タイトル(別表記) An effective case of peroral endoscopic myotomy for esophageal abnormal peristalsis after Heller-Dor myotomy
著者 杉原 雄策| 原田 馨太| 加藤 諒| 山内 健司| 髙嶋 志保| 山崎 泰史| 井口 俊博| 高原 政宏| 川野 誠司| 平岡 佐規子| 眞部 紀明| 大塚 文男| 岡田 裕之|
抄録 Esophageal achalasia is a disorder of the lower esophageal sphincter muscle. Our patient, a Japanese male in his 80's, had been experiencing dysphagia for almost 60 years. He was treated with balloon dilations and Heller-Dor 5 years prior to his present admission. Esophagogastroduodenoscopy, esophageal radiography, and high-myotomy manometry indicated that the symptoms were likely due to abnormal peristalsis. With the patient’s informed consent, we performed a peroral endoscopic myotomy(POEM). The patient was discharged 4 days post-surgery. At the 6-month postoperative examination, no worsening of symptoms or relapse was observed. POEM is an excellent treatment method for esophageal achalasia from the perspective of therapeutic effect. We recommend that POEM be considered as the first-choice treatment for abnormal peristalsis after a Heller-Dor myotomy.
キーワード POEM(peroral endoscopic myotomy) 食道アカラシア(esophageal achalasia)
備考 症例報告 (Case Report)
出版物タイトル 岡山医学会雑誌
発行日 2018-08-01
130巻
2号
出版者 岡山医学会
出版者(別表記) Okayama Medical Association
開始ページ 67
終了ページ 71
ISSN 0030-1558
NCID AN00032489
資料タイプ 学術雑誌論文
関連URL isVersionOf https://doi.org/10.4044/joma.130.67
言語 Japanese
著作権者 Copyright (c) 2018 岡山医学会
論文のバージョン publisher
査読 有り
DOI 10.4044/joma.130.67
NAID 130007481050
Sort Key 5
Eprints Journal Name joma
タイトル(別表記) Achalasia treated with per-oral endoscopic myotomy (POEM)
著者 杉原 雄策| 原田 馨太| 加藤 諒| 山内 健司| 高嶋 志保| 竹井 大介| 井口 俊博| 高原 政宏| 川野 誠司| 平岡 佐規子| 田辺 俊介| 野間 和宏| 白川 靖博| 眞部 紀明| 井上 晴洋| 岡田 裕之|
抄録 Esophageal achalasia is a disorder of the lower esophageal sphincter muscle. Patients present with dysphagia, chest pain, vomiting, and aspiration. Esophageal achalasia had traditionally been treated with esophageal achalasia balloon dilatation and the Heller-Dor method, but in recent years, the use of per-oral endoscopic myotomy (POEM) has increased. Our patient, a 39-yr-old male, began experiencing dysphagia 4 years prior to his referral to our hospital. Based on the results of esophagogastroduodenoscopy, esophageal radiography and high-resolution manometry, we made the diagnosis of esophageal achalasia (Chicago classification type I) . After informed consent from the patient and his family and approval from our hospital's ethics committee were obtained, we performed a POEM. The patient was discharged on the 4th day post-surgery. At the 1-year post-operative examination, no worsening of symptoms and no relapse were observed. POEM is an excellent treatment method for esophageal achalasia from the perspective of therapeutic effect and prevention of invasion. We recommend that it be considered as the first-choice treatment for achalasia. However, accessibility to the procedure itself is limited due to the few adequately trained operators worldwide. POEM should thus be performed by an expert operator at a high-volume center.
