Nonwovens composed of nanofibers of poly(ethylene-co-vinyl alcohol) (EVAL) blended with poly(acrylic acid) (PAA) were prepared by an electrospinning technique and then crosslinked by a heat treatment. A process for adsorbing alternating polyelectrolytes in solutions, termed the "layer-by-layer (LBL) technique'', was used to coat the nanofibers in the nonwovens. A combination of electrolytes was used: poly(diallyldimethylammonium chloride) (PDDAC) was used as the cationic polymer and poly(sodium 4-styrenesulfonate) (PSSNa) was used as the anionic polymer for the polycation:polyanion combinations. The water content of the modified nanofiber nonwovens increased with the number of LBL treatments at various relative humidities.

A malignant hilar biliary stricture is usually unresectable at the time of diagnosis and requires multiple biliary stentings. Metallic mesh stents remain patent for a relatively long time in the biliary stricture compared to tube stents [1]. However, employing multiple metallic mesh stents is sometimes very difficult because of their small lumen, which impedes the delivery of a catheter. The Soehendra stent retriever (Soehendra SR; Wilson-Cook Medical Inc., Winston-Salem, North Carolina, USA) is useful for dilating a stenosed biliary or pancreatic duct [2] [3] [4]. We used it to expand the mesh holes in metallic mesh stents placed in patients with malignant biliary hilar stricture who were undergoing multiple stenting.

BACKGROUND:There have been few reports that compare the effect of histamine H2-receptor antagonists (H2RAs) and proton pump inhibitors (PPIs) using continuous gastric pH monitoring for a long duration.AIM:To assess the early effects of both drugs on gastric pH using a wireless pH monitoring system.METHODS:The test was conducted by a cross-over test: 10 healthy male volunteers were administered famotidine 20 mg twice a day and lansoprazole 30 mg once a day. Monitoring of gastric pH over four consecutive days was performed using a unique method we have developed that is an elaboration of the Bravo system.RESULTS:The time to reach a pH level of 3 or more with famotidine was significantly shorter than that for lansoprazole. The pH3 holding time ratio of famotidine during the first 4 h of administration was significantly higher than that of lansoprazole. The pH3 holding time ratio on each day from day 1 to day 3 was significantly higher following lansoprazole administration compared with famotidine administration.CONCLUSIONS:Famotidine was shown to act quickly in elevating gastric pH; however, lansoprazole was superior to famotidine in terms of its ability to elevate gastric pH for a long duration.

Granular cell tumor (GCT) of esophagus is a rare lesion, usually found incidentally during upper gastrointestinal endoscopic examination undertaken for another reasons. The origin of this neoplasm is still unclear but no organ seems to be immune to this neoplasm. Although most of the lesions are benign, few reports of malignant GCT, synchronous as well as metachronous, are also reported. It can occur at any age, but are most commonly observed in fourth and fifth decade of life. We herein report a case of multiple GCT treated by endoscopic mucosal resection and review the relevant literatures.

Background The Bravo system was designed mainly to monitor esophageal pH, and there have been no reports on gastric pH monitoring using this system. Objective To place the Bravo capsule on the gastric wall and monitor gastric pH. Design Experimental clinical trial with the cooperation of volunteers. Setting Academic medical center. Patients Eleven volunteers (9 men, 2 women; mean age 38 years; 3 had symptoms of GERD). Interventions The Bravo system was introduced into the esophagus and stomach along a thin endoscope and capsules were attached, one each to the esophageal and gastric walls under direct vision through the endoscope. Esophageal and gastric pHs were simultaneously monitored. Results The 2 capsules were successfully placed in 10 of the 11 subjects, and both esophageal and gastric pHs were monitored for 48 hours in 9 subjects. Mild to moderate precordial pain was observed in 7 subjects, but no other complications or side effects were observed in this study. The gastric pH of 10 subjects increased after meals and returned to baseline pH 2 hours later. Decrease of esophageal pH was observed 1 hour after a meal in the symptomatic subjects and corresponded to the time when gastric pH decreased secondary to the increase of pH with meals. Conclusions The Bravo capsule is easily placed on the gastric wall under endoscopic assistance and enables long ambulatory monitoring of gastric pH.

