Endoscopic Resection of Rectal Carcinoids Using Double Snare Polypectomy Technique

Abstract: Between 1993 and 1997, 11 patients with rectal carcinoids less than 8 mm in diameter (mean size: 5.5 mm) were endoscopically treated at Tsuboi Hospital. Seven patients were treated by polypectomy or endoscopic mucosal resection. Three of the seven lesions were microscopically diagnosed as having positive submucosal margins. The remaining four showed a distance between the tumor and the resection line(DBTRL) of 0 to 0.33 mm. Then, we attempted endoscopic double snare polypectomy (EDSP) in 1996 and 1997. In four consecutive patients, the tumor was completely resected by this method. The DBTRL ranged from 0.08 to 0.75 mm in four lesions resected by EDSP. With endoscopic resection of these tumors, the incidence of positive margins is high using the conventional single snare methods, even when the lesions are less than 10 mm in diameter. EDSP was useful for total removal of small rectal carcinoids.     

A Case of Gastric Lipoma Removed by Endoscopic Polypectomy

Abstract: A rare case of gastric lipoma removed by endoscopic polypectomy is presented herein. A 64-year-old female was found to have a polypoid lesion in the stomach on periodic X-ray examination. Endoscopy revealed a submucosal tumor located on the posterior wall of the antrum. Endoscopic ultrasonography demonstrated a homogeneous, hyperechoic mass continuous with the submucosal layer, suggesting a lipoma. Because the likelihood of the tumor ultimately causing obstruction or prolapse into the duodenum was high, endoscopic polypectomy was performed. There were no complications. The histological examination revealed a mass of mature adipose tissue underneath the normal mucosa, which was consistent with the diagnosis made prior to polypectomy. The preferred treatment for gastric lipomas to date has been surgical excision, because the diagnosis is difficult to make prior to treatment. In the literature, only 17 cases undergoing endoscopic treatment for gastric lipomas have been reported. Endoscopic ultrasonography and computed tomography apparently facilitate preoperative diagnosis of lipomas.     

Endoscopic polypectomy： A promising therapeutic choice for esophageal carcinosarcoma

Esophageal carcinosarcoma is a rare malignant tumor composing of both carcinomatous and sarcomatous elements. Endoscopic therapy is less invasive and may represent an alternative to esophagectomy for superficial esophageal carcinosarcoma. Here, we report a 61-year-old male who was diagnosed as esophageal carcinosarcoma and underwent endoscopic polypectomy with well tolerance and favorable prognosis. We also present a brief review of the literature.     

直肠类癌内镜诊断及治疗46例

目的:探讨内镜下直肠类癌的诊断率及其内镜治疗方法的安全性和有效性.方法:对46例直肠类癌病例进行回顾性分析,总结其内镜下表现,对瘤体直径小于2.0 cm的16例直肠类癌采用内镜下黏膜切除术进行治疗.结果:本组共诊断直肠类癌46例,内镜下治疗16例,术中或术后即刻出血2例,迟发性出血1例,术中穿孔1例,均经内镜治疗及内科保守治疗痊愈,无患者死亡.1例肿瘤切除不完全,转外科追加手术治疗.1例术后3 mo随访时见复发,转外科行手术治疗.结论:直肠类癌可通过内镜下钳取组织行病理检查或全瘤切除后活检而确诊,内镜治疗对于直径小于1.0 cm的直肠类癌是一种简单、安全有效的方法,术后应定期随访.     

直肠类癌的内镜超声图像特征

目的探讨直肠类癌的内镜超声(EUS)图像特征，以提高其诊断正确率。方法连续收集2001年4月至2004年4月直肠黏膜及黏膜下肿物29例，行EUS检查及病理检查，分析经病理确诊的直肠类癌的EUS图像，找出其特征性表现。结果29例共检出病灶29个，其中类癌12个，腺瘤11个，炎性病灶6个。直肠类癌病灶中10个呈低回声结节，2个呈等回声；5个病灶位于黏膜层，7个位于黏膜下层；12个病灶边界均清晰。结论直肠类癌的EUS声像图特征是：病灶边界清，回声均匀，位于黏膜下层或黏膜层，绝大多数呈低回声结节。EUS声像图特征有助于直肠类癌的早期诊断。     

