preserved; UC-SM, hypoechoic changes reach the superficial portion of third layer with the thickening of whole wall; UC-SM deep, hypoechoic changes reach the deeper portion of third layer with the thickening of whole wall; UC-MP, hypoechoic changes reach the fourth layer with the thickening of whole wall; UC-SS/SE, hypoechoic changes penetrate through the fourth layer with the thickening of whole wall. With the help of EUS we can demonstrate the severity of inflammation in UC. Moreover, in severe cases of UC, the treatment strategy including emergency surgery can be determined. EUS is a valuable method in the management of UC. [ABSTRACT FROM AUTHOR]

Intraductal papillary-mucinous tumor (IPMT) of the pancreas has a broad spectrum of histology ranging from hyperplasia to adenocarcinoma. Therefore, it is important to differentiate between the malignant and benign lesions to determine the therapeutic strategy for IPMT. Thirty-nine patients with IPMT (27 men and 12 women, mean age: 63.3 years) underwent surgery between January 1985 and March 2002. The size of the cystic lesion, the maximum diameter of the main pancreatic duct (MPD), and the height of the papillary tumor inside the cyst were investigated by endoscopic ultrasonography (EUS) and/or intraductal ultrasonography (IDUS) before operation. These preoperative clinical findings were compared with the pathological findings of the resected specimen. The size of the cystic lesion, the diameter of MPD, and the height of the papillary tumor in cases with malignant IPMT (invasive and non-invasive carcinoma) were larger than those in cases with benign IPMT (adenoma and hyperplasia). Analysis of the images of the lesions revealed that the following three factors are important for diagnosing IPMT: (i) the size of the cystic lesion is ≥ 30 mm; (ii) the diameter of MPD is ≥ 8 mm; (iii) the height of the papillary tumor inside the cyst is ≥ 3 mm. It was not significant to differentiate between benign and malignant IPMT based on factor (i), but statistically significant ( P < 0.001) based on factors (ii) and (iii). EUS and IDUS are useful in the differential diagnosis of IPMT, especially in the differentiation between malignant and benign IPMT. [ABSTRACT FROM AUTHOR]

Background: A new plastic stent was designed for endoscopic biliary stenting to achieve a long and effective drainage period. Method: The Double layer stent is composed of Teflon as the inner layer and nylon as the outer layer divided with metallic mesh. This structure gives the stent several side-flaps without side-holes. Double layer stents were applied in 24 patients with inoperable malignant biliary obstruction. Results: The Double layer stents were successfully placed in all cases, and the effective drainage rate of these stents was 96%. The mean patency period evaluated by the Kaplan–Meier method without ineffective cases was 207 days, which was longer than the ordinary plastic stent of the same diameter. Concerning the complications related to inserting, we experienced dislocation was experienced in three patients. Conclusions: The authors regard this new device as an useful stent, which users can expect long patency period, easy exchange management, and reduced cost for the patients with inoperable obstruction in the biliary tract. [ABSTRACT FROM AUTHOR]

Abstract Background: It has been reported that cathepsin E (CTSE) is a non-secretory and intracellular aspartic proteinase found in the superficial epithelial cells of the stomach and that it is also expressed in pancreatic ductal adenocarcinoma. We evaluated the diagnostic value of CTSE in the pancreatic juice in the diagnosis of pancreatic ductal adenocarcinoma compared with that of CA19–9, carcinoembryonic antigen (CEA) and K-ras mutations. Methods: One hundred and one patients (25 with pancreatic ductal adenocarcinoma and 76 with chronic pancreatitis) were examined for the diagnostic significance of CTSE in the pancreatic juice in the diagnosis of pancreatic ductal adenocarcinoma. Forty of 101 patients (15 with pancreatic ductal adenocarcinoma and 25 with chronic pancreatitis) were examined to compare the diagnostic value of various tumor markers in the pancreatic juice, namely CA19–9, CEA, K-ras mutations and CTSE. Results: The detection frequency of CTSE was significantly higher in patients with pancreatic ductal adenocarcinoma (64.0%) than in patients with chronic pancreatitis (7.9%; χ2 = 34.76; P < 0.0001). The sensitivity, specificity and diagnostic accuracy of CTSE in the pancreatic juice for pancreatic ductal adenocarcinoma was 66.7, 92.0 and 82.5%, respectively. These values were more efficient in comparison with those of CA19–9, CEA and K-ras mutations. The main cause of the detection failure of CTSE in pancreatic ductal adenocarcinoma was obstruction of the main pancreatic duct. Sensitivity was 85.7% in patients without obstruction of the main pancreatic duct. Conclusions: Cathepsin E in the pancreatic juice is a novel marker for a definitive diagnosis of pancreatic ductal adenocarcinoma. [ABSTRACT FROM AUTHOR]

Focuses on a study which detailed a clinical experience with peroral cholangiopancreatoscopy under duodenoscopic guidance. Description of the duodenoscope and cholangiopancreatoscopes used; Examination techniques used in the study; Clinical characteristics of patients.

