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Colonic Perforation Secondary to Idiopathic Intramural Hemorrhage
Takashi Sakamoto,Akira Saito,Alan Kawarai Lefor,Tadao Kubota 대한대장항문학회 2016 Annals of Coloproctolgy Vol.32 No.6
Intramural colonic hemorrhage is rare and often secondary to trauma or anticoagulation therapy. Idiopathic intramural hemorrhages in the alimentary tract have rarely been reported. While several reports of spontaneous perforation of an intramural rectal hematoma have been published, no reports of spontaneous perforation in the ascending colon due to a hematoma have. We describe a patient with an ascending colonic perforation secondary to spontaneous intramural hemorrhage. The patient is a 35-year-old male, who presented with acute abdominal pain and no history of trauma. An abdominal computed tomography scan showed a high-density area around the ascending colon, and nonoperative management was instituted. On the eighth hospital day, the pain worsened, and abdominal computed tomography scan showed free air. An emergent right hemicolectomy was performed. Intramural hematoma and ischemia with perforation, with no obvious etiology, were found. The patient was discharged on the 14th postoperative day.
Hani Abutalib,Tomonori Yano,Satoshi Shinozaki,Alan Kawarai Lefor,Hironori Yamamoto 대한소화기내시경학회 2020 Clinical Endoscopy Vol.53 No.4
The small bowel had long been considered a dark unapproachable tunnel until the invention of capsule endoscopy and doubleballoon enteroscopy in the 21st century, which revolutionized the diagnosis and management of small bowel diseases, includingbleeding. Various imaging modalities such as computed tomographic enterography, angiography, capsule endoscopy, and balloonassisted enteroscopy play vital roles in the diagnosis and management of small bowel bleeding. The choice of modality to use andtiming of application differ according to the availability of the modalities, patient’s history, and physician’s experience. Small bowelbleeding is managed using different strategies as exemplified by medical treatment, interventional radiology, endoscopic therapy,or surgical intervention. Balloon-assisted enteroscopy enables endoscopic interventions to control small bowel bleeding, includingelectrocautery, argon plasma coagulation, clip application, and tattooing as a prelude to surgery. In this article, we clarify the recentapproaches to the optimal diagnosis and management of patients with small bowel bleeding.
Satoshi Shinozaki,Yoshimasa Miura,Yuji Ino,Kenjiro Shinozaki,Alan Kawarai Lefor,Hironori Yamamoto 대한소화기내시경학회 2016 Clinical Endoscopy Vol.49 No.1
Background/Aims: Poor suction ability through a narrow working channel prolongs esophagogastroduodenoscopy (EGD). The aim of this study was to evaluate suction with a new ultrathin endoscope (EG-580NW2; Fujifilm Corp.) having a 2.4-mm working channel in clinical practice. Methods: To evaluate in vitro suction, 200 mL water was suctioned and the suction time was measured. The clinical data of 117 patients who underwent EGD were retrospectively reviewed on the basis of recorded video, and the suction time was measured by using a stopwatch. Results: In vitro, the suction time with the EG-580NW2 endoscope was significantly shorter than that with the use of an ultrathin endoscope with a 2.0-mm working channel (EG-580NW; mean ± standard deviation, 22.7±1.1 seconds vs. 34.7±2.2 seconds; p<0.001). We analyzed the total time and the suction time for routine EGD in 117 patients (50 in the EG-580NW2 group and 67 in the EG-580NW group). In the EG-580NW2 group, the total time for EGD was significantly shorter than that in the EG-580NW group (275.3±42.0 seconds vs. 300.6±46.5 seconds, p=0.003). In the EG-580NW2 group, the suction time was significantly shorter than that in the EG-580NW group (19.2±7.6 seconds vs. 38.0±15.9 seconds, p<0.001). Conclusions: An ultrathin endoscope with a 2.4-mm working channel considerably shortens the routine EGD time by shortening the suction time, in comparison with an endoscope with a 2.0-mm working channel. Background/Aims: Poor suction ability through a narrow working channel prolongs esophagogastroduodenoscopy (EGD). The aim of this study was to evaluate suction with a new ultrathin endoscope (EG-580NW2; Fujifilm Corp.) having a 2.4-mm working channel in clinical practice. Methods: To evaluate in vitro suction, 200 mL water was suctioned and the suction time was measured. The clinical data of 117 patients who underwent EGD were retrospectively reviewed on the basis of recorded video, and the suction time was measured by using a stopwatch. Results: In vitro, the suction time with the EG-580NW2 endoscope was significantly shorter than that with the use of an ultrathin endoscope with a 2.0-mm working channel (EG-580NW; mean ± standard deviation, 22.7±1.1 seconds vs. 34.7±2.2 seconds; p<0.001). We analyzed the total time and the suction time for routine EGD in 117 patients (50 in the EG-580NW2 group and 67 in the EG-580NW group). In the EG-580NW2 group, the total time for EGD was significantly shorter than that in the EG-580NW group (275.3±42.0 seconds vs. 300.6±46.5 seconds, p=0.003). In the EG-580NW2 group, the suction time was significantly shorter than that in the EG-580NW group (19.2±7.6 seconds vs. 38.0±15.9 seconds, p<0.001). Conclusions: An ultrathin endoscope with a 2.4-mm working channel considerably shortens the routine EGD time by shortening the suction time, in comparison with an endoscope with a 2.0-mm working channel.
