Home About us Contact
|
Home About us Contact | ||
|
|
||
Greater Curvature (greater + curvature)
Selected AbstractsEOSINOPHILIC GASTROENTERITIS ASSOCIATED WITH GIANT FOLDSDIGESTIVE ENDOSCOPY, Issue 4 2010Kenji Ishido We describe a 54-year-old man who presented with right subcostal pain. Minocycline had been prescribed to treat pruritus, and the symptoms resolved. Subsequently, the patient consulted a local physician because of right subcostal pain. Giant folds were found in the greater curvature of the gastric body, and he was referred to the Department of Gastroenterology, Kitasato University East Hospital. Upper gastrointestinal endoscopy revealed markedly enlarged folds in the greater curvature of the stomach, with redness and edematous mucosa in the lesser curvature. Biopsy showed marked inflammatory cell infiltration (mainly eosinophils), but no atypical cells. Blood tests showed marked eosinophilia and elevated immunoglobulin E levels in the serum. The results of various allergic examinations were negative, but the clinical course suggested drug-induced eosinophilic gastroenteritis, and treatment was started. Minocycline was withdrawn without adequate resolution of symptoms. Because the leukocyte and eosinophil counts continued to increase, the patient was given suplatast, an anti-allergic agent. The symptoms and hematological values improved promptly. The patient recovered uneventfully, with no recurrence. [source] ENDOSCOPIC IDENTIFICATION OF HELICOBACTER PYLORI GASTRITIS IN CHILDRENDIGESTIVE ENDOSCOPY, Issue 2 2010Nao Hidaka Aim:, The role of endoscopic findings in deciding whether to biopsy the gastric mucosa of children remains unclear. The present study attempted, for the first time, to identify the value of endoscopic features for diagnosis of Helicobacter pylori (Hp) infection in children. Methods:, Hp status of consecutive children receiving esophagogastroduodenoscopy (EGD) was established by combinations of histology, 13C-urea breath test, and serum Hp immunoglobulin (Ig)G antibody. After routine EGD using a conventional endoscope, the presence of RAC (regular arrangement of collecting venules) was scored by close observation, which was carried out at two sites of lower corpus lesser curvature and upper corpus greater curvature. RAC-positive was defined as the presence of minute red points in a regular pattern. Antral nodularity was also scored as present/absent. Results:, Eighty-seven consecutive children (38 boys, median age 13 years, range 9,15 years) were evaluated; 25 (29%) were Hp positive. Antral nodularity was seen in 21 (84%) all of whom were Hp positive. The RAC-negative pattern based on examination of the upper and lower corpus yielded a sensitivity, specificity, positive predictive value and negative predictive value for the presence of Hp infection of 100%, 90%, 81%, and 100%. Magnifying endoscopy confirmed that the RAC pattern corresponded to collecting venules in the gastric corpus. Conclusions:, The absence of RAC pattern suggests that gastric mucosa biopsies should be taken despite otherwise normal-appearing gastric mucosa for the diagnosis of Hp infection in children. [source] MAGNIFICATION ENDOSCOPIC VIEW OF AN EARLY GASTRIC CANCER USING ACETIC ACID AND NARROW-BAND IMAGING SYSTEMDIGESTIVE ENDOSCOPY, Issue 2006Hideki Toyoda A 62-year-old woman was referred to Mie University Hospital, Tsu, Japan, for examination of upper gastrointestinal tract. The conventional endoscopy showed a slightly depressed lesion on the greater curvature at the gastric body. The surface of surrounding non-neoplastic mucosa using magnification endoscopy with acetic acid was gyrus-villous pattern whereas the surface of the lesion was rough. Furthermore, magnification endoscopy using acetic acid and narrow-band imaging system visualized clearer fine surface pattern of carcinoma. The lesion had a rough mucosa with irregularly arranged small pits. The lesion was resected completely by endoscopic mucosal resection with insulated-tip electrosurgical knife. Narrow-band imaging system with acetic acid may be able to visualize not only the capillary pattern but also the fine surface pattern of gastric carcinoma. [source] Differences in endoscopic views during