We have developed a new electronic endoscopes to record and reproduce the arbitrary spectral images of the mucous membrane such as the gullet, colon and stomach. The reflectance spectra of those membranes can be estimated by the Wiener estimation method based on the principal component analysis of measured reflectance spectra of membrane by the endoscope spectrophotometer. In this paper, we show that the endoscopes are greatly significant to diagnose the various kinds of diseases in comparison with the conventional electronic endoscopes used R, G and B color information.

BACKGROUND/AIMS:Electrochemotherapy, which uses two parallel electrodes for delivery of electric pulses, may be useful for treatment of tumor nodules. However, in clinical fields, tumors that are larger than the distance between the two electrodes are frequently observed, and it would be difficult in such cases to deliver electric pulses to the tumor. This study was done to define how host antitumor immunity is generated by repeated electrochemotherapy treatments, and whether it is associated with regression of even large tumor nodules.METHODOLOGY:Balb/c mice and Balb/c nude mice were inoculated subcutaneously with colon 26. Electrochemotherapy using bleomycin and electroporation (CUY21) was administered as a treatment for tumor nodules that were larger than the distance between the electrodes.RESULTS:In Balb/c mice, growth of large tumors at the start of treatment is not inhibited by a single electrochemotherapy treatment. However, complete tumor regression was obtained through repeated electrochemotherapy treatments. No tumor cure was observed among Balb/c nude mice under the same therapeutic conditions. Inflammatory cells were accumulated in the tumor tissue seven days after the third electrochemotherapy treatment.CONCLUSIONS:Repeated electrochemotherapy is a promising treatment, even for large tumors, such as are usually encountered in clinical practice, by generating T-cell dependent, antitumor immunity.

BACKGROUND/AIMS Circumferential endoscopic mucosal resection (EMR) around lesions performed by an insulation-tipped diathermic knife (IT knife) increases en bloc resection rates, suggesting the possibility of expanding indications for EMR. METHODOLOGY Clinical outcome of EMR performed by IT knife under general anesthesia was evaluated for 26 patients with 29 early gastric cancer. RESULTS Successful en bloc resection rates obtained by the IT knife were 100, 87.5, 90.0 and 100% for lesions < or =10 mm in size, 11-20 mm, 21-30 mm, and > or =31 mm, respectively. They were significantly higher with the IT knife than those obtained by the conventional method (IT knife method: 93.1% vs. conventional method: 28.5%, p<0.0001). Two lesions were lateral margin positive, and in three cases invasion of lesions was observed as deep as the submucosa. Distal, total, and proximal gastrectomy with D2 lymphadenectomy, respectively, was provided in 3 cases; however, no lymph node involvement was found in any of the resected specimens. Bleeding and perforation were observed in 3 cases, respectively, however, no additional surgical treatment was required for these patients. CONCLUSIONS EMR by means of the IT knife under general anesthesia can be performed safely and adequately. It is a useful treatment modality for early gastric cancer.

The Soehendra stent retriever is reported to be useful for dilating a stenosed pancreatic or biliary duct [1] [2] [3] [4]. We have also used it to drain a pancreatic pseudocyst under endoscopic ultrasound (EUS) guidance.

Primary malignant melanoma of the esophagus (PMME) is an uncommon but aggressive tumor with very poor prognosis. There is no established treatment plan for the disease, which may be attributed to its rarity and aggressiveness. Surgery is the choice of treatment in early cases. Radiotherapy follows surgery, and chemotherapy has an insignificant role in its treatment. Radiation with heavy ion beams is showing promising results in cancer therapy. Compared to conventional radiation, it permits selective irradiation with minimal injury to the surrounding normal tissue, and treatment with a low dose within a short interval of time is possible. We herein report a case of PMME treated with heavy ion radiation, the first case to be reported so far, and review the relevant literature.