キーワード POEM 食道アカラシア (esophageal achalasia)
備考 症例報告(Case Reports)
出版物タイトル 岡山医学会雑誌
発行日 2017-08-01
129巻
2号
出版者 岡山医学会
出版者(別表記) Okayama Medical Association
開始ページ 115
終了ページ 121
ISSN 0030-1558
NCID AN00032489
資料タイプ 学術雑誌論文
関連URL https://doi.org/10.4044/joma.129.115
言語 Japanese
著作権者 Copyright (c) 2017 岡山医学会
論文のバージョン publisher
査読 有り
DOI 10.4044/joma.129.115
Sort Key 9
Eprints Journal Name joma
参考文献 1 ) Inoue H, Minami H, Kobayashi Y, Sato Y, Kaga M, et al. : Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy (2010) 42, 265-271. 2 ) Eckardt AJ, Eckardt VF : Treatment and surveillance strategies in achalasia : an update. Nat Rev Gastroenterol Hepatol (2011) 8, 311-319. 3 ) Vaezi MF, Baker ME, Achkar E, Richter JE : Timed barium oesophagram : better predictor of long term success after pneumatic dilation in achalasia than symptom assessment. Gut (2002) 50, 765-770. 4 ) Pasricha PJ, Hawari R, Ahmed I, Chen J, Cotton PB, et al. : Submucosal endoscopic esophageal myotomy : a novel experimental approach for the treatment of achalasia. Endoscopy (2007) 39, 761-764. 5 ) Friedel D, Modayil R, Stavropoulos SN : Per-oral endoscopic myotomy : major advance in achalasia treatment and in endoscopic surgery. World J Gastroenterol (2014) 21, 17746-17755. 6 ) Onimaru M, Inoue H, Ikeda H, Yoshida A, Santi EG, et al. : Peroral endoscopic myotomy is a viable option for failed surgical esophagocardiomyotomy instead of redo surgical heller myotomy : a single center prospective study. J Am Coll Surg (2013) 217, 598-605. 7 ) Familiari P, Gigante G, Marchese M, Boskoski I, Tringali A, et al. : Peroral endoscopic myotomy for the treatment of achalasia in children. J Pediatr Gastroenterol Nutr (2013) 57, 794-797. 8 ) von Renteln D, Inoue H, Minami H, Werner YB, Pace A, et al. : Peroral endoscopic myotomy for the treatment of achalasia : a prospective single center study. Am J Gastroenterol (2012) 107, 411-417. 9 ) Costamagna G, Marchese M, Familiari P, Tringali A, Inoue H, et al. : Peroral endoscopic myotomy (POEM) for oesophageal achalasia : preliminary results in humans. Dig Liver Dis (2012) 44, 827-832. 10) Minami H, Isomoto H, Yamaguchi N, Matsushima K, Akazawa Y, et al. : Peroral endoscopic myotomy for esophageal achalasia : clinical impact of 28 cases. Dig Endosc (2013) 26, 43-51. 11) Von Renteln D, Fuchs KH, Fockens P, Bauerfeind P, Vassiliou MC, et al. : Peroral endoscopic myotomy for the treatment of achalasia : an international prospective multicenter study. Gastroenterology (2013) 145, 309-311. 12) Bredenoord A, Rosch T, Fockens P : Peroral endoscopic myotomy for achalasia. Neurogastroenterol Motil (2014) 26, 3-12. 13) Vaezi MF, Pandolfino JE, Vela MF : ACG Clinical Guideline : Diagnosis and Management of Achalasia. Am J Gastroenterol (2013) 108, 1238-1249. 14) Triadafilopoulos G, Aaronson M, Sackel S, Burakoff R : Medical treatment of esophageal achalasia : Double-blind crossover study with oral nifedipine, verapamil, and placebo. Dig Dis Sci (1991) 36, 260-267. 15) Gunasingam N, Perczuk A, Talbot M, Kaffes A, Saxena P : Update on therapeutic interventions for the management of achalasia. J Gastroenterol Hepatol (2016) 31, 1422-1428. 16) Hulselmans M, Vanuytsel T, Degreef T, Sifrim D, Coosemans W, et al. : Long-term Outcome of Pneumatic Dilation in the Treatment of Achalasia. Clin Gastroenterol Hepatol (2010) 8, 30-35. 17) Alderliesten J, Conchillo JM, Leeuwenburgh I, Steyerberg EW, Kuipers EJ : Predictors for outcome of failure of balloon dilatation in patients with achalasia. Gut (2011) 60, 10-16. 18) Richter JE, Boeckxstaens GE : Management of achalasia : surgery or pneumatic dilation. Gut (2011) 60, 869-876. 19) Farhoomand K, Connor JT, Richter JE, Achkar E, Vaezi MF : Predictors of outcome of pneumatic dilation in achalasia. Clin Gastroenterol Hepatol (2004) 2, 389-394. 20) Campos GM, Vittinghoff E, Rabl C, Takata M, Gadenstätter M, et al. : Endoscopic and Surgical Treatments for Achalasia : A Systematic Review and Meta-Analysis. Annals of Surgery (2009) 249, 45-57. 21) Ujiki MB, Yetasook AK, Zapf M, Linn JG, Carbray JM, et al. : Peroral endoscopic myotomy : a short-term comparison with the standard laparoscopic approach. Surgery (2013) 154, 893-900.