In our opinion, endoscopic sphincterotomy is a sale and bloodless method for removing common duct stones. The indications for the procedure are: 1. common duct stones residual or recurrent after cholecystectomy with or without cholcdocholithotomy; 2. common duct stones impacted or incarcerated at the ampulla or in the lowermost portion of the common duct and 3. choledocholithiasis in poor operative risk patients. [ABSTRACT FROM AUTHOR]

Background/Aims: There have been few reliable published studies permitting assessment of therapeutic regimens for Helicobacter pylori infection in gastric ulcer (GU) patients. The aim of the present study was to evaluate the efficacy of omeprazole-based dual and triple therapy regimens, both including clarithromycin, for the cure of H. pylori infection in active GU and duodenal ulcer (DU) patients. The study was conducted in Japan, a country in which GU is more prevalent than DU. Methods: Two hundred and thirty-four consecutive peptic ulcer patients (GU: n = 124; DU: n = 103; GDU: n = 7) suffering from H. pylori infection were randomly treated with either omeprazole 20 mg b.i.d. + amoxicillin 500 mg q.i.d. + clarithromycin 400 mg b.i.d. (OAC) or with omeprazole 20 mg b.i.d. + clarithromycin 400 mg b.i.d. (OC) for 14 days. H. pylori infection was evaluated by histology and culture from antral and corpus biopsies 6 weeks after completing antimicrobial therapy. Results: Follow-up data were available in 202 patients. The cure rates of H. pylori infection in GU patients were 83.9% (47/56) with OAC and 59.2% (29/49) with OC. Corresponding rates in DU patients were 91.5% (43/47) and 70.5% (31/44), respectively. The cure rates with OAC were significantly higher than those with OC (p < 0.001, χ[sup 2] test). The cure rates in GU patients were lower than those in DU patients for both regimens, but these differences were not statistically significant. Side effects were generally mild and did not interfere with compliance. One patient in the OAC group and 2 patients in the OC group complained of severe side effects that led to therapy discontinuation. Conclusions: Triple therapy with omeprazole, amoxicillin and clarithromycin is a safe and effective regimen for the cure of H. pylori infection in GU patients as well as in DU patients. We recommend this triple regimen as a first-line treatment in all patients with peptic ulcers associated with H. pylori infection in Japan. [ABSTRACT FROM AUTHOR]

Endoscopic sphincterotomy (EST) is a non-surgical treatment for residual or relapsing common bile duct stones in patients with a history of cholecystectomy and/or choledochotomy. Indications for its use have gradually expanded and now include removal of choledochal stones prior to cholecystectomy and removal of large bile duct stones not originally considered suitable for endoscopic removal. EST is used world wide and it now plays an indispensable role in transpapillary diagnostic and therapeutic procedures such as insertion of thin caliber endoscopes into the biliopancreatic system and inserstion of endoprostheses for malignant biliary obstruction. However, some, doubts have been voiced about the extension of indications for EST. The problem of loss of function of the duodenal papilla, for example, is controversial. We summarize the circumstances surrounding the development of EST, the controversies that have occurred in the process of expanding EST indications, and the history of overcoming the technological problems with transpapillary endoscopic procedures. The importance of conducting well-controlled clinical trials to determine the usefulness of new techniques is discussed. [ABSTRACT FROM AUTHOR]

Endoscopic sphincterotomy (EST) for removal of stones is a major therapeutic advance in the management of choledocholithiasis. However, this technique, using a standard Dormia basket or balloon catheters, often fails with large stones (exceeding 15mm in diameter). Mechanical basket lithotripsy (MBL) has been developed to overcome this deficiency. With recently improved devices, consisting of an entirely, i.e., one self-contained system which can be used without removing the endoscope, the overall efficacy of stone removal is more than 93%, regardless of the size of the stones. This MBL is a simple, safe, effective and inexpensive procedure in experienced hands and has emerged as the procedure of choice for endoscopic management of difficult stones. [ABSTRACT FROM AUTHOR]

