芳野 純治

Omeprazole, a proton pump inhibitor is known to function not only as a proton pump inhibitor but also as an anti-inflammatory agent, an antioxidant or a stimulator of gastric mucus secretion. We have shown that the pathogenesis of acute gastric mucosal lesions induced by compound 48/80, a mast cell degranulator, in rats involves neutrophil infiltration, lipid peroxidation, and mucin depletion, but not acid secretion, in the gastric mucosal tissue. Therefore, we examined whether omeprazole protects against acute gastric mucosal lesions induced by compound 48/80 in rats. Rats were injected with omeprazole (10 or 50 mg kg(-1), i.p.) at 0.5 h before injection of compound 48/80 (0.75 mg kg(-1), i.p.). Omeprazole prevented gastric mucosal lesion development at 0.5 and 3 h after compound 48/80 injection. Omeprazole attenuated decreased nonprotein sulfhydryl content and increased myeloperoxidase and xanthine oxidase (XO) activities and lipid peroxide (LPO) content in the gastric mucosa at 0.5 h after compound 48/80 injection and increased myeloperoxidase and XO activities and LPO content, but not decreased hexosamine and adherent mucus contents, in the gastric mucosa at 3 h. These results indicate that omeprazole protects against compound 48/80-induced acute gastric mucosal lesions in rats possibly through its anti-inflammatory and antioxidant actions. (C) 2002 Elsevier Science Ltd. All rights reserved.

Background: The normal gastric wall has been reported to appear to be a five-layered structure. The structure of the gastric wall using a 30MHz endoscopic ultrasound probe and especially the identification of the muscularis mucosae (MM), has not been analyzed clearly. Methods: In a basic study, 11 sections of normal gastric wall with 26 horizontally inserted nylon sutures were immersed in water. The sections were scanned and the findings correlated using standard histology. In a clinical study, 15 early gastric cancers were examined by a 30 MHz endoscopic ultrasound probe. Results: In a basic study, layers deeper than the lower part of the submucosa could not be seen using ultrasonography. The first to fourth layers represented the mucosal layer except the MM, the fifth layer (high-echo layer) represented the boundary echo and a part of the MM, while the sixth layer (low-echo layer) represented the rest of the MM. The muscularis mucosae was seen clearly in all samples. In a clinical study the layers deeper than the submucosal layer could not be seen and the MM was visible in 87% of cases. The depth of invasion was estimated accurately in 90% of mucosal cancers and in 80% of submucosal cancers. Conclusion: A 30MHz endoscopic ultrasound probe, which cannot image the entire gastric wall, can visualize the MM and may help to confirm the structure of gastric wall layers and improve the ability to determine the depth of invasion in gastric cancer.

Background: This prospective study was designed to clarify the present status and problems inherent in endoscopic treatment of early gastric cancer by endoscopic mucosal resection and other modalities in Japan and to investigate the possibility of extending the indications for endoscopic treatment. Methods: A total of 409 patients with early gastric cancer lesions were enrolled in this study. Of these, 219 lesions (182 in group I and 37 in group II) were evaluated. Results: Histological evaluation in group I showed that complete resection, relatively incomplete resection, and absolutely incomplete resection were carried out for 103 (56.6%), 20 (11.0%), and 59 (32.4%) lesions, respectively. Surgery was performed for two lesions of the absolutely incomplete resection group. The remaining 180 lesions were followed up with endoscopy after endoscopic treatment. Recurrence occurred in 14 of 57 lesions with absolutely incomplete resection receiving additional endoscopic treatment, while no recurrence was noted in the lesions of the complete resection or relatively incomplete resection group. At present, 175 lesions of group I have been followed up with endoscopy. Histological evaluation of 30 lesions with differentiated carcinoma in group II revealed that complete resection was successful in only six (20%) lesions. Thirty lesions, including 24 receiving additional endoscopic treatment for absolutely incomplete resection, were followed up endoscopically. None of the lesions showed recurrence. Conclusion: An interim report of this study is presented herein. Both groups have been followed up over the past 5 years, and in the final report of this study the authors aim to discuss the effectiveness of various kinds of therapeutic modalities and extend the indication of endoscopic treatment for early gastric cancer.

