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ObjectivesLittle has been reported on the yield and characteristics of colorectal neoplasia detected by the two-sample faecal immunochemical test (FIT), particularly the difference between subjects with two-positive results on the two-sample FIT and those with one-positive results. We aimed to assess risk stratification among patients with positive two-sample FIT to prioritise colonoscopy.DesignA retrospective cross-sectional study.SettingA single-centre, representative endoscopy clinic in Japan.ParticipantsConsecutive patients who underwent colonoscopy were enrolled. Indications for colonoscopy included two-positive results on the two-sample FIT (FIT (+/+)), one-positive results on the two-sample FIT (FIT (+/−)), and other reasons (non-FIT group, including presence of symptoms, screening or surveillance).Primary and secondary outcome measuresPrimary outcomes were detection rates of colorectal cancers, including in situ (all cancers) and invasive cancers, based on the indications for colonoscopy. Secondary outcomes were cancer features, such as location, size, T stage and histological subtype.ResultsOf the 8724 patients, 264 underwent colonoscopy following FIT (+/+), 1018 following FIT (+/−) and 7442 for reasons other than positive FIT. Detection rates of all (and invasive) cancers in the FIT (+/+), FIT (+/−) and non-FIT groups were 12.1% (8.3%), 1.9% (0.3%) and 0.4% (0.2%), respectively. The cancer detection rates were much higher in the FIT (+/+) group than in the FIT (+/−) group, which in turn had higher rates than the non-FIT group. Moreover, the FIT (+/+) group showed more advanced T stages on tumour, node, metastasis (TNM) classification (Tis/T1/T2/T3/T4: 10/7/4/10/1) than the FIT (+/−) group (16/1/2/0/0, pConclusionsTwo-positive results for two-sample FIT showed a much higher yield for more advanced colorectal cancers than the one-positive result. High priority for diagnostic colonoscopy should be assigned to patients with two-positive-FIT results.

Depletion syndrome (以下DS) をきたす大腸絨毛腺腫 (villous adenoma) は極めて稀で, 本邦ではこれまで23例の報告が見られるにすぎない.今回われわれは頻回, 多量の粘液性下痢によりDSを呈した直腸絨毛腺腫の2例を経験した.症例1 : 66歳, 女性.1日10数行の粘液性下痢で便中Na118.4mEq/l, K46.7mEq/lと多量の電解質喪失を認め, 血清電解質はNa125mEq/l, K1.8mEq/lと低下.著明な脱水による腎前性腎不全に陥ったが, 水・電解質投与による補正後, 腹会陰式直腸切断術を施行, 腫瘍は24×19cmの巨大な広基性のvillous adenomaであった.症例2 : 73歳男性.頻回の粘液性下痢を主訴に入院.Na232mEq/l, K110.4mEq/lを含む最大3940gの便を排出.入院時血清Na129mEq/l, K2.3mEq/lと著明な低電解質血症および脱水を認めた.水, 電解質補正後, 腹会陰式直腸切断術を施行.腫瘍は14×12cmの広基性villous adenoma with sever dysplasiaであった.2症例とも術後DSは改善された.以上, 本邦報告23例とともに文献的考察を加え報告する.

症例は胃集団検診で異常を指摘され, 精査目的に入院した47歳, 女性.胃内視鏡検査で胃体下部に山田II型の隆起性病変を認め, 表面は正常粘膜におおわれた粘膜下腫瘍であった.超音波内視鏡では胃壁第4層に一致して大きさ1.8×1.2cmの境界明瞭な腫瘤を認め, 内部エコーは固有筋層よりやや高く, 一部に低エコーの部分も伴っていた.胃内腔発育型の平滑筋芽腫を疑い, 外科治療施行.開腹時, 胃体下部に拇指頭大の腫瘤を触知, 周囲への浸潤, リンパ節の腫脹はなく, 術中迅速病理診断では良性病変と判断され, 正常粘膜を含めた腫瘍摘出術を施行した.腫瘍の大きさは2.0×2.0×1.0cmで, 組織学的には核分裂像のない楕円形細胞の充実性増殖, 核の近傍に透明帯を有する細胞の存在から, 平滑筋芽腫と診断された.術前検査として超音波内視鏡が有用であった胃平滑筋芽腫の1例を報告する.

This study compared a new method, endoscopic scleroligation, intravariceal injection sclerotherapy followed by ligation plus extravariceal injection sclerotherapy, with ligation plus extravariceal injection sclerotherapy. Fifty-nine patients with cirrhosis and esophageal varices were treated by endoscopic scleroligation (ESL group, n = 28) or ligation plus extravariceal injection sclerotherapy (EVL + extraEIS group, n = 31). The demographics and clinical characteristics of the two treatment groups were similar, as was the rate of complete eradication with initial treatment. However, the 1- and 3-year cumulative recurrence rates in the ESL group (3.8% and 22.4%) were very significantly lower than those in the EVL + extraEIS group (48.3% and 81.0%) (p < 0.0001). The overall survival rates in the two groups were similar. In conclusion, endoscopic scleroligation is superior to ligation plus extravariceal injection sclerotherapy in preventing variceal recurrence. The efficacy of intravariceal injection sclerotherapy before ligation is believed to arise from the eradication of feeder vessels.