タイトル(別表記) Adenocarcinoma in the jejunum 20 years after surgery for familial adenomatous polyposis
著者 杉原 雄策| 川野 誠司| 原田 馨太| 高嶋 志保| 竹井 大介| 井口 俊博| 高原 政宏| 平岡 佐規子| 母里 淑子| 岸本 浩行| 永坂 岳司| 岡田 裕之|
抄録 A 58-year-old Japanese man visited a local clinic for the evaluation of a stomachache. He was diagnosed with intestinal obstruction. His medical history included a proctocolectomy at the age of 38 years, due to familial adenomatous polyposis (FAP). He was referred to our institution, where he underwent a computed tomography examination and endoscopy of the small intestine. The pathological diagnosis was adenocarcinoma. No invasive or metastatic lesions were observed. Therefore, partial resection of the ileum with lymphadenectomy and reconstruction of the ileostomy were performed. Pathological examination revealed that the tumor was type 2, pT3 (SS) , pN1, pPM0, pDM0, pRM0, INFb, ly1, v1, pEX0, PN0. Twenty-nine days after the surgery, the patient was diagnosed with lung metastasis and he underwent lung radiofrequency ablation. We suggest that long-term follow-up is necessary for patients after surgery for FAP, because of the risk of malignant disease developing in other organs.
キーワード 家族性大腸腺腫症 (familial adenomatous polyposis) 小腸癌 (jejunal cancer) 小腸内視鏡検査 (small intestine endoscope)
備考 症例報告 (Case Reports)
出版物タイトル 岡山医学会雑誌
発行日 2017-08-01
129巻
2号
出版者 岡山医学会
出版者(別表記) Okayama Medical Association
開始ページ 111
終了ページ 114
ISSN 0030-1558
NCID AN00032489
資料タイプ 学術雑誌論文
関連URL https://doi.org/10.4044/joma.129.111
言語 Japanese
著作権者 Copyright (c) 2017 岡山医学会
論文のバージョン publisher
査読 有り
DOI 10.4044/joma.129.111
Sort Key 8
Eprints Journal Name joma
参考文献 1 ) 中川一彦, 権藤延久, 藤原由規 : 家族性大腸腺腫症. 外科治療 (2000) 82, 838-845. 2 ) Jagelman DG, DeCosse JJ, Bussey HJR : Upper Gastrointestinal cancer in familial adenomatous polyposis. Lancet (1988) 21, 1149-1151. 3 ) 八重樫寛治, 岩間毅夫, 三島好雄 : 家族性大腸ポリポーシス. 日臨 (1991) 49, 2910-2916. 4 ) Vasen H, Moslein G, Alonso A, Aretz S, Bernstein I, et al. : Guidelines for the clinical management of familial adenomatous polyposis (FAP) . Gut (2008) 57, 704-713. 5 ) 澤田 傑, 上坂克彦, 加藤知行, 森本剛史, 小寺泰弘, 他 : 多発性十二指腸癌と腹腔内デスモイド腫瘍を併発した大腸腺腫症の1例. 日消外会誌 (1996) 29, 122-126. 6 ) 塩田摂成, 星野和義, 梶谷慎司, 万木英一, 阿部重郎, 他 : 大腸全摘術施行後, 胃全摘術後に多発性十二指腸腺腫内癌を生じた家族性腺腫性ポリポーシスの1例. 癌の臨床 (1999) 45, 237-241. 