http://chineseinput.net/에서 pinyin(병음)방식으로 중국어를 변환할 수 있습니다.
변환된 중국어를 복사하여 사용하시면 됩니다.
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 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.
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.
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.
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.
Hiraoka, Yuji,Miura, Yoshimasa,Osawa, Hiroyuki,Nomoto, Yoshie,Takahashi, Haruo,Tsunoda, Masato,Nagayama, Manabu,Ueno, Takashi,Lefor, Alan Kawarai,Yamamoto, Hironori The Korean Gastric Cancer Association 2021 Journal of gastric cancer Vol.21 No.2
Purpose: Screening image-enhanced endoscopy for gastrointestinal malignant lesions has progressed. However, the influence of the color enhancement settings for the laser endoscopic system on the visibility of lesions with higher color contrast than their surrounding mucosa has not been established. Materials and Methods: Forty early gastric cancers were retrospectively evaluated using color enhancement settings C1 and C2 for laser endoscopic systems with blue laser imaging (BLI), BLI-bright, and linked color imaging (LCI). The visibilities of the malignant lesions in the stomach with the C1 and C2 color enhancements were scored by expert and non-expert endoscopists and compared, and the color differences between the malignant lesions and the surrounding mucosa were assessed. Results: Early gastric cancers mainly appeared orange-red on LCI and brown on BLI-bright or BLI. The surrounding mucosae were purple on LCI regardless of the color enhancement but brown or pale green with C1 enhancement and dark green with C2 enhancement on BLI-bright or BLI. The mean visibility scores for BLI-bright, BLI, and LCI with C2 enhancement were significantly higher than those with C1 enhancement. The superiority of the C2 enhancement was not demonstrated in the assessments by non-experts, but it was significant for experts using all modes. The C2 color enhancement produced a significantly greater color difference between the malignant lesions and the surrounding mucosa, especially with the use of BLI-bright (P=0.033) and BLI (P<0.001). C2 enhancement tended to be superior regardless of the morphological type, Helicobacter pylori status, or the extension of intestinal metaplasia around the cancer. Conclusions: Appropriate color enhancement settings improve the visibility of malignant lesions in the stomach and color contrast between the malignant lesions and the surrounding mucosa.
Masato Tsunoda,Yoshimasa Miura,Hiroyuki Osawa,Tsevelnorov Khurelbaatar,Mio Sakaguchi,Hisashi Fukuda,Alan Kawarai Lefor,Hironori Yamamoto 대한소화기내시경학회 2019 Clinical Endoscopy Vol.52 No.5
A 62-year-old man with a flat early esophageal cancer was referred for endoscopic treatment. White light imaging revealed a pale redlesion, whereas linked color imaging (LCI) and blue laser imaging (BLI) yielded purple and brown images, respectively. Iodine stainingdemonstrated a large unstained area with a homogenous but very weak pink-color sign. This area appeared more clearly as purpleand green on LCI and BLI, respectively; however, a different colored portion was observed at the 4 o’clock position inside the iodineunstainedarea. Histopathology findings of the resected specimen revealed squamous intraepithelial neoplasia at the 4 o’clock positionand an esophageal squamous cell carcinoma in the remaining iodine-unstained area. LCI and BLI combined with iodine stainingproduce characteristic images that overcomes the pink-color sign, reflecting the histological features of a flat esophageal neoplasm. Thisnew method is useful for detailed evaluation of early flat squamous cell neoplasms.