Clinical Impact of Endoscopic Ultrasound and Endoscopic Ultrasound-Guided Fine-Needle Aspiration in the Management of Rectal Carcinoma

PURPOSE: There is scant data about the clinical impact of endoscopic ultrasound-guided fine-needle aspiration in rectal carcinoma. This study was designed to determine the impact of endoscopic ultrasound-guided fine-needle aspiration on the staging and management of rectal carcinoma and to compare the staging accuracy of computed tomography scan, endoscopic ultrasound, and endoscopic ultrasound-guided fine-needle aspiration. METHODS: The records of 60 consecutive patients diagnosed with rectal carcinoma referred for endoscopic ultrasound staging were reviewed. Computed tomography scans, endoscopic ultrasound imaging, endoscopic ultrasound-guided fine-needle aspiration staging, surgical pathology, and subsequent treatment were compared. RESULTS: Of 48 patients who underwent computed tomography scan imaging, the additional information provided by endoscopic ultrasound changed management in 38 percent of patients. Sixteen patients identified as having nonjuxtatumoral lymph nodes underwent fine-needle aspiration and the additional information obtained changed therapy in three (19 percent) of these patients. All five cases of recurrent rectal carcinoma were correctly diagnosed by fine-needle aspiration. Tumor staging accuracy was 45 percent (computed tomography) and 89 percent (endoscopic ultrasound; P < 0.0001); nodal staging accuracy was 68 percent (computed tomography), 85 percent (endoscopic ultrasound), and 92 percent (endoscopic ultrasound-guided fine-needle aspiration; P = not significant). CONCLUSIONS: Endoscopic ultrasound imaging was better than computed tomography scanning at overall tumor staging, whereas endoscopic ultrasound-guided fine-needle aspiration demonstrated a trend toward more accurate nodal staging. Preoperative staging with endoscopic ultrasound resulted in a change of management in 38 percent of patients. The addition of fine-needle aspiration changed the management in 19 percent of those who underwent nonjuxtatumoral lymph node sampling. Endoscopic ultrasound-guided fine-needle aspiration accurately diagnosed 100 percent of those with recurrent rectal carcinoma. Clearly, endoscopic ultrasound and endoscopic ultrasound-guided fine-needle aspiration are important for the staging and management of rectal carcinoma and for detecting disease recurrence.Presented at the EUS 13th International Symposium on Endoscopic Ultrasound, New York, New York, October 4 to 6, 2002     

A Case of Terminal Ileum Lipoma Treated by Endoscopic Polypectomy

Abstract: This study reports on the case of a 71-year-old man who complained of repeated episodes of right lower abdominal pain. A barium enema and colonoscopy revealed a 20 times 20 times 15 mm smooth-surfaced polypoid tumor (Yamada type III) located in the terminal ileum. An endoscopy showed that the lesion had a slightly yellowish surface and the cushion sign was observed, so the tumor was considered to be an intestinal lipoma. During colonoscopy, prolapse of the tumor occurred through the orifice of Bauhin's valve and the patient simultaneously complained of right lower abdominal pain. The tumor was removed endoscopically. After a colonoscopic polypectomy, the patient's right lower abdominal pain disappeared. A pathological examination of the specimen revealed a lipoma of the terminal ileum. In general, the correct preoperative diagnosis of intestinal lipoma is difficult. Furthermore, 80% of lipomas situated at the terminal ileum are complicated by acute intussusception. We suggest that a colonoscopic polypectomy is a useful procedure for confirming the diagnosis of intestinal lipoma and for the prophylaxis of intussusception when the tumor is located in the terminal ileum.     

超声内镜引导深挖活检联合黏膜切除术诊治早期直肠类癌

目的 探讨超声内镜引导下深挖活检早期诊断直肠类癌以及内镜下黏膜切除术治疗直肠类癌的安全性、有效性。方法在超声内镜引导下深挖活检、结合病理及免疫组化检查,诊断直肠类癌24例。对24例直肠类癌的内镜及超声影像特点进行回顾性分析,总结其特征。对病灶直径小于1．5cm、浸润深度不超过黏膜下层、无肝转移及腹水发生的直肠类癌采取内镜下黏膜切除术治疗。结果24例直肠类癌分别距离肛缘5cm～12cm,病灶大小0．8cm～1．5cm,术后切除的标本切缘完整,基底无残留,治疗过程中均未发生穿孔,无迟发性出血,术后创面即刻渗血1例,经内镜治疗血止。随访3至5年无转移及再发。结论直肠类癌可通过超声内镜引导下深挖活检,钳取组织行病理及免疫组化检查而确诊,内镜下黏膜切除术治疗直径小于1．5cm的直肠类癌简单、安全有效。     