7 ) 秋山典夫, 石﨑正壽, 田中司玄文, 藤田耕一郎 : 家族性大腸選手用に大腸癌, 胃癌, 十二指腸乳頭部癌を合併した1例. 日消外会誌 (2000) 61, 1613-1617. 8 ) Kashiwagi H, Kanazawa K, Koizumi M, Shibusawa H, Spigelman A : Development of duodenal cancer in a patient with familial adenomatous polyposis. J Gastroenterol (2000) 35, 856-860. 9 ) 吉田 信, 河島秀昭, 原 隆志, 石後岡正弘, 樫山基矢, 他 : 家族性大腸腺腫症の術後回腸瘻閉鎖部に発症した小腸癌の1例. 日消外会誌 (2002) 35, 1438-1442. 10) Iizuka T, Sawada T, Hayakawa K, Hashimoto M, Udagawa H, et al. : Successful Local Excision of Ileostomy Adenocarcinoma After Colectomy for Familial Adenomatous Polyposis : Report of a Case. Surg Today (2002) 32, 638-641. 11) 永橋昌幸, 土屋嘉昭, 野村達也, 梨本 篤, 藪崎 裕, 他 : 十二指腸癌に対して膵頭温存十二指腸全摘術を施行した家族性大腸腺腫症の1例. 日消外会誌 (2000) 61, 28-33. 12) 木村 理, 平井一郎, 渡邊利広, 森谷敏幸, 高須直樹, 他 : 家族性大腸腺腫症術後に発生したVater 乳頭部癌に対して乳頭切除術を施行した1例. 胆道 (2008) 22, 732-735. 13) 星野伸晃, 加藤岳人, 平松和洋 : 胃全摘23年後に十二指腸球部盲端に腺癌が発症したGardner 症候群の1例. 日消外会誌 (2013) 46, 85-90. 14) 鈴木秀幸, 柴田 近, 三浦 康 : FAP に対する大腸全摘後の永久回腸ストーマに発生した回腸癌の2例. 日消外会誌 (2012) 45, 451-458. 15) 星野伸晃, 加藤岳人, 平松和洋 : 胃全摘後23年目に十二指腸球部盲端に腺癌が発症したGardner 症候群の1例. 日消外会誌 (2013) 46, 85-90. 16) 村木 愛, 堀 明洋, 森岡 淳 : 家族性大腸腺腫症に対する大腸全摘術後の回腸人工肛門部癌の1例. 日臨外会誌 (2013) 74, 2841-2845. 17) Ishida H, Kumamoto K, Amano K : Identification of APC Gene Mutations in Jejunal Carcinomas from a Patient with Familial Adenomatous Polyposis. Jpn J Clin Oncol (2013) 43, 929-934. 18) 石橋敬一郎, 渡辺雄一郎, 近範 泰 : 家族性大腸腺腫症に発生した子宮内膜癌, 卵巣癌, 十二指腸癌の1例. Jpn J Cancer Chemother (2015) 42, 1715-1717. 19) Vogelstein B, Fearon ER, Hamilton SR, Kern SE, Preisinger AC, et al. : Genetic alterations suring colorectal tumor development. N Engl J Med (1988) 319, 525-532. 20) 牛尾恭輔, 石堂達也, 中嶋秀麿, 宮川邦久, 石川 勉, 他 : 臨床研究から明らかなにしえた家族性大腸腺腫症の病態. 胃と腸 (1993) 28, 1305-1321. 21) Spigelman AD, Talbot IC, Penna C, Nugent KP, Phillip RK, et al. : Evidence for adenoma-carcinoma sequence in the duodenum of patients with familial adenomatous polyposis. J Clin Pathol (1994) 47, 709-710. 22) 新井賢一郎, 船橋公彦, 小池淳一, 栗原聰元, 塩川洋之, 他 : 早期診断と治療において腹腔鏡補助下手術が有用であった原発性早期小腸癌の1例の本邦報告41例の文献的考察. 臨床と研究 (2013) 88, 108-113. 23) Matsumoto M, Nakajima T, Kakugawa Y, Sakamoto T, Kuribayashi S, et al. : Surveillance using capsule endoscopy is safe in postcolectomy patients with familial adenomatous polyposis : a prospective Japanese study. Fam Cancer (2016) 15, 75-83.