biopsy through the right and left lower biopsy channels of the upper gastrointestinal endoscopeDIGESTIVE ENDOSCOPY, Issue 3 2004Naoki Mantani Background:, It has not been established as to which side the biopsy (instrument) channel should be placed in the tip of a front-viewing upper gastrointestinal (GI) endoscope to allow an en-face approach to lesions on various aspects of the stomach wall. Methods:, Using a front-viewing two-channel endoscope, we identi,ed a difference in endoscopic views during biopsy between lower-right and lower-left channels. Colored marks were distributed on the lesser curvature (LC), greater curvature (GC), anterior wall (AW), and posterior wall (PW) in the ,stomach' of a dummy for mock-performance of upper GI endoscopy. When biopsy forceps through the different channels touched the marks, an endoscopic photograph was taken. Furthermore, when biopsy specimens were obtained from PW lesions in several patients, endoscopic views were compared between the two biopsy channels. Results:, In the dummy study, no remarkable difference was detected in targeting the marks on AW, LC, or GC of the stomach. The dummy and the patient study showed that the lower-right approach could target PW lesions with a more adequate endoscopic view than from the lower left. The lower-left approach targeted PW lesions on the higher body with a nearly blinded endoscopic view. Specimens from PW of the upper body, which could be precisely obtained under direct visual control through the lower-right channel, were no smaller than those obtained using the channel on the lower left. Conclusion:, The present study suggests that the lower-right channel may be preferable to the lower-left channel in the tip of a front-viewing upper GI endoscope. [source] SOLITARY PEDUNCULATED GASTRIC GLAND HETEROTOPIA TREATED BY ENDOSCOPIC POLYPECTOMY: REPORT OF A CASEDIGESTIVE ENDOSCOPY, Issue 1 2001Kazuo Kitabayashi The patient, a 68-year-old woman with a long-standing history of schizophrenia, was admitted to our hospital complaining of vomiting which had lasted approximately 3 weeks. Endoscopic examination of the stomach revealed a solitary pedunculated submucosal tumor, of approximately 2 cm in diameter, on the anterior wall of the upper body, close to the greater curvature. The lesion was endoscopically excised using a polypectomy snare without any complication. Microscopic examination was compatible with the diagnosis of gastric gland heterotopia showing submucosal proliferation of pseudopyloric glands, fundic glands and foveolar epithelium with fibromuscular stromal framework. The proliferating foveolar epithelium and fibromuscular stroma were in continuity with the overlaying gastric mucosa and muscularis mucosae, respectively. The lesion was entirely covered by normal gastric epithelium. No atypical cells were revealed in the lesion. The clinical significance of gastric gland heterotopia is unclear because of its controversial histogenesis and carcinogenetic potential. We herein report a rare case of solitary pedunculated gastric gland heterotopia with some review of scientific reports. [source] Biopsy Strategies for Endoscopic Surveillance of Pre-malignant Gastric LesionsHELICOBACTER, Issue 4 2010Annemarie C. De Vries Abstract Background:, Endoscopic surveillance of pre-malignant gastric lesions may add to gastric cancer prevention. However, the appropriate biopsy regimen for optimal detection of the most advanced lesions remains to be determined. Therefore, we evaluated the yield of endoscopic surveillance by standardized and targeted biopsy protocols. Materials and Methods:, In a prospective, multi-center study, patients with intestinal metaplasia (IM) or dysplasia (DYS) underwent a surveillance gastroscopy. Both targeted biopsies from macroscopic lesions and 12 non-targeted biopsies according to a standardized protocol (antrum, angulus, corpus, cardia) were obtained. Appropriate biopsy locations and the yield of targeted versus non-targeted biopsies were evaluated. Results:, In total, 112 patients with IM (n = 101), or low-grade (n = 5) and high-grade DYS (n = 6) were included. Diagnosis at surveillance endoscopy was atrophic gastritis (AG) in one, IM in 77, low-grade