直肠类癌的内镜超声诊断和内镜黏膜下切除

目的 研究内镜超声对直肠类癌的诊断价值，探讨内镜下黏膜切除术治疗直肠类癌的应用价值。方法 应用微超声探头对结肠镜发现的黏膜正常的大肠隆起性病灶进行超声检查，对诊断直肠类癌病例应用套扎器对准病灶负压吸引进行圈套结扎，再在皮圈根部连皮圈电切病灶。比较内镜超声诊断和病理检查结果，观察切除标本基底有无肿瘤累及。结果 126例黏膜正常的大肠隆起性病灶经内镜超声诊断，25例直肠类癌全部得到病理证实。直肠类癌表现为黏膜下层的边界清晰、回声欠均匀的低回声肿块。全部类癌病例无固有肌层和血管浸润，行内镜黏膜下切除无一例出现出血和穿孔，切除标本边缘和基底无肿瘤累及。结论 内镜超声可以明确直肠类癌的肠壁来源、大小、内部回声性质、边界、有无肌层和周围血管浸润，内镜下黏膜切除术治疗直肠类癌疗效确切。     

超声内镜检查在消化道隆起性病变应用中的临床价值

目的 评价超声内镜检查在消化道隆起性病变应用中的临床价值.方法 用超声内镜及超声小探头检查126例消化道隆起性病变患者,其中105例行无痛超声内镜检查.结果 息肉13例,癌4例,囊肿13例,血管瘤2例,异位胰腺2例,炎性隆起3例,胃黏膜异位2例,黏膜下肿瘤61例,壁外压迫14例,未见异常11例,均明确了病变起源层次.对部分病例进行内镜下或外科手术治疗,术后病理诊断与超声内镜诊断符合率92%.结论 应用超声内镜检查可以明确上、下消化道隆起性病变的起源(定位)和初步诊断,对隆起性病变的治疗方案具有指导意义.     

Current Status of Endoscopic Papillectomy for Ampullary Tumors

Detection of tumors of the ampulla of Vater, including ampullary adenoma, has been improved by routine screening endoscopic procedures and imaging modalities. Endoscopic resection by endoscopic papillectomy is rapidly replacing classic surgical resection and is a less invasive procedure. Endoscopic resection can have a role not only in the final histopathologic diagnosis but also as a definite therapeutic option. However, the indications for endoscopic resection are not fully established, and endoscopic procedures are not standardized. Significant complications, including severe pancreatitis, intractable bleeding and duodenal perforation, are rare but can occur, especially in less experienced hands. Severe pancreatitis is the most feared complication, but it can be prevented by pancreatic duct stent insertion in most cases. However, in some cases, pancreatic stenting can be challenging after resection. Incomplete resections are sometimes performed to avoid complications. Endoscopic surveillance is also important for identifying and managing remnant adenomatous tissue or recurrent lesions. Further technical development is needed to expand the indications for this procedure, minimize complications and ensure a high success rate.     

