Comparison Between Endoscopic Biliary Stenting and Nasobiliary Drainage in Patients with Acute Cholangitis due to Choledocholithiasis: Is Endoscopic Biliary Stenting Useful?

BACKGROUND/AIMS: To clarify whether or not use of an endoscopic biliary stenting (EBS) is superior to endoscopic nasobiliary drainage (ENBD) in cases of acute cholangitis due to choledocholithiasis. METHODOLOGY: Of 447 patients with choledocholithiasis who were treated in the Department of Gastroenterology, Fukuoka University Chikushi Hospital between January 1994 and September 2006, the subjects were 99 moderate acute cholangitis patients who underwent endoscopic drainage as initial treatment. Clinical efficacy, complications and patient satisfaction (meal intake rete) were investigated in the EBS group (67 patients) and the ENBD group (32 patients). RESULTS: There were no significant differences in the improvement in inflammation, total bilirubin, or biliary enzymes between the EBS and ENBD groups. Catheter occlusion was seen in three patients (4%) in the EBS group, and the catheter was self-extracted by three patients (10%) in the ENBD group. CONCLUSION: In moderate acute cholangitis due to choledocholithisis, the treatment efficacy and safety of EBS are equal to those of ENBD, and EBS appears to be a better choice in elderly patients in particular.

A prospective study of the prevalence of gastroesophageal reflux disease and confounding factors.

BACKGROUND: The prevalence of gastroesophageal reflux disease (GERD) has reportedly risen in recent years. Difficulties associated with endoscopic diagnosis mean it is not easy to determine its precise prevalence. A prospective study of the prevalence of endoscopy-positive GERD (EP-GERD) was conducted at Higuchi Hospital, a general hospital in Northwestern Kyushu, Japan. The study also correlated factors that might affect prevalence (age, sex, and functions of the gastroesophageal junction). METHODS: From consecutive patients undergoing endoscopic examination at Higuchi Hospital between January 2000 and April 2003, 1234 patients without severe complications were examined for the possible presence of GERD. Patients were stratified by age and sex, and the prevalence in each group ascertained. EP-GERD was defined on the four-level scale of the Los Angeles classification. Endoscopic classification of gastroesophageal flap valve ([GEFV] functional anomalie; using a four-level scale), was done as proposed by Hill et al. in 1996, to assess flap-valve morphology. Six items were evaluated: (1) symptoms and primary diseases; (2) prevalence of development of EP-GERD classified by age and sex; (3) endoscopic morphology of the GEFV as an expression of the functions of the gastroesophageal junction, and its prevalence by age and sex; (4) regression analysis and Spearman's rank correlation of GEFV and EP-GERD grades; (5) prevalence of EP-GERD and GEFV stratified by age and analyzed; and (6) multiple regression analysis of EP-GERD and explanatory variables (age, sex, and GEFV). RESULTS: The overall prevalence of EP-GERD was 5.8% (72/1234) and this patient group was dominated by men. Aging had minimal effect on prevalence in men, but the prevalence rose among women as they aged. The age-stratified prevalence of GEFV functional anomalies was similar to the age-stratified prevalence of EP-GERD in both sexes. The correlation between EP-GERD and GEFV functional anomalies was high regardless of sex. CONCLUSIONS: We postulate that the mechanisms leading to the development of GEFV functional anomalies in men are different from those in women. Future evaluations of EP-GERD should also observe GEFV function.

Prevalence and clinicopathological features of autoimmune pancreatitis in Japanese patients with inflammatory bowel disease.

OBJECTIVES: The purpose of this study was to clarify the clinicopathological characteristics of autoimmune pancreatitis (AIP) in Japanese patients with inflammatory bowel disease (IBD). METHODS: The clinicopathological findings of 7 patients with IBD whose definite AIP was diagnosed in our hospital according to the International Consensus Diagnostic Criteria were reviewed. RESULTS: Five (0.5%) of 961 patients with ulcerative colitis (UC) and 2 (0.3%) of 790 patients with Crohn disease had AIP. All of 7 patients whose AIP was diagnosed were type 2. The rate of elevated values of serum immunoglobulin G4 was 0%. Most patients with the diagnosis of IBD preceded that of AIP, and disease activity of IBD were active. Granulocyte epithelial lesion is similar to the cryptitis seen in colonic tissue of UC. All of 7 patients were given corticosteroids, immunomodulators, and/or biological agents for IBD. One patient had a recurrence. CONCLUSIONS: The frequency of AIP in Japanese patients with IBD was low. All cases were type 2 and responded well to corticosteroids, immunomodulators, and biological agents. Autoimmune pancreatitis in UC patients may be an extraintestinal manifestation of UC.

A new stereoscopic endoscopy system: accurate 3-dimensional measurement in vitro and in vivo with distortion-correction function.

BACKGROUND: The purpose of this study was to evaluate the accuracy and reproducibility of measurements obtained with a new 3-dimensional stereoscopic endoscopy system in vitro and in vivo. METHODS: The system includes an electronic stereoscopic endoscope and a personal computer. After correction of barrel distortion by an image-processing technique, 3-dimensional data are computed with triangulation. Initially, graph paper and models of gastric lesions, both elevated and depressed, were used as objects. For evaluating accuracy and reproducibility, the absolute error (/E/) and the coefficient of variation (CV) were calculated: /E/ = average value of absolute value (measured value minus sign true value)/true value. Then, the sizes of 50 gastric lesions were measured by 2 endoscopists, one experienced and the other inexperienced, and the findings were compared with measurements made radiographically. RESULTS: The maximum for /E/ and for the CV for the distance on the graph paper were, respectively, 5.6% and 7.0%. The /E/ and CV for the diameter and for the height of the elevated model were, respectively, 5.9% and 5.7% for the former and, respectively, 16.8% and 16.5% for the latter. The /E/ and CV for the area of the depressed model were, respectively, 9.0% and 1.6%. The correlation coefficients between the sizes of lesions measured by stereoscopic endoscopy and radiographically were 0.91: 99% CI [0.81, 1.00], and 0.98: 99% CI [0.85, 1.00], respectively, for the experienced and inexperienced endoscopists. CONCLUSIONS: The new stereoscopic endoscopy system is useful for measuring gastric lesion size in clinical practice.