上部消化管異物に対する内視鏡的処置は比較的日常的に遭遇することの多い事象であり，迅速で適切な対応が必要といえる．過去の症例を集計し解析することで診断・治療の一助として期待できることから2013年5月から2025年5月までに当院で診療した内視鏡的処置を集計した．対象は食道・胃・十二指腸に異物が確認された症例であり，異物の種類や治療に要した時間等を集計し検討した．全体の95％の症例で内視鏡的摘出可能であったが4症例で治療の断念や外科的摘出を要したものもあった．治療を要する合併症は全症例中1例のみであった．これらのデータを基に上部消化管異物に対しての内視鏡治療の有用性および安全性について実際の症例を呈示し検討した．集計の結果内視鏡的異物除去は有効な選択肢であるとともに，合併症リスクについて慎重に検討し必要に応じて外科的治療や経過観察も検討する必要があることが示唆された．

【背景と目的】微小病変ではCSPが難しいことがある．CSP中の適切な送気量を客観的に知ることはできなかった．今回CSP中の腸管内圧と切除検体の病理診断との関係を検討した．

【背景】対策型胃癌内視鏡検診において，受検率が低下することは胃癌発見機会の喪失になることが懸念されている．本研究では，日本で行われている対策型胃癌内視鏡検診戦略において，受検率低下が費用対効果に与える影響を決定することを目的とした．

An 87-year-old female patient presented with hematochezia. Clinical examination revealed an elevated, erythematous lesion on the perianal skin. Imaging studies, including computed tomography, showed edema of the rectal mucosa with enlargement of the regional lymph nodes, particularly the left inguinal and aortic nodes. Colonoscopy revealed a 20 mm high lesion on the rectal mucosa, which was not in continuity with the perianal lesion. Histopathological analysis of both the perianal skin and the rectal biopsy confirmed the diagnosis of colorectal cancer, with subsequent identification of pagetoid spread from the rectal malignancy. Differentiating between perianal Paget's disease and pagetoid spread originating from nearby carcinomas is a diagnostic challenge, and the use of immunohistochemical staining is proving to be an invaluable adjunct. In the presence of perianal mucosal lesions, colonoscopy is strongly recommended to assess the potential for pagetoid spread from other primary sites.

A 66-year-old female patient presented with hematemesis. Esophagogastroduodenoscopy (EGD) revealed a 30 mm solitary polyp in the middle part of the stomach. The bleeding source was not identified. Contrast-enhanced CT showed a 30 mm mass in the stomach. The area surrounding the mass was well enhanced in the arterial phase, suggesting possible bleeding from this area.

We report the case of a 70-year-old woman who underwent breast-conserving surgery for right breast cancer. Fourteen years after surgery, elevated CA15-3 levels were detected. A PET/CT scan revealed enhancement in the gastric body, and esophagogastroduodenoscopy showed mild edema and erosions throughout the gastric body. These findings didn't resemble the typical mucosal pattern of gastric cancer. A biopsy of the lesion revealed adenocarcinoma with signet-ring cells, and immunohistochemistry confirmed ER and GATA3 positivity, consistent with gastric metastasis from breast cancer.

We report eight cases of the endoscopic covered colonic stenting for the obstruction of the colonic cancer. Covered colonic stent is effective and safe for the obstruction of the colonic cancer.

We report a case proximal release-type colonic stent for malignant rectal obstruction. The proximal release-type colonic stent showed good result of decompression for lower rectal obstruction close to the dentate line. Further studies are warranted to investigate the new stent's efficacy and indications.

【背景】超音波内視鏡検査は太径の内視鏡を使用するため，鎮静薬の使用は必須であるが，鎮痛薬を使用すべきか否かについては十分検討されていない．【目的】外来超音波内視鏡検査における鎮痛薬の必要性を明らかにすることを目的とした．【方法】ミダゾラムのみを使用した患者をミタゾラム単独群，ミダゾラムとペンタゾシンを使用した患者をペンタゾシン併用群とした．評価項目は，アンケート調査による患者満足度，リカバリールーム滞在時間とした．【結果】アンケート調査では鎮静薬の効き具合に関する質問に対して満足と回答した患者は，ミダゾラム単独群95.8%，ペンタゾシン併用群87.8%とミダゾラム単独群が多い傾向にあった（P=0.066）．リカバリールームを60分で退室許可となった患者は，ミダゾラム単独群22.2%，ペンタゾシン併用群9.7%とミダゾラム単独群が有意に多かった（P=0.013）．【結論】外来超音波内視鏡検査にはペンタゾシンを用いない方がよいかもしれない．

A man in his 80s was scheduled to undergo percutaneous endoscopic gastrostomy (PEG) because he was at high risk for aspiration due to Parkinson's disease. PEG was performed using the modified introducer technique with the EndoVive Seldinger PEG kit 24 Fr 3.5 cm (Boston Scientific Japan, Tokyo, Japan). The device through which the PEG tube would be connected was implanted on the anterior wall of the middle gastric body by endoscopy. Enteral nutrition and drug infusion were started the following day. Eleven days after implantation of the device, the patient experienced abdominal pain and hematemesis, and went into shock (day 0). Abdominal computed tomography revealed emphysematous gastritis, and intravenous administration of norepinephrine and antibiotics was started. His overall condition improved, and he was discharged on day 42. Although the occurrence of gastric emphysema after PEG is rare, conservative management can ensure recovery in such patients.