Transanal Endoscopic Microsurgical Resection of pT1 Rectal Tumors

Purpose Transanal endoscopic microsurgery has emerged as an improved method of transanal excision of neoplasms because its enhanced visibility, superior optics, and longer reach permit a more complete excision and precise closure. This study will show that transanal endoscopic microsurgical treatment of pT1 rectal cancers is safe and achieves low local recurrence and high survival rates. Methods Retrospective review performed of all pT1 rectal cancers treated by a single surgeon (TS) using transanal endoscopic microsurgery between 1991 and 2003. Patient age, gender, tumor distance from the anal verge, lesion size, operative time, blood loss, complications, recurrence, and survival rates were prospectively recorded. Results Fifty-three patients (average age, 65.6 (range, 31–89) years) were studied. Forty-nine percent were male. Average tumor distance from the anal verge was 7 (range, 0–13) cm; average size was 2.4 (range, 1–10) cm. Radiation and/or chemotherapy were not administered. Sixteen patients had pT1 lesions removed piecemeal during colonoscopy; there was no residual tumor after transanal endoscopic microsurgical resection of the polyp site. Mean follow-up was 2.84 years. Fifty-one percent had longer than two-year follow-up. For the entire group, there were four recurrences (7.5 percent) occurring at 9 months, 15 months, 16 months, and 11 years. Two were treated with abdominoperineal resection, one with low anterior resection, and one with fulguration alone. There were no recurrences in the 16 patients who had excision of the polypectomy site. If excluded, recurrence was 11 percent (4/37). Patients were examined at three-month intervals for the first two years and every six months thereafter. There have been no cancer-related deaths. Conclusions Transanal endoscopic microsurgical resection of pT1 rectal cancers yields low recurrence rates. Close follow-up permits curative salvage for those that do recur. Transanal excision remains a viable option. Read at the meeting of The American Society of Colon and Rectal Surgeons, Dallas, Texas, May 8 to 13, 2004. Reprints are not available.     

直肠类癌的内镜下诊断与治疗

目的探讨直肠类癌的临床病理特点、诊断及治疗。方法对17例经内镜及病理学证实的直肠类癌病例进行回顾性分析,总结其临床表现、病理及治疗情况。结果直肠类癌多以腹痛、腹泻、大便性状改变为主要临床表现,免疫组化结果 CgA阳性率为53%,Syn阳性率为88%。所有患者经内镜下EMR或ESD治疗,无术中及术后迟发性出血发生。3例患者术后病理切缘可见肿瘤细胞,进一步追加外科手术治疗。结论直肠类癌主要通过内镜及病理学检查确诊,对于直径<1 cm的直肠类癌可采取内镜下切除治疗。     

Treatment of solitary gastric carcinoid tumor by endoscopic polypectomy in a patient with pernicious anemia

Type I gastric carcinoid tumors result from hypergastrinemia in 1%-7% of patients with pernicious anemia. We diagnosed pernicious anemia in a 48-year-old female patient with complaint of fatigue for three months. She had no gastrointestinal symptoms. Endoscopic examination ot the upper gastrointestinal tract revealed atrophic gastritis and a polypoid lesion in the corpus of 3-4 mm in size. Endoscopic polypectomy was performed. Histopathological examination of the specimen revealed positive chromogranin A and synaptophysin stainings compatible with the diagnosis of a carcinoid tumor. Serum gastrin level was increased, urinary 5-hydroxyindoleacetic acid was within the normal range. There was no other symptom, sign, or laboratory finding of a carcinoid syndrome in the patient. No metastasis was found with indium-111 octreotide scan, computed tomographies of abdomen and thorax. Type I gastric carcinoid tumors are only rarely solitary and patients with tumors < 1 cm in size may benefit from endoscopic polypectomy.     

Indications for and Technical Aspects of Colorectal Endoscopic Submucosal Dissection

Due to the widespread acceptance of gastric and esophageal endoscopic submucosal dissections (ESDs), the number of medical facilities that perform colorectal ESDs has grown and the effectiveness of colorectal ESD has been increasingly reported in recent years. The clinical indications for colorectal ESD at the National Cancer Center Hospital, Tokyo, Japan include laterally spreading tumor (LST) nongranular type lesions >20 mm and LST granular type lesions >30 mm. In addition, 0-IIc lesions >20 mm, intramucosal tumors with nonlifting signs and large sessile lesions, all of which are difficult to resect en bloc by conventional endoscopic mucosal resection (EMR), represent potential candidates for colorectal ESD. Rectal carcinoid tumors less than 1 cm in diameter can be treated simply, safely, and effectively by endoscopic submucosal resection using a ligation device and are therefore not indications for ESD. The en bloc resection rate was 90%, and the curative resection rate was 87% for 806 ESDs. The median procedure time was 60 minutes, and the mean size for resected specimens was 40 mm (range, 15 to 150 mm). Perforations occurred in 23 (2.8%) cases, and postoperative bleeding occurred in 15 (1.9%) cases, but only two perforation cases required emergency surgery (0.25%). ESD was an effective procedure for treating colorectal tumors that are difficult to resect en bloc by conventional EMR. ESD resulted in a higher en bloc resection rate as well as decreased invasiveness in comparison to surgery. Based on the excellent clinical results of colorectal ESDs in Japan, the Japanese healthcare insurance system has approved colorectal ESD for coverage.     