Background and Study Aims: In three-dimensional endoscopic ultrasonography (3D-EUS), a surface-rendering method can provide both a surface image and a cross-sectional ultrasonographic image. We evaluated the usefulness of this imaging method for digestive tract lesions. Patients and Methods: A total of 30 patients underwent 3D-EUS with surface-rendering using a 3D probe system which arranged individual radial scanning images into 128 points on a computer monitor to outline the surface of a lesion. A complete surface image of the lesion was displayed on the computer monitor using lines obtained from 40 radial scanning images. Results: Surface-rendering images of lesions were similar to endoscopic images. The surface-rendering method permitted precise correlation of two-dimensional images depicting a slice of a lesion with the corresponding surface of the lesion. Unlike conventional endoscopy, this approach permitted observations of lesions at any desired angle. Complete images of lesions were achieved in 14 patients and were half-completed in another five, but could not be obtained in 11 patients: in six the distance between the lesion and the 3D probe was too short to avoid artifacts, while in five the lesion was larger than the longitudinal scanning length of 4 cm or greater than 90 degrees in extent in radial scanning images. Artifacts caused by heartbeat led to irregular images in four patients, including three with esophageal cancer and one with gastric cancer. Conclusions: Despite some problems, surface-rendering imaging should prove useful for diagnosis, and the method will improve as software is perfected.

We used endoscopic color Doppler ultrasonography to detect hemorrhagic gastric ulcer, and to determine whether this modality could show blood vessels present deep to ulcers and whether these vessels influenced clinical course. Subjects were 20 patients with hemorrhagic gastric ulcers which had visible vessels on the ulcer base endoscopically. In 11 of 20 patients (group P) color signals indicating blood flow were observed, in which a weak pulsatile wave was detected in five cases. In two operated cases the signals were confirmed as blood vessels histologically. The diameters of these vessels were over 0.35 mm. It was thought that in cases undetectable on endoscopic color Doppler ultrasonography (group N) the diameter of vessels was too narrow or the velocity of blood too slow. There were no differences in the clinical background of group P and group N. However, ulcer bleeding was more severe in group P cases (P &lt 0.05). Many patients in whom blood flow was detected experienced repeated ulcer bleeding as well as ulcer recurrences. Patients with hemorrhagic ulcers and in whom ultrasonic imaging demonstrates blood flow should be managed with great care.

30 patients with main pancreatic duct stones were treated by ESWL. In 18 of 22 patients who had not previously undergone endoscopic pancreatic sphincterotomy (EPST) or endoscopic sphincterotomy (EST), the stone fragments disappeared after ESWL. The fragments were removed endoscopically in the remaining 4 cases. Complete clearance was achieved in 8 cases with endoscopically unextractable stones by ESWL. After the ESWL procedure, absolute relief from pain was reported by in 19 of 22 patients with abdominal complaints. Serum amylase levels decreased significantly, and dilatation of the main pancreatic duct (MPD) was reduced. In the medium-term follow-up period, pancreatic exocrine function and endocrine function had a possibility to be preserved. One case of pancreatic cancer and one case of an intraductal papillary tumor of the pancreas were found, indicating that careful observation is necessary even after complete removal of pancreatic stones. In cases of Santorini duct dominant, multiple stones, or stricture of the MPD, ESWL should be combined with EPST and endoscopic stenting for preventing recurrence of acute pancreatitis and pancreatic stones. In conclusion, ESWL is the first choice of treatment for pancreatolithiasis and useful procedure and the limited complications.

A patient with a cholecystocolic fistula, complicating cholecysto‐choledocholithiasis, was treated endoscopically with gallbladder observation by peroral cholecystoscopy (POCCS). The patient was a 71‐year‐old female admitted to our hospital for investigation and treatment of biliary stones and a cholecystocolic fistula. Endoscopic lithotripsy and extracorporeal shock wave lithotripsy (ESWL) were performed after endoscopic sphincterotomy, and the gallbladder was subsequently investigated using a duodenoscope/ cholangioscope of the mother and baby type. Full distension of the gallbladder with saline solution allowed POCCS observation of the entire surface. The gallbladder mucosa was smooth, and neither stones nor tumors were observed. Though the cholecystocolic fistula itself could not be observed, we concluded that it had resulted from cholecystitis. Peroral cholecystoscopy is thus a useful method of investigating the gallbladder in such cases. Copyright © 1995, Wiley Blackwell. All rights reserved

