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Summary Aim : To investigate the effect of famotidine on gastric blood flow reduction induced by diclofenac sodium, a common non-steroidal anti-inflammatory drug in Japan, using laser Doppler flowmetry in the canine stomach. Methods : The gastric mucosal blood flow was measured by laser Doppler flowmetry in 15 healthy male beagles before and 60 min after the administration of diclofenac suppository (1.0 mg/kg) into the rectum. The examination was done in a crossover, single-blinded fashion. All dogs underwent both famotidine (0.5 mg/kg) and placebo (saline) injection simultaneously with the administration of diclofenac. In addition, the tissue concentration of prostaglandin E2 was measured. Results : The blood flow decreased by 18.3 ± 9.1% in the gastric body, by 26.3 ± 8.1% in the antrum in the placebo group after the administration of diclofenac sodium, while the decreases seen were significantly smaller in the famotidine group: 3.2 ± 12.6% in the gastric body and 7.9 ± 16.5% in the antrum (P = 0.001 for the gastric body, P = 0.0034 for the antrum). Conversely, the percentage of mucosal prostaglandin E2 concentration decrease in each group did not show a significant difference. Conclusion : Famotidine alleviates the reduction of gastric blood flow induced by diclofenac sodium. Further, not only mucosal prostaglandins but also gastric acid may play an important role in non-steroidal anti-inflammatory drugs-induced gastric microcirculatory disturbance.

Background High-frequency catheter probe US provides detailed images when the scanning plane is perpendicular to the area of interest and the latter is within the focal zone. A multibending endoscope has been developed that has two bending sections that can be deflected independently. The aim of this study was to determine whether this new endoscope enhances high-frequency catheter probe US. Methods High-frequency catheter probe US was performed with the multibending endoscope in 33 patients with upper-GI lesions. The endoscope was carefully maneuvered until the scanning plane was perpendicular to the area of interest and the target area was within the focal zone of the probe. The effects of deflecting the second bending section on the image and on the rotating elements in the probe were evaluated. Results For 28 lesions, no improvement was observed with use of both bending sections. However, for 5 lesions, the US image was improved by use of the second bending section. These lesions were located in the stomach on the lesser or greater curve. In no instance did deflection of both bending sections result in uneven rotation of the mechanical elements in the probe. Conclusions For certain lesions, US images obtained with a catheter probe can be improved by using an endoscope with a second bending section.

Tumor vascularity is strongly related to the prognoses of patients with various malignant primary tumors, including colorectal cancer. The aim of this study was to confirm the usefulness of harmonic flash echo imaging (H-FEI) for the preoperative evaluation of tumor vascularity in colorectal cancer by comparison with CD34 staining of resected specimens.Seventeen patients undergoing surgical resection for advanced colorectal cancer (9 M, 8 F) were enrolled in this study. An ultrasound system transmitting ultrasound pulses at 2.3 MHz and receiving them at 4.6 MHz (second harmonic) was used for H-FEI. After intravenous injection of ultrasonic contrast medium (SHU 508A), intermittent harmonic scanning was carried out for 120 s at intervals of 4 s. On the tumor image of the strongest enhancement in each patient, 5 regions of interest were taken to decide the mean echo intensity of the tumor. Immunohistochemistry using antibodies against CD34 was carried out on resected specimens. The mean microvessel density was decided by counting microvessels on 5 fields (x 400) of CD34-stained specimens.The mean value of H-FEI intensity was 5.44+/-1.10, and the mean microvessel count with CD34 staining was 35.0+/-7.95. A significant positive linear correlation was observed between the intensity of H-FEI determined preoperatively and the microvessel count in CD34-stained specimens (r=0.741, p=0.0006).Vascularity of colon cancer can be evaluated non-invasively using H-FEI.

Background Small-bowel bleeding is difficult to treat and diagnose. The recent introduction of wireless capsule endoscopy permits examination of the entire small intestine, but this method lacks tissue sampling and therapeutic capabilities. Recently, Yamamoto et al established a double-balloon insertion method for enteroscopy that allows examination of the entire small bowel and interventional options. Objective To evaluate double-balloon enteroscopy in patients with obscure GI bleeding. Setting Single-center prospective study. Patients Thirty-one consecutive patients with obscure GI bleeding (13 females, 18 males; mean age 56.4 ± 3.2 years). Criteria for inclusion in the study were documented iron deficiency anemia (hemoglobin level 2 g/dL over ≥2 months); upper endoscopy not revealing a site/cause of blood loss; and similarly uninformative lower endoscopy including examination of the terminal ileum. Interventions Endoscopic biopsy or therapy was performed as clinically indicated. Main Outcome Measurements Diagnostic yield for patients with obscure GI bleeding and patient follow-up. Results Double-balloon enteroscopy was completed without complications in all patients. Bleeding points were identified in 23 patients (74.2%). In 21 (91.3%) of these 23 patients the cause of blood loss was identified and treated with no further bleeding at 8.5 ± 0.6 months of follow-up. Limitations Small number of patients. Conclusions These data suggest that double-balloon enteroscopy is useful for evaluation and treatment of patients with GI bleeding of obscure origin.