DYS in two, high-grade DYS in three, and gastric cancer in one patient. The angulus (40%), antrum (35%) and lesser curvature of the corpus (33%) showed the highest prevalence of pre-malignant conditions. Non-targeted biopsies from the lesser curvature had a significantly higher yield as compared to the greater curvature of the corpus in diagnosing AG and IM (p = .05 and p = .03). Patients with extensive intragastric IM, which was also present at the cardia were at high risk of a concurrent diagnosis of dysplasia or gastric cancer. High-grade DYS was detected in targeted biopsies only. Conclusions:, At surveillance endoscopies, both targeted and non-targeted biopsies are required for an appropriate diagnosis of (pre-)malignant gastric lesions. Non-targeted biopsies should be obtained in particular from the antrum, angulus and lesser curvature of the corpus. [source] Biopsy site for detecting Helicobacter pylori infection in patients with gastric cancerJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 3 2009Chan Gyoo Kim Abstract Background:,Helicobacter pylori eradication is recommended in post-gastric cancer resection, but premalignant changes may prevent the detection of H. pylori. The aim of this study was to determine appropriate biopsy site for detecting H. pylori in gastric cancer patients. Materials and Methods:, Consecutive patients (194) with gastric adenocarcinoma were prospectively enrolled. Helicobacter pylori was evaluated by serology, histology and rapid urease test. Biopsy sites included antrum lesser curvature, upper body lesser curvature (UBLC) and upper body greater curvature (UBGC). Two biopsy specimens were obtained from each site for histological examination. One additional specimen was obtained from UBGC for the rapid urease test. Results:, The overall infection rate of H. pylori was 84.0% (95% CI 78.9,89.2). The sensitivity of histology for detecting H. pylori at various sites was: antrum (54.9%; 95% CI 45.7,63.9), UBLC (80.3%; 95% CI 72.2,87.0) and UBGC (95.1%; 95% CI 89.6,98.2). Specificities of all three biopsy sites were more than 95%. Sensitivity and specificity of the rapid urease test performed at UBGC were 96% and 100%, respectively. Sensitivities of histology decreased in correlation with increasing severity of atrophy and intestinal metaplasia (both P < 0.001 using the chi-square test for trend). The proportions of moderate to marked atrophy/intestinal metaplasia at UBGC (12.8%/14.7%) were significantly lower than those at antrum (50.0%/57.8%, P < 0.001 respectively) or UBLC (40.0%/48.9%, P < 0.001 respectively). Conclusions:, The UBGC side is the most sensitive and specific biopsy site to detect H. pylori in gastric cancer patients due to less frequent atrophy and intestinal metaplasia than at the antrum or UBLC side. [source] Morphological Features of the Stomach of Malayan Pangolin, Manis javanicaANATOMIA, HISTOLOGIA, EMBRYOLOGIA, Issue 5 2010C. Nisa' With 6 figures Summary The morphology of the stomach of Malayan pangolin, Manis javanica was studied at macroscopic, light microscopic, and scanning electron microscopic levels. The stomach of M. javanica was C-shaped with short lesser curvature. At the oesophageal junction, the inner smooth muscle was thickened in the greater curvature side. The entire stomach was lined by a thick cornified stratified squamous epithelium, except at the duct orifices of glands and in the pyloric gland region. The wall of the fundus was thin and devoid of glands. The gastric glands consisted of mucous, oxyntic, and pyloric glands. The mucous glands were observed in the lesser curvature (Mg-L), in the greater curvature (Mg-G), and in the pyloric canal (Mg-C) respectively. The oxyntic glands were organized into gland mass, making an oval mound elevated to the gastric lumen, in the middle of the greater curvature. The oxyntic gland mass has a single common duct with opening directed to the pyloric side. This duct was surrounded by mucus gland (Mg-G). The pyloric glands were located caudal to the pylorus. There was no sphincter at the pyloric-duodenal junction. Large mucosal protuberance, the torus pyloricus was observed in the side of the lesser curvature of the pyloric canal. In the lumen