A new method for measuring distances using electrically charged jets of water is described, and its precision examined. When combined with endoscopy, this method can be utilized to measure the lengths and areas of objects inside human body cavities. The apparatus used consists of a catheter with three metal needles at the tip, a personal computer, and a commercially available videoendoscopy system. To test the system, a regulated voltage was passed between the catheter tip and a wooden board, and two salt solutions of different concentrations were ejected at three different angles from the catheter to the board. The coordinates of the board were then computed from the amperages of the currents passing through the three jets of saline, and optical distortion was corrected using the computer. The length and area of an object could be measured rapidly by setting electrically the coordinates to match the endoscopic image. Lengths ranging from 10 to 50 mm were measured while varying the distance between catheter tip and board (10, 20, and 30 mm), as well as the angle formed by the catheter and the board (45, 60, and 90 degrees). The mean measurement error was less than 5.6 % and accuracy was relatively independent of the angle between catheter and target.

This study investigated diagnostic indications of malignancy and parenchymal invasion of so-called mucin-producing tumor of the pancreas (MPT). We reviewed 40 patients with this type tumor. In diagnosis of malignancy, jaundice, mural nodule (EUS), displacement or compression of the portal vein (angiography), compression of the common bile duct (cholangiography) and Group IV-V in biopsy, Class III-V in brushing cytology were important. In diagnosis of parenchymal invasion, solid mass (US, EUS, CT), arterial encasement (angiography), defect in the common bile duct (cholangiography), stenosis or obstruction of the MPD (pancreatography) and elevation of serum CA19-9, CEA levels were important. By these findings, MPT diagnosed as benign can be observed without surgical treatment. On the other hand, MPT diagnosed as malignant must be treated by surgical resection, and operative procedure must be chosen according to whether the MPT was accompanied by parenchymal invasion or not. © 1994, The Japanese Society of Gastroenterology. All rights reserved.

To study the influence of gastric acid on the extension of the regenerative epithelium, 26 patients (28 ulcers) of gastric ulcer were examined by the stereo video-endoscope being able to measure the length and 24-hours intragastric pH monitoring. Extending speeds of the regenerative epithelium were measured from the time the regenerative epithelium of the ulcer was observed till the last examination, but which was limited 8 weeks after the first observation of the regenerative epithelium. The relationship was not observed between the extending speeds and the stages (A2-H1, H1-H2, H2-S1) of the ulcer. For 21 ulcers followed up by the stereo video-endoscope from active stage, the extending speed of the regenerative epithelium and the pH 3 holding time in a day were significantly correlated (r=0.51, p=0.014), and the same relationship (r=0.56, p=0.008) were observed in the nighttime. It was confirmed that the gastric acid regulated strongly the extending speed of regenerative epithelium of gastric ulcer. The intragastric circumstance of the low acid secretion induced by the antacid-drugs was considered to accelerate the extension of regenerative gastric epithelium. © 1994, The Japanese Society of Gastroenterology. All rights reserved.

We reported MR endoscopy developed as a new modality for precise diagnosis of digestive diseases. MR endoscopes consisted of a non-magnetic scope and an antena-probe incorporated with a small RF coil, 10×47 mm in size, at the tip of the endoscope. We obtained MR images of the stomach, rectum, liver, gallbladder, and pancreas resected from pigs and humans. MR images disclosed the stomach wall of human being as four layers : the first layer, high signal intensity the second, lower signal intensity, the third, slight higher signal intensity, and the fourth, higher signal intensity. Histological examination revealed the first layer to be compatible with the mucosa layer, the second, the submucosa layer and a part of the proper muscle layer, the third, the proper muscle layer, and the fourth, a part of the proper muscle layer, subserosa, and serosa. Invasion of gastric and rectal cancers was shpown as destruction of the layers. MR images showed clear and charastaristic findings of the liver, gallbladder, and pancreas. MR images revealed metastatic liver cancer as an area with round, higher signal intensity. MR endoscopy is expected as a new modality of a precise dignosis of gastric cancer, rectal cancer, and hepato-pancreato-biliary diseases. © 1993, Japan Gastroenterological Endoscopy Society. All rights reserved.