In Japan, the results of histopathologic analyses on esophageal carcinomas have shown that almost all of them are squamous epithelial cancers. The abnormal epithelium that is difficult to differentiate by endoscopy can be easily visualized by chromoendoscopy with the use of iodine staining. Since the establishment of endoscopic mucosal resection (EMR), it has been used increasingly to treat mucosal cancers. It is necessary to diagnose accurately the depth of invasion of mucosal cancer when it is to be treated by EMR. In this article, we explain our routine techniques to visualize and interpret the lesions that are candidates for EMR. It is of great benefit to detect lesions at their early stage, which leads to the most desirable endoscopic treatment.

It is mandatory to have a confident diagnosis for an extension of indication of endoscopic mucosal resection. From the standpoint of endoscopic ultrasonography (EUS) using a high-frequency ultrasound probe, it is important to scan as perpendicularly as possible in order to visualize the esophageal wall having at least nine layers. It is also important to confirm the deepest point of invasion by moving the probe over the whole area of the lesion of interest under endoscopic control. It is crucial to interpret subtle grayscale changes, visualized as a low-echoic areas. This is useful in order to be able to differentiate mass from cysts, esophageal glands, or blood vessels. It is especially necessary to recognize the lymph follicles, usually found in the lamina propria. in superficial esophageal carcinoma.A tip to use, when trying to differentiate m3.sm1 from sm2.sm3, is to focus on the existence of the 3/9 layer of the muscularis mucosae during a high-frequency-probe EUS.

Strong evidence exists for the efficacy of H. pylori eradication in achieving gastric low-grade MALT lymphoma (L-MALT) regression when the bacteria present. Besides histological evaluation, the appearance of endoscopic finding such as 'discolored mucosa-like atrophy' after treatment may be useful for the prediction of its outcome (endoscopic evaluation). However, a reliable marker for molecular evaluation is not obtained so far. On the other hand, long-term control of L-MALT with H. pylori eradication therapy is uncertain and there still remains a subset of patients with no evidence of H. pylori or who fail H. pylori eradication therapy. Therefore, the optimal non antibiotic therapy for these patients has been studied. According to the recent report, radiation therapy appears to be well tolerated and effective for patients with gastric L-MALT.

We performed esophagocardioplasty with the gastric patch (original GP) as the treatment of first choice in patients with esophageal achalasia. However, postoperative reflux esophagitis occurred in many due to secretory dysfunction of the gastric mucosa implanted in the mediastinum. We therefore developed two modifications of the gastric patch technique (GP II and GP III) which do not involve implantation of the gastric mucosa in the esophagus. Twenty-three patients have undergone the modified GP II procedure in our institution. Postoperative changes in the esophagus were examined fluoroscopically, and it was found that esophageal diameter increased from an average 2.9 +/- 0.6 cm to 5.2 +/- 1.0 cm at an average follow-up of 7.1 months (p < 0.01). All 23 patients experienced amelioration of symptoms, even though some reddening was still present in the lower esophagus, with a maximum follow-up of 8 years. Based on these results, the modified GP procedures are an acceptable open surgery modality for esophagocardioplasty in esophageal achalasia.

We evaluated diagnostic X-ray and endoscopic examination findings in 486 patients with esophageal achalasia. Concerning the association between the duration of disease and the X-ray dilatation type, the duration was 1-4 years in more than 50% of patients with the Sp type, a mean of 8.5 years in those with the F type, and frequently more than 10 years in those with the S type. Endoscopy is generally used to determine the presence or absence of abnormal movement. In achalasia, the endoscope can be inserted into the stomach despite resistance at the stenotic site, and the mucosal surface is normal. Squamous cell carcinoma as a complication was observed in 21 patients (4.3%). The carcinoma complication rate was higher with a longer duration of disease and a longer observation period. The mean total course including the postoperative course was 27 years. Long-term and periodic X-ray and endoscopic observation of the disease course is important, and iodine staining is indispensable for early detection of esophageal cancer.