Hironori Yamamoto,Satoshi Shinozaki,Yoshikazu Hayashi,Yoshimasa Miura,Tsevelnorov Khurelbaatar,Hiroyuki Osawa,Alan Kawarai Lefor 대한소화기내시경학회 2019 Clinical Endoscopy Vol.52 No.2
Early detection and resection of neoplastic lesions are key objectives to diminish colorectal cancer mortality. Resection of superficialcolorectal neoplasms, cold snare polypectomy, endoscopic mucosal resection, and endoscopic submucosal dissection have all beendeveloped and used worldwide. The pocket-creation method facilitates the resection of tumors in diffcult and routine locations. Earlydetection is the most important first step to maximize the benefits of recent advancements in endoscopic techniques. However, thedetection of small, flat-shaped, or faded color lesions remains diffcult. Linked color imaging, a novel multi-light technology, facilitatesthe recognition of minor differences in tissue by enhancing the color contrast between early colorectal neoplasms and surroundingnormal mucosa in a bright field of view. The most striking feature of linked color imaging is its ability to display the color of earlyneoplastic lesions as distinct from inflammatory changes, both of which have similar “redness” when viewed using white light imaging. To increase the detection rate of neoplasms, linked color imaging should be used from the outset for endoscopic observation. Earlydetection of superficial colorectal tumors can result in decreased mortality from colorectal cancer and maintain a good quality of life forpatients.
Yoshikazu Hayashi,Masahiro Okada,Takaaki Morikawa,Tatsuma Nomura,Hisashi Fukuda,Takahito Takezawa,Alan Kawarai Lefor,Hironori Yamamoto 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.3
Superficial colonic neoplasms sometimes extend into a diverticulum. Conventional endoscopic mucosal resection of these lesionsis considered challenging because colonic diverticula do not have a muscularis propria and are deeply inverted. Even if the solutionis carefully injected below the mucosa at the bottom of the diverticulum, the mucosa is rarely elevated from the diverticular orifice,and it is usually just narrowed. Although endoscopic submucosal dissection or full-thickness resection with an over-the-scope clipdevice enables the complete resection of these lesions, it is still challenging, time consuming and expensive. Underwater endoscopicmucosal resection without submucosal injection (UEMR) is an innovative technique enabling en bloc resection of superficial colonlesions. We report three patients with colon adenomas extending into a diverticulum treated with successful UEMR. UEMR enabledrapid and safe en bloc resection of colon lesions extending into a diverticulum.