Endoscopie electromyography of the human sphincter of ODDI has provided useful information for the patho-physiological studies on the choledocho-duodenal junction. The pattern and rhythm of the electromyogram observed on the sphincter of ODDI were different from those of the duodenum recorded simultaneously in basal tracings of our initial four cases. In the half of other ten cases with consecutive tracings, the different pattern and rhythm of electromyograms between the sphincter of ODDI and the duodenum were also confirmed. It was possible, from our results, to speculate that the functional independence of the sphincter of ODDI from the duodenal wall muscles was in existance. [ABSTRACT FROM AUTHOR]

The ultrasonograms of ulcerative colitis (UC) in active stage show hypoechoic changes of the colorectal wall from the mucosal layer to the deeper layers. These endoscopic ultrasound (EUS) changes of the wall recognized in active stage disappear or normalize in the stage of remission. When the stage of UC is exacerbated, the hypoechoic changes of the wall extend from the mucosal layer to the deeper layers with the increase of wall thickness. These EUS images of active UC are classified into the following types: UC-M, thickening of the whole wall with the structure preserved; UC-SM, hypoechoic changes reach the superficial portion of third layer with the thickening of whole wall; UC-SM deep, hypoechoic changes reach the deeper portion of third layer with the thickening of whole wall; UC-MP, hypoechoic changes reach the fourth layer with the thickening of whole wall; UC-SS/SE, hypoechoic changes penetrate through the fourth layer with the thickening of whole wall. With the help of EUS we can demonstrate the severity of inflammation in UC. Moreover, in severe cases of UC, the treatment strategy including emergency surgery can be determined. EUS is a valuable method in the management of UC. [ABSTRACT FROM AUTHOR]

Examines the role of endoscopic ultrasonography (EUS) in colorectal cancer diagnosis. Diagnostic procedures for cancer invasion; Accuracy of EUS in determining the disorder; Classification of tumor node metastasis.

In patients with carcinoma of the bile duct, a primary tumor with tumor spread along the bile duct is frequently shown as a stricture of the bile duct with ductal irregularity and rigidity on ERCP. In patients in whom histological diagnosis is necessary, larger caliber peroral cholangioscopes with a larger working channel should be chosen because they have the advantage of simultaneous biopsy diagnosis. However, peroral cholangioscopy (POCS) has limitations to inspect mucosal tumor spread along the upstream ducts due to the tight stricture, to obtain sufficient biopsy material for confirming the diagnosis, and to identify submucosal tumor spread. With further improvement of techniques, the combined use of POCS with biopsy under direct vision and intraductal ultrasonography (IDUS) is expected to be the best way in the diagnosis of biliary tumors. [ABSTRACT FROM AUTHOR]

Mucin-producing cholangiocarcinoma, which excretes excessive amounts of mucin into the biliary tract and causes obstructive jaundice and cholangitis due to the mucin retention, is rare. In this paper, we report two cases of this disease, which were demonstrated by peroral cholangioscopy (POCS). The radiologic features of these tumors show the diffuse dilatation of the bile ducts demonstrated by computed tomography (CT) and ultrasonography (US), the amorphous filling defects in the dilated bile ducts revealed by cholangiography. Their endoscopic features are mucin flowing out from the papilla of Vater during endoscopic retrograde cholangiography (ERC), and the papillary tumor with contiguous superficial spread in the bile ducts observed by cholangioscopy, although removal of mucin in the biliary tract is sometimes necessary before cholangioscopy in order to examine the lesion sufficiently. According to the previous reports, prognosis after curative resection of these tumors is better than that of ordinary type of cholangiocarcinoma. Therefore, it is important to examine the tumor extension in the bile ducts by cholangioscopy, although a selection of route inserting cholangioscope is controversial. [ABSTRACT FROM AUTHOR]

An abstract of the article "Endoscopic Optical Coherence Tomography (EOCT) in the Diagnosis of Colorectal Diseases" by Eisai Cho, Koji Uno, Kiyohito Tanaka, Kenjiro Yasuda and Masatsugu Nakajima is presented.