Pedunculated Submucosal Ectopic Mucosa of the Stomach Treated by Endoscopic Polypectomy: Report of Two Cases

We report here two cases of submucosal ectopic gastric mucosa which grew with pedunculation. A lesion 23 mm in size was located in the posterior wall of the upper gastric body in a 61-year-old female. A 58-year-old female had a lesion 12 mm in size in the anterior wall of the upper gastric body. Both were elevated lesions expressed as Yamada's type IV and were endoscopically diagnosed as submucosal tumors. For the purpose of total biopsy, endoscopic polypectomy was performed in both cases. Histological examination of the polypectomized specimens showed gastric mucosa in the submucosal layer. These two cases were unique in that ectopic gastric mucosa was pedunculated and diagnosed after endoscopic polypectomy, not by postoperative pathological examination.     

Endoscopic mucosal resection for rectal carcinoids under micro-probe ultrasound guidance

AIM: To assess the therapeutic value of endoscopic mucosal resection (EMR) under micro-probe ultrasound guidance for rectal carcinoids less than 1 cm in diameter. METHODS: Twenty-one patients pathologically diagnosed with rectal carcinoids following colonoscopy in our hospital from January 2007 to November 2012 were included in this study. The patients consisted of 14 men and 7 women, with a mean age of 52.3 ± 12.2 years (range: 36-72 years). The patients with submucosal tumors less than 1 cm in diameter arising from the rectal and muscularis mucosa detected by micro-probe ultrasound were treated with EMR and followed up with conventional endoscopy and micro-probe ultrasound. RESULTS: All of the 21 tumors were confirmed by micro-probe ultrasound as uniform hypoechoic masses originating from the rectal and muscularis mucosa, without invasion of muscularis propria and vessels, and less than 1 cm in diameter. EMR was successfully completed without bleeding, perforation or other complications. The resected specimens were immunohistochemically confirmed to be carcinoids. Patients were followed up for one to two years, and no tumor recurrence was reported. CONCLUSION: EMR is a safe and effective treatment for rectal carcinoids less than 1 cm in diameter.     

经食道内镜超声检查在纵隔和肺疾病诊断中的作用

目的 评价内镜超声(EUS)检查在纵隔和肺疾病诊断中的应用价值。方法 采用PENTAX FG-36UX内镜经食道超声检查纵隔疾病和肺癌30例。结果 对11例纵隔疾病EUS检查纵隔疾病的准确率为81．8％，内镜超声引导下细针吸取细胞学检查(EUS-FNA)5例，阳性率100％，准确率为100％。19例肺癌患者EUS检查既了解病变纵隔侵润情况、纵隔病变与周围脏器的关系，又明确纵隔淋巴结转移数目，EUS检查肺癌纵隔侵润的准确率为89．4％，行EUS-FNA6例，阳性率83．3％，准确率为100％。结论 EUS是一项先进、安全、对纵隔和肺疾病的临床诊断有较大帮助的检查手段。     

Usefulness and Limitations of Endoscopic Ultrasonography in Diagnosis of Adenomyomatosis of the Gallbladder

Abstract: Although endoscopic ultrasonography (EUS) is commonly used to examine lesions in the gallbladder, its ability to accurately diagnose adenomyomatosis (ADM) has not been evaluated. We compared the accuracy of EUS and various other imaging techniques in the diagnosis of ADM. Thirty-one patients undergoing cholecystectomy after elevated lesions were found in the gallbladder by various imaging techniques were studied retrospectively. Based on histopathologic examination, the sensitivity and specificity of EUS were evaluated in ADM. The sensitivity of abdominal ultrasonography, CT and ERCP in ADM were also evaluated. Of the 11 patients diagnosed with ADM by EUS, 9 cases were confirmed histologically (81.8%). Of the 11 patients with histologic diagnosis of ADM, 9 were accurately diagnosed preoperatively by EUS (81.8%). EUS proved more reliable for diagnosis of ADM than the other imaging techniques. Important diagnostic features include preservation of the three-layered structure of the gallbladder, wall-thickening exceeding 3 mm, and 2 or more Rokitansky-Aschoff sinuses occurring within a 1 cm area of the gallbladder.