of pyloric canal region, numerous spines and small pebbles were observed. The muscle layers in the wall of this region were considerably thickened. The present results on the stomach of M. javanica are thought to be closely related to the toothless and eating habits of this animal species. [source] Initial experience in laparoscopic sleeve gastrectomy for Japanese morbid obesityASIAN JOURNAL OF ENDOSCOPIC SURGERY, Issue 3 2009M Ohta Abstract Introduction: We evaluated the safety and efficacy of laparoscopic sleeve gastrectomy (LSG) in Japanese patients with morbid obesity. Materials and Methods: Between June 2006 and March 2009, seven morbidly obese Japanese patients (four women, three men; mean age 36±12 years; mean body mass index (BMI) 51±3 kg/m2) underwent LSG at our institute. The inclusion criteria were morbid obesity (BMI>35 kg/m2), the presence of obesity-related disorders, and failure to lose weight while using other medical therapies for at least 6 months. The criteria also included contraindications for laparoscopic adjustable gastric banding or super-obesity (BMI>50 kg/m2). LSG was carried out using endoscopic linear staplers from the greater curvature of the antrum 6,7 cm proximal to the pyloric ring to the angle of His alongside a 32-Fr endoscope or a 45-Fr overtube of the endoscope. Results: In all of the patients, LSG was successfully performed without open conversion. There were no serious postoperative complications and there was no mortality. The mean weight loss and percent excess weight loss after LSG were 33±8 kg and 47±16% at 6 months, and then 44±16 kg and 63±30% at 12 months. Due to the weight loss, the resolution and improvement rates of comorbidities in the five patients followed up for >3 months were 100% and 100% in type 2 diabetes, 67% and 100% in hypertension, 60% and 100% in dyslipidemia, and 100% and 100% in metabolic syndrome. Discussion: Although further long-term studies are necessary with regard to weight maintenance, LSG is a feasible and safe treatment for Japanese patients with morbid obesity. [source] Endoscopic classification of chronic gastritis based on a pilot study by the research society for gastritisDIGESTIVE ENDOSCOPY, Issue 4 2002Michio Kaminishi Background:,Various types of classification of gastritis have been proposed, but no plausible classification has been available until now. The Research Society for Gastritis performed a pilot study to establish an endoscopic classification, taking into consideration the following: (i) ease of use; (ii) permitting everyone the common image; and (iii) presence of histopathological evidence. Methods:,One hundred and fifty-five patients were enrolled and underwent gastroscopy. Eight basic endoscopic and histological types of gastritis (superficial, hemorrhagic, erosive, verrucous, atrophic, metaplastic, hyperplastic and special types) were defined. Gastritis was endoscopically diagnosed according to the definition of the endoscopic types of gastritis. Four or more biopsy specimens were obtained from the lesser and the greater curvatures of the antrum and the corpus of each patient, and the histological findings of gastritis and Helicobacter pylori infection were assessed. The histological diagnosis of gastritis was made according to the definition of histology types of gastritis. The endoscopic and the histological diagnoses were then compared in a blinded fashion. Results:,Endoscopic diagnosis was 62% as sensitive as histological diagnosis for erosive gastritis, 67% for verrucous gastritis and 84% for atrophic gastritis in the antrum. In superficial gastritis, sensitivity was approximately 25% in the corpus, but only 8% in the antrum. Metaplastic and hyperplastic gastritis were correctly diagnosed only in severe cases. Conclusion:,Five basic types of gastritis (superficial, erosive, verrucous, atrophic and special types) should be employed for the new endoscopic gastritis classification. Metaplastic and hyperplastic gastritis are considered to be subtypes of atrophic gastritis and they should be excluded from the basic endoscopic classification. A new definition of gastritis in the antrum accompanied by redness still remains to be investigated. [source] | ||||||||||