Used with narrow band imaging (NBI), peroral cholangiopancreatoscopy (PCPS) was performed in eight patients with biliary and pancreatic diseases. The procedures were successfully performed in all patients without any complications after endoscopic sphincterotomy. Direct endoscopic diagnosis within both the bile and pancreatic ducts was well accomplished by the baby scope with NBI. NBI produced higher quality images and was able to show changes of the bile duct wall due to tumor growth. However, bile is seen as red on NBI, so sufficient cleaning of the bile duct is recommended. It is concluded that this procedures is considerably valuable and enables PCPS to easily detect biliary lesions. [ABSTRACT FROM AUTHOR]

The height of the mural nodules and papillary tumors in main pancreatic duct or dilated branch duct is the most important factor for diagnosis of intraductal papillary mucinous neoplasm (IPMN). In this study, the authors compared the height of the papillary lesions and mural nodules between the height of resected tissues and the height detected by the preoperative imaging tools (endoscopic ultrasonography [EUS] and intraductal ultrasonography [IDUS]) in 38 patients with IPMN. In 21 out of 23 cases of adenoma, and in cases with the non-invasive cancer, the difference of the height of operative and preoperative analysis measured by EUS and IDUS was within 1–2 mm. EUS and IDUS are useful for diagnosis of degree of malignancy in IPMN. [ABSTRACT FROM AUTHOR]

Recently, an indication of gastrointestinal stenting is not only esophageal stenosis but it extends from the esophagus to the gastric outlet and duodenum. However, there are some problems such as shortness of the device for esophageal stenting, angulations of stenotic sites, and so on, when we perform the stenting for stenoses of the gastric outlet and duodenum. Until now, some refinements of stent insertion technique have been attempted to solve these problems. In this paper, we report three cases in which self-expanding metallic stents were placed for stenoses of the gastric outlet and duodenum with refinements of stent insertion technique. Our attempts in these patients were an extension of stenting device to insert stents easily, and placement of covered metallic stent inside non-covered metallic stent or a fixation of covered metallic stent to the gastrointestinal wall by means of endoclips to avoid dislocation of stents. Stents were inserted successfully in all patients, and the nutrition of these patients was improved after the placement of stents. Further refinements of stents and stent insertion technique are expected to achieve easy manipulation. [ABSTRACT FROM AUTHOR]

We have experienced a case with perforation after endoscopic balloon dilatation. The patient was diagnosed as having malignant lymphoma in the terminal ileum, and treated with eradication of H. Pylori and chemotherapy. The severe stenosis appeared at the same site of the tumor after the medical treatment. The first dilatation with a 15 mm balloon was successful. The lower small bowel obstruction occurred 14 months after the first balloon dilatation. The second dilatation with an 18 mm balloon was performed. The stricture site was remarkably dilated and could be passed by the scope. Perforation was confirmed because of the complaint of severe abdominal pain. The laparotomy finding showed the hole at the stricture site and remarkable fibrosis without tumorous tissue. The fragility of the tissue, the excessive inflation of the balloon and the insertion of the scope might be causes of the perforation. The case with severe stricture having almost no flexibility should be considered carefully in the determination of treatment procedures for the balloon dilatation. [ABSTRACT FROM AUTHOR]

Presents the preface of the July 2004 issue of the journal "Digestive Endoscopy."

An abstract of the article "EUS in the Diagnosis of Ischemic Colitis (IC) and Antibiotic-Associated Colitis (AAC)" by Eisai Cho, Kiyohito Tanaka, Koji Uno, Kenjiro Yasuda and Masatsugu Nakajima is presented.

Highlights the Fourth Endoscopy Forum Japan held in Awaji Island on July 27-28, 2002. Theme of the conference; Topics discussed; Speaker.

Endoscopic papillectomy has become common in recent years as a non-invasive therapeutic procedure for tumor of the papilla of Vater, although the lesions, which indicate endoscopic papillectomy, are very rare. In order to decide the indication for this procedure, intraductal ultrasonography (IDUS) is useful to obtain the correct diagnosis. For the successful and safe procedure of papillectomy, it is important to use the cutting mode of generator. and it is sometimes useful to inject the saline into the submucosal layer of the duodenum and to place the plastic stent into the bilio-pancreatic ducts. [ABSTRACT FROM AUTHOR]

We applied a newly developed endoscopic resection technique for a rectal mucosal cancer of 4.2 cm. This method resulted in a curable treatment and provided precise information for histological examinations. This technique, using IT-knife, may involve the risk of bleeding and perforation compared with conventional methods. Further improvements are needed to make this technique safer and more reliable for a standard endoscopic method for large colorectal tumors. [ABSTRACT FROM AUTHOR]

The echocolonoscope has been accepted as a useful apparatus of endoscopic ultrasonography (EUS) for colorectal diseases. However, it is difficult to manipulate because of the large caliber and the long distal tip of scope. Because of this, a prototype echocolonoscope has been newly developed. In this paper, we report the usefulness of this tool for colorectal diseases. [ABSTRACT FROM AUTHOR]