1. Background We developed this surgical protocol about performing intraoperative laparoscopy for staging in every patient affected by stomach cancer. Sensitivity and specificity of intraoperative laparoscopy are compared with conventional preoperativestaging techniques.2. Methods From January 1994 to June 1999, 83 patients affected by stomach cancer were accepted in our department: 12 patients (14.5&#37;) were excluded from our study after the preoperative staging; in 71 patients (85.5&#37;) an explorative laparoscopy as the first stepof the operation was performed.3. Results Laparoscopy confirmed preoperative staging in 53 cases (74.6&#37;), in 12 patients demonstrated an overstaging. Laparoscopy demonstrated in 6 patients unsuspected causes of unresectability.4. Conclusions When performed in patients affected by malignant neoplasm and declared resectable, intraoperative laparoscopy can demonstrate conditions not detectableby traditional preoperative investigations, consequently reducing to zero explorative laparotomies.

Gian Carlo Roviaro

Federico  Varoli

Davide  Sonnino

Ombretta  Nucca

Gianni  Rabughino

Alessandro  Scarduelli

Can Routine Laparoscopy Help to Reduce the Rate of Explorative Laparotomies for Gastric Cancer&#63; Laparoscopy in Gastric Cancer

Colonoscopic polypectomy is a major advance in the therapy of colon neoplasms. The techniques for safe and efficient polyp removal are described. The uses of a variety of ancillary
devices are discussed, including clips, loops, submucosal injection of fluid, and several thermal
probes, including the argon plasma coagulator. The location of a lesion may be difficult to
ascertain by intracolonic landmarks, but can be more precisely determined by X-ray, magnetic
imaging, or intraoperative colonoscopy. Alternatively, it is possible to permanently mark the
site of polyp removal with a carbon particle submucosal injection to facilitate subsequent
localization either by surgery or interval colonoscopy.

Jerome D. Waye

Colonoscopic Polypectomy

We investigated the relationship between histological factors and lymph node metastasis in77 lesions with submucosally invasive colorectal carcinomas to establish useful criteria forlesions in which endoscopic treatment alone results in cure of malignancy. There were positivecorrelations between histological factors, including the level of invasion, the histologic grade,presence or absence of lymphatic invasion, presence or absence of budding, and lymph nodemetastasis (p &#60; 0.05, p &#60; 0.05, p &#60; 0.005, p &#60; 0.01). The presence or absence of venousinvasion did not influence lymph node metastasis. Laparoscopic surgery involving lymph nodedissection should be indicated for sm1 carcinoma lesions with unfavorable histological factors.In lesions diagnosed as sm2 or sm3 prior to resection, intestinal resection involving lymph nodedissection by laparoscopic surgery should be directly performed without endoscopic resection.In treating submucosally invasive colorectal carcinomas, the level of invasion can beclinically diagnosed, consequently endoscopic resection should be initially performed whenlesions are evaluated as sm1 prior to resection. When histological investigation reveals sm1carcinoma with histologic grade I (well-differentiated) or II (moderately-differentiated), andthe absence of lymphatic invasion and budding, endoscopic treatment alone is sufficient.

Osamu  Tsuruta

Yuichiroh  Tsuji

Hiroshi  Kawano

Shiroh  Miyazaki

Masahide  Watanabe

Keita  Nakahara

Hideo  Tateishi

Mitsutake  Fujita

Shigeki  Ban

Michio  Sata

Atsushi  Toyonaga

Minoru  Morimatsu

Indication for Endoscopic Resection of Submucosal Colorectal Carcinoma: Special Reference to Lymph Node Metastasis

Yoshihiro Sakai

Preface

We present a case report of a 66-year-old female with a laryngeal saccular cyst that wastreated endoscopically. Although this is an uncommon laryngeal anomaly, when it is recognizedand managed appropriately early in the course of its presentation patient complicationsand morbidity can be avoided. The laryngeal saccular cyst can mimic or be associated withother, more serious, laryngeal pathology, including carcinoma of the larynx. Because of theknown association between carcinoma of the larynx and laryngeal saccular cysts, theselesions should be fully evaluated endoscopically and surgically excised. Direct microlaryngoscopywith the use of the operating microscope is a safe and effective method for the treatmentof laryngeal saccular cysts.

Craig  Benoit

Terry  Day

Laryngeal Saccular Cyst

Benign laryngeal disorders result in dysphonia because of effects on glottic closure and thevibratory characteristics of the true vocal fold. Treatment is initially directed at reversingmedical conditions and patterns of abuse with surgery reserved for unresolving lesions resultingin troublesome dysphonia. Benign lesions that require surgery are excised as precisely aspossible sparing overlying mucosa and the underlying vocal ligament. Vocal fold scarring iscurrently best treated by augmentation procedures, and atrophy may be compensated for bymedialization thyroplasty or by adding bulk to the affected folds. Application of currentknowledge of laryngeal histology and physiology is prerequisite to endoscopic surgicalintervention.