Satoshi Shinozaki,Yoshimasa Miura,Yuji Ino,Kenjiro Shinozaki,Alan Kawarai Lefor,Hironori Yamamoto 대한소화기내시경학회 2015 Clinical Endoscopy Vol.48 No.6
Background/Aims: Poor suction ability through a narrow working channel prolongs esophagogastroduodenoscopy (EGD). The aim of this study was to evaluate suction with a new ultrathin endoscope (EG-580NW2; Fujifilm Corp.) having a 2.4-mm working channel in clinical practice. Methods: To evaluate in vitro suction, 200 mL water was suctioned and the suction time was measured. The clinical data of 117 patients who underwent EGD were retrospectively reviewed on the basis of recorded video, and the suction time was measured by using a stopwatch. Results: In vitro, the suction time with the EG-580NW2 endoscope was significantly shorter than that with the use of an ultrathin endoscope with a 2.0-mm working channel (EG-580NW; mean ± standard deviation, 22.7±1.1 seconds vs. 34.7±2.2 seconds; p<0.001). We analyzed the total time and the suction time for routine EGD in 117 patients (50 in the EG-580NW2 group and 67 in the EG-580NW group). In the EG-580NW2 group, the total time for EGD was significantly shorter than that in the EG-580NW group (275.3±42.0 seconds vs. 300.6±46.5 seconds, p=0.003). In the EG-580NW2 group, the suction time was significantly shorter than that in the EG-580NW group (19.2±7.6 seconds vs. 38.0±15.9 seconds, p<0.001). Conclusions: An ultrathin endoscope with a 2.4-mm working channel considerably shortens the routine EGD time by shortening the suction time, in comparison with an endoscope with a 2.0-mm working channel.
Blue Laser Imaging with a Small-Caliber Endoscope Facilitates Detection of Early Gastric Cancer
Haruo Takahashi,Yoshimasa Miura,Hiroyuki Osawa,Takahito Takezawa,Yuji Ino,Masahiro Okada,Alan Kawarai Lefor,Hironori Yamamoto 대한소화기내시경학회 2019 Clinical Endoscopy Vol.52 No.3
Conventional endoscopy often misses early gastric cancers with minimal red discoloration because they cannot be distinguished frominflamed mucosa. We treated a patient with a small early gastric cancer that was diffcult to diagnose using conventional endoscopy. Conventional endoscopy using a small-caliber endoscope showed only subtle red discoloration of the gastric mucosa. However, bluelaser imaging showed a clearly discolored area measuring 10 mm in diameter around the red lesion, which was distinct from thesurrounding inflamed mucosa. Irregular vessels on the tumor surface (suspicious for early gastric cancer) were observed even withsmall-caliber endoscopy. Biopsy revealed a well-moderately differentiated tubular adenocarcinoma, and endoscopic submucosaldissection was performed. Histopathological examination of the specimen confirmed well-moderately differentiated adenocarcinomalocalized to the mucosa with slight depression compared to the surrounding mucosa, consistent with the endoscopic findings. Thissmall early gastric cancer became clearly visible with blue laser imaging using small-caliber endoscopy.
Single-Stage Endoscopic Stone Extraction and Cholecystectomy during the Same Hospitalization
Toshiaki Terauchi,Hiroharu Shinozaki,Satoshi Shinozaki,Yuichi Sasakura,Masaru Kimata,Junji Furukawa,Alan Kawarai Lefor,Yoshiro Ogata,Kenji Kobayashi 대한소화기내시경학회 2019 Clinical Endoscopy Vol.52 No.1
Background/Aims: The clinical impact of single-stage endoscopic stone extraction by endoscopic retrograde cholangiopancreatography(ERCP) and cholecystectomy during the same hospitalization remains elusive. This study aimed to determine the effcacy and safety ofsingle-stage ERCP and cholecystectomy during the same hospitalization in patients with cholangitis. Methods: We retrospectively reviewed the medical records of 166 patients who underwent ERCP for mild to moderate cholangitis dueto choledocholithiasis secondary to cholecystolithiasis from 2012 to 2016. Results: Complete stone extraction was accomplished in 92% of patients (152/166) at the first ERCP. Among 152 patients whounderwent complete stone extraction, cholecystectomy was scheduled for 119 patients (78%). Cholecystectomy was performed duringthe same hospitalization in 89% of patients (106/119). We compared two groups of patients: those who underwent cholecystectomyduring the same hospitalization (n=106) and those who underwent cholecystectomy during a subsequent hospitalization (n=13). In thedelayed group, cholecystectomy was performed about three months after the first ERCP. There were no significant differences betweenthe groups in terms of operative time, rate of postoperative complications, and interval from cholecystectomy to discharge. Conclusions: Single-stage endoscopic stone extraction is recommended in patients with mild to moderate acute cholangitis due tocholedocholithiasis. The combination of endoscopic stone extraction and cholecystectomy during the same hospitalization is safe andfeasible.