Magnified endoscopic observation of the gastrointestinal tract has become possible. However, such observation at the cellular level remains difficult. Laser-scanning confocal microscopy (LCM) is a novel, noninvasive optical imaging method that provides instant microscopic images of untreated tissue under endoscopy. We compared prototype catheter-based reflectance-type LCM images in vivo and histologic images of early gastroesophageal cancer to assess the usefulness of LCM in diagnosing such cancer. Twenty sites in the esophagus and 40 sites in the stomach were examined by LCM under endoscopy prior to endoscopic or surgical resection. A prototype catheter LCM system, equipped with a semiconductor laser that oscillates at 685 nm and analyzes reflected light (Mauna Kea Technologies, Paris, France; Fujinon, Saitama, Japan), was used in vivo without fluorescent agent. In all normal esophageal mucosa and esophageal cancers, the nuclei were visualized. In 9 of the 10 normal esophageal mucosa, cell membranes were visualized, and in 5 of the 10 esophageal cancers, cell membranes were visualized. In all normal gastric mucosa, nuclei and cell membranes were not visualized, but in 10 of the 20 gastric cancers, nuclei were visualized. This novel method will aid in immediate diagnosis under endoscopy without the need for biopsy.

Diagnostic Yield of Double-Balloon Enteroscopy in Patients with Various Ulcerative Diseases of the Small Intestine: Present Status and Problems Concerning Endoscopic Diagnosis Noriaki Manabe, Shinji Tanaka, Akira Fukumoto, Yoshiaki Matsumoto, Toshiki Yamaguchi, Madoka Nakao, Yutaka Mitsuoka, Jiro Hata, Ken Haruma, Kazuaki Chayama Background and Aims: Various diseases of the small intestine are now detected by double-balloon enteroscopy (DBE), which has revolutionized endoscopy of the small intestine. One of the most common DBE findings is ulcerative lesion. The etiology of ulcerative lesions varies. It is a matter of great importance to diagnose these lesions, including etiology, accurately. The aim of this investigation was to evaluate the diagnostic yield of DBE in patients with ulcerative lesions of the small intestine. Subjects and Methods: Between August 1, 2003, and October 31, 2005, 118 patients underwent DBE, and 52 patients (30 men, 22 women; mean age, 52.8 years) in whom a total of 159 ulcerative lesions in the small intestine were detected were enrolled in this study. After detailed endoscopic observation, biopsy specimens were obtained, and double-contrast barium examination was performed as deemed necessary. Final diagnosis was made comprehensively on the basis of endoscopic findings, pathologic findings and clinical course. Results: The most common indication for DBE in these patients was gastrointestinal bleeding (n Z 31, 59.6%). There were 12 patients (23.1%) with ulcerative lesions related to tumor (Ul-tm) and 40 patients (76.9%) with ulcerative lesions related to chronic inflammation (Ul-inf). Ten patients (83.3%) with Ul-tm had lesions located in the upper small intestine; 29 patients (72.5%) with Ul-inf had lesions located in the lower small intestine. Small (3-4 mm), circular, scattered ulcerations were commonly detected endoscopically. Twelve patients showed stenotic lesions caused by Crohn’s disease (n Z 5), tuberculosis (n Z 4) and other causes (n Z 3). A definitive diagnosis was obtained by DBE in 17 patients (42.5%). A definitive diagnosis was obtained by double-contrast barium examination after DBE in 4 patients (10%) and by consideration of DBE findings and the clinical course in 8 patients (20%). Seven cases (17.5%) remained undiagnosed. Thus, most lesions of the small intestine could be diagnosed definitively from characteristic endoscopic findings. However, some ulcerative lesions, especially those related to chronic inflammation, could not be diagnosed on the basis of a single DBE examination because configurations of the lesions varied easily according to disease stage or treatment. Conclusions: Our results suggest that about half ulcerative lesions in about 50% of patients cannot be diagnosed definitively on the basis of a single endoscopic observation.