John M. Schweinfurth

Robert H. Ossoff

Current Endoscopic Treatment of Dysphonia

The present study is a comprehensive retrospective analysis of 1341 gastric neoplasms out of10 733 individuals subjected to upper gastrointestinal endoscopy at the main teaching cumreferral hospital in the Kashmir Valley. Of these 78&#37; were males and 22&#37; females, majoritybeing in the age group of 41&#8211;60 years with 60&#37; of the patients being smokers. On endoscopy,the commonest site of cancer was the body of stomach 40.7&#37;, followed by the antrum 35.5&#37;and the cardiac region 23.8&#37;. Endoscopic features revealed nodular masses 39&#37;, polypoidmasses 21&#37;, malignant ulcers 11&#37;, infiltrative masses 12&#37;, rounded tumor masses 9&#37;,linitus plastica 5&#37; and early gastric carcinoma 3&#37;. Histology revealed adenocarcinoma91&#37;, (including mucoid carcinoma 9&#37;, and schirrous carcinoma 7&#37;), leiomyosarcoma 7&#37;,and reticulum cell sarcoma 2&#37;. No significant association between Helicobacter pyloriinfection and gastric cancer was observed in a short study out of these patients. The peculiargeography and some special dietary habits with a possible familial predisposition may havea bearing on the high risk of gastric cancer in the valley.

G. M. Malik

M.  Mubarik

S. A. Kadla

H. A. Durrani

Gastric Cancer Profile in Kashmiri Population With Special Dietary Habits

Magnifying electronic endoscopes are frequently used to evaluate the pit patterns of the
colorectal mucosa, but such endoscopes suffer from a number of problems. For example, they
tend to have long, hard tips and heavy controller sections. In addition, the magnified
endoscopic images obtained are often quite coarse due to the small number of pixels in the
charge-coupled device (CCD). As a result, at higher magnification ratios, the orientation of
the field of view is easily lost. A newly developed prototype colorectal electronic endoscope
(Toshiba Corporation, Tokyo) overcomes these problems. The length of the hard tip of the
scope and the weight of the controller section are comparable to those of the TCE-3680MH
(Toshiba Corporation). High-resolution magnified images can be obtained, because a
410,000-pixel CCD is employed. Two magnification methods are available, optical
magnification and electronic zooming, permitting images to be magnified by a factor of up
to 90&#x2013;120 without losing the orientation of the field of view. This newly developed magnifying
electronic endoscope was found to be very useful, allowing us to observe the pit patterns of the
colorectal mucosa in 82 small colorectal polyps measuring 7 mm or less in diameter.

O. Katayama

K. Namiki

K. Iwakoshi

H. Fujita

H. Yasuhara

I. Ohi

S. Tomatsu

Magnified Examination of Small Colorectal Polyps Using a Prototype Electronic Endoscope

Background The short- and long-term results of balloon dilation therapy in Crohn's
patients with non-anastomotic obstructive gastrointestinal lesions are investigated.Materials and methods Fifty-five patients with Crohn's disease who had obstructive
gastrointestinal lesions were treated prospectively by endoscopic balloon dilation.Short-term results Eight of the initial dilations were unsuccessful giving no symptomatic
relief (14.5%).Long-term results The subjects of the long-term prognosis were 40 cases followed up
for more than 6 months (average 37 months) and their strictures were non-anastomotic in
more than half (59%). Avoidance of surgery, was possible in 31 of 40 patients (78%). Surgery
was avoided in 92%, 81% and 77% of patients after one, two, and three years, respectively
(Kaplan–Meier's method). There was no difference in long-term outcome between
anastomotic strictures and strictures in the absence of prior surgery.Conclusion Our results suggest that, (1) strictures in the absence of prior surgery
might be treated in this way as well as anastomotic strictures; (2) if followed for a prolonged
time period, more than 70% of patients, who have undergone balloon dilation for
obstructive gastrointestinal Crohn's disease, may be able to avoid surgery.

Toshiyuki Matsui

Keisuke Ikeda

Sumio Tsuda

Kenshi Yao

Suketo Sou

Shigeru Satoh

Sadamune Hatakeyama

Hiroaki Matake

Toshihiro Sakurai

Tsuneyoshi Yao

Long-Term Outcome of Endoscopic Balloon Dilation in Obstructive Gastrointestinal Crohn's Disease: A Prospective Long-Term Study

The present study was conducted to determine how long hyperplastic polyps (HPs) and fundicgland hyperplastic polyps (FGPs) should be endoscopically followed up. Our findings showedthat in the case of FGPs, yearly endoscopy is not required and it is sufficient to repeat X-rayand compare films with those obtained in the previous year. In contrast, yearly follow-up byendoscopy is necessary in the case of HPs.

Minoru  Kawaguchi

Toshihiko  Saito

Study on the Optimal Interval of Monitoring Following Gastric Polyp

Yasumi  Uchida

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Diagnostic and Therapeutic Endoscopy - Table of contents 2000

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