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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.

Background: We examined the hemodynamic changes associated with recurrent esophageal varices after esophageal transection (ET) and evaluated the effectiveness of endoscopic injection sclerotherapy (EIS) as the treatment for these varices. Methods: Nineteen patients with recurrent esophageal varices after ET were treated by EIS. Endoscopic varicealography during injection sclerotherapy, following oral blockage of flow by a balloon, identified three patterns: (i) type 1: common type, continuous filling by the feeder vessel of the varix; (ii) type 2: retrograde-disappearing type, confirmed hepatofugal flow; and (iii) type 3: immediate washout type, immediate washout of contrast medium. Results: Angiography revealed that the hepatofugal feeder vessel was the right gastric vein in all cases. Fourteen patients (73.7%) were classified as type 1, 4 patients (21.1%) as type 2, and 1 patient (5.3%) as type 3. Fewer treatment sessions were required in type 1 than in type 2 (P

Background: We devised a new combined method of endoscopic variceal ligation and injection sclerotherapy, namely, endoscopic scleroligation, for the treatment of esophageal varices. The aim of this prospective randomized trial was to compare endoscopic scleroligation with endoscopic variceal ligation alone with regard to efficacy, complications, variceal recurrence, and survival. Methods: Fifty-one patients with cirrhosis and esophageal varices were randomly assigned to be treated by endoscopic scleroligation (n = 25) or endoscopic variceal ligation (n = 26). In the initial session in the endoscopic scleroligation group, endoscopic injection sclerotherapy was performed with injection of 5% ethanolamine oleate around the lower esophagus to obliterate the feeding veins. This was followed by endoscopic variceal ligation from the injection site to the most orad varix. In subsequent sessions, endoscopic injection sclerotherapy was performed with 1% polidocanol. In the endoscopic variceal ligation group, that procedure was performed in all treatment sessions. Results: Both methods were equally effective in achieving complete eradication of esophageal varices. Among the cases in which complete eradication was achieved, the 1- and 3-year cumulative recurrence rates in the endoscopic scleroligation group (9.5%, 22.1%) were significantly lower than those in the endoscopic variceal ligation group (61.9%, 72.2%) ( p Conclusions: Endoscopic scleroligation is superior to endoscopic variceal ligation in preventing variceal recurrence. (Gastrointest Endosc 1999;50:7-12.)

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.

Endoscopic variceal ligation (EVL) has been widely adopted because it is technically easy to perform. However, it is not always possible to eradicate varices by the standard ligation method. Therefore, we examined the effectiveness of the intensive ligation method as an alternative for the eradication of varices. In applying this method, rubber bands are used to make ligations much closer to each other, than with the standard method, just above the esophago-gastric junction (EG-junction). We also compared the effectiveness of EVL in nine cases undergoing the standard ligation method with that in nine cases treated by the new intensive ligation method. With the standard ligation method, the average number of sessions was 2.2 per week, while the average number of rubber bands used was 9.6 per patient. Varices disappeared in three of nine cases. With the intensive ligation method, the number of sessions was two per week in all cases, while the average number of rubber bands was 19.9 per patient. Varices disappeared in all nine cases. Chest discomfort, as a complication, was experienced by three of nine cases in both groups. It is concluded that the intensive ligation method is a very effective means of achieving early, safe eradication of varices.

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.