Follow-up Endoscopic Examination Research Articles

Value of Gastric Juice Carcinoembryonic Antigen in Identifying High-Risk Patients for Gastric Cancer

The relationship of the level of carcinoembryonic antigen (CEA) in the gastric juice to the extent of intestinal metaplasia and gastric cancer, and clinical values of gastric CEA for identifying high-risk patients for gastric cancer were examined. A significant correlation was found between the levels of gastric CEA and the distribution of intestinal metaplasia. Studies were made by the endoscopic Congo red-methylene blue test developed at our hospital. Gastric CEA levels were significantly higher in patients with localized and diffuse intestinal metaplasia than in those with no intestinal metaplasia. The mean levels of gastric CEA in patients with well-differentiated adenocarcinomas were significantly higher than in those with diffuse intestinal metaplasia. They were also significantly higher in patients with poorly differentiated adenocarcinomas than in patients with no intestinal metaplasia, but not significantly higher than in those with diffuse intestinal metaplasia. Endoscopic follow-up examinations show that gastric cancer was detected in only 1 patient with a gastric CEA level of 10 ng/ml or more, but in none of those with gastric CEA of less than 10 ng/ml, during the average observation period of 4.3 years. These results indicate that gastric CEA is produced both by intestinal metaplasia and well- and poorly differentiated adenocarcinomas, and that gastric CEA is useful in identifying high-risk patients for gastric cancer.

Balloon-tipped catheter arterial occlusion for prevention of hemorrhage caused by guttural pouch mycosis: 13 cases (1982-1985)

Summary Epistaxis, caused by guttural pouch mycosis, was treated by balloon-tipped catheter and ligature occlusion of the involved arteries in 13 horses. In 7 horses, more than one artery was catheterized. Serious postoperative hemorrhage was prevented in all horses. Long-term endoscopic follow-up examination was possible in 8 horses, and all had complete regression of the fungal lesion as early as 5 weeks after surgery. Six of the 8 horses did not receive medical treatment. Problems related to the use of the balloon-tipped catheter technique were rare. There were incisional infections in 3 horses, catheter breakage during removal occurred twice, and in one horse, a catheter was inappropriately placed.

Dysplasia and carcinoma in the Billroth II resected stomach 27-35 years post-operatively.

In a previous endoscopic follow-up examination of patients who 22-30 years before had undergone Billroth II resection for duodenal ulcer the prevalence of dysplasia and carcinoma of the gastric remnant was 14.8 and 0%, respectively. In this second follow-up study five years later the figures had increased to 30.3 and 5.6%. It is uncertain whether these changes result from the higher number of biopsies taken at the re-examination or reflect a time-dependent rise in the morbidity. Although the observed prevalences may seem high, we do not find prophylactic endoscopic examination of such patients indicated, as other investigations by us have shown that the series of Billroth II resected patients under study does not show excess incidence or excess mortality of gastric carcinoma.

Carcinoma of Reconstructed Stomach Tube after Radical Operation of Esophageal Cancer

There are 250 cases of double cancer of the esophagus and the stomach reported in Japan by 1978. However, few have reported carcinoma arising from the reconstructed stomach tube after radical operation for esophageal cancers.We have come across two such cases. One was a IIa type early stomach cancer, 1.0×0.6cm in diameter, discovered by follow-up endoscopic examination 2 years and 2 months after radical operation for esophageal cancer. The other was a Borrmann III type stomach cancer discovered 11 years after esophageal resection and was treated by resection of the stomach tube and esophago-colo-duodenostomy using midsternotomy.Sixteen such cases reported in Japan, including our two, are reviewed and summarized.

Acute Epiglottitis

Forty-seven patients treated for acute epiglottitis by nasotracheal intubation under general anaesthesia following a preset protocol are presented. The results are compared with 61 cases treated by tracheostomy following induction of general anaesthesia and intubation in the same institution. Both groups were followed clinically, and 13 of the children treated by nasotracheal intubation alone had a follow-up endoscopic examination of the larynx. There was no mortality in either group, but the morbidity was significantly higher in the children who had tracheostomy. Details of the management protocol are presented. Only inhalation anaesthetic agents are recommended and it is concluded that children with acute epiglottitis should always have an artificial airway inserted. Nasotracheal intubation seems to be associated with less morbidity than tracheostomy in experienced hands.

Acute epiglottitis: Current management and review

Forty-seven patients treated for acute epiglottitis by nasotracheal intubation under general anaesthesia following a preset protocol are presented. The results are compared with 61 cases treated by tracheostomy following induction of general anaesthesia and intubation in the same institution. Both groups were followed clinically, and 13 of the children treated by nasotracheal intubation alone had a follow-up endoscopic examination of the larynx. There was no mortality in either group, but the morbidity was significantly higher in the children who had tracheostomy. Details of the management protocol are presented. Only inhalation anaesthetic agents are recommended and it is concluded that children with acute epiglottitis should always have an artificial airway inserted. Nasotracheal intubation seems to be associated with less morbidity than tracheostomy in experienced hands.

The Significance of Endoscopy for Gastric Diseases

The effective practice of endoscopic examination in gastric disorders is described based on the author's experience in Japan and Germany. The gastrocamera is recommended for mass examinations, the gastrofiberscope for the primary detailed endoscopic examination. The first step, however, in the morphological diagnosis of gastric diseases remains roentgenology in spite of the progress in endoscopy. But only the combined adoption of both methods assures exact pre-operative diagnosis. In addition the significance of endoscopic follow-up examinations is stressed.