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Difficulty in differentiating two cases of sigmoid stenosis by diverticulitis from cancer

World Journal of Gastroenterology 2012年第27期18卷 3623-3626页

作者： Noriko Nishiyama Hirohito Mori Hideki Kobara Kazi Rafiq shintarou fujihara Mitsuyoshi Kobayashi Tsutomu Masaki Department of Gastroenterology and Neurology Faculty of MedicineKagawa UniversityKagawa 761-0793Japan Department of Pharmacology Faculty of MedicineKagawa UniversityKagawa 761-0793Japan

The incidence of colonic diverticulosis with or without diverticulitis has increased in the Japanese population due to the modernization of food and aging.The rate of diverticulitis in colon diverticulosis ranges from 8.1% to 9.6%.However,few cases of stenosis due to diverticulitis have been reported.These reports suggest that the differentiation between sigmoid diverticulitis and colon cancer is difficult.This report describes two cases of colon stenosis due to diverticulitis that were difficult to differentiate from colon cancer.Case 1 was a 70-year-old woman with narrowed stools for 1 month who underwent colonofiberscopy (CFS).CFS revealed a diverticulum and circumferential stenosis in the sigmoid colon.Barium enema revealed a marked,hourglassshaped,2-cm circumferential stenosis in the sigmoid colon.Fluorodeoxyglucose (FDG)-positron emission tomography computed tomography (CT) revealed an increased FDG uptake at the affected portion of the sigmoid colon.Sigmoid colon cancer was suspected,and laparoscopic sigmoidectomy was performed.Pathological examination demonstrated active inflammation with no evidence of malignancy.Case 2 was a 50-yearold man who presented to a nearby clinic with reduced stool output despite the urge to defecate.CFS detected severe stenosis in the sigmoid colon approximately 25 cm from the dentate line.Contrast-enhanced abdominal CT revealed multiple diverticula,wall thickening,and swelling of the lymph nodes around the peritoneal aorta and the inferior mesenteric artery.A partial sigmoidectomy was performed.Pathological examination of the resected specimen revealed no changes in the mucosal epithelial surface,but a marked infiltration of inflammatory cells was observed.

关键词：结肠癌狭窄正电子发射断层扫描计算机断层扫描癌症食物安全病理检查脱氧葡萄糖

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Bleeding duodenal hemangioma: Morphological changes and endoscopic mucosal resection

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World Journal of Gastroenterology 2012年第22期18卷 2872-2876页

作者： Noriko Nishiyama Hirohito Mori Hideki Kobara shintarou fujihara Takako Nomura Mitsuyoshi Kobayashi Tsutomu Masaki Department of Gastroenterology and Neurology Faculty of Medicine Kagawa Medical University

Recently, the development of endoscopic procedures has increased the availability of minimally invasive treatments; however, there have been few case reports of duodenal hemangioma treated by endoscopic mucosal resection. The present report describes a case of duodenal hemangioma that showed various endoscopic changes over time and was treated by endoscopic mucosal resection. An 80-year-old woman presented with tarry stools and a loss of appetite. An examination of her blood revealed severe anemia, and her hemoglobin level was 4.2 g/dL. An emergency upper gastrointestinal endoscopy was performed. A red, protrusive, semipedunculated tumor (approximately 20 mm in diameter) with spontaneous bleeding on its surface was found in the superior duodenal angle. Given the semipedunculated appearance of the tumor, it was suspected to be an epithelial tumor with a differential diagnosis of hyperplastic polyp. The biopsy results suggested a telangiectatic hemangioma. Because this lesion was considered to be responsible for her anemia, endoscopic mucosal resection was performed for diagnostic and treatment purposes after informed consent was obtained. A histopathological examination of the resected specimen revealed dilated and proliferated capillary lumens of various sizes, which confirmed the final diagnosis of duodenal hemangioma. Neither anemia nor tumor recurrence has been observed since the endoscopic mucosal resection (approximately 1 year). Duodenal hemangiomas can be treated endoscopically provided that sufficient consideration is given to all of the possible treatment strategies. Interestingly, duodenal hemangiomas show morphological changes that are influenced by various factors, such as mechanical stimuli.

关键词：毛细血管扩张十二指肠形态学变化切除术内镜黏膜出血鉴别诊断

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Efficacy and safety of over-the-scope clip: Including complications after endoscopic submucosal dissection

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World Journal of Gastroenterology 2013年第18期19卷 2752-2760页

作者： Noriko Nishiyama Hirohito Mori Hideki Kobara Kazi Rafiq shintarou fujihara Mitsuyoshi Kobayashi Makoto Oryu Tsutomu Masaki Department of Gastroenterology and Neurology Faculty of Medicine Kagawa University Kagawa 761-0796 Japan Department of Pharmacology Faculty of Medicine Kagawa University Kagawa 761-0796 Japan

AIM: To retrospectively review the results of over-thescope clip (OTSC) use in our hospital and to examine the feasibility of using the OTSC to treat perforations after endoscopic submucosal dissection (ESD). METHODS: We enrolled 23 patients who presented with gastrointestinal (GI) bleeding, fistulae and perforations and were treated with OTSCs (Ovesco Endoscopy GmbH, Tuebingen, Germany) between November 2011 and September 2012. Maximum lesion size was defined as lesion diameter. The number of OTSCs to be used per patient was not decided until the lesion was completely closed. We used a twin grasper (Ovesco Endoscopy GmbH, Tuebingen, Germany) as a grasping device for all the patients. A 9 mm OTSC was chosen for use in the esophagus and colon, and a 10 mm device was used for the stomach, duodenum and rectum. The overall success rate and complications were evaluated, with a particular emphasis on patients who had undergone ESD due to adenocarcinoma. In technical successful cases we included not only complete closing by using OTSCs, but also partial closing where complete closure with OTSCs is almost difficult. In overall clinical successful cases we included only complete closing by using only OTSCs perfectly. All the OTSCs were placed by 2 experienced endoscopists. The sites closed after ESD included not only the perforation site but also all defective ulcers sites.RESULTS: A total of 23 patients [mean age 77 years (range 64-98 years)] underwent OTSC placement during the study period. The indications for OTSC placement were GI bleeding (n = 9), perforation (n = 10), fistula (n = 4) and the prevention of post-ESD duodenal artificial ulcer perforation (n = 1). One patient had a perforation caused by a glycerin enema, after which a fistula formed. Lesion closure using the OTSC alone was successful in 19 out of 23 patients, and overall success rate was 82.6%. A large lesion size (greater than 20 mm) and a delayed diagnosis (more than 1 wk) were the major contributing factors for the overall unsuccessful clinical cases

关键词： Over-the-scope clip Gastrointestinal bleed-ing Endoscopic submucosal dissection complications Gastrointestinal fistulae Gastrointestinal perforation

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