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Kobayashi R, Hirasawa K, Ozeki Y, Sawada A, Nishio M, Sato C, Miwa H, Kaneko T, Sugimori K, Maeda S. Clinical course of small gastric subepithelial lesion less than 20 mm diagnosed by endoscopic ultrasound-guided fine-needle aspiration. J Gastroenterol Hepatol 2024. [PMID: 38450593 DOI: 10.1111/jgh.16534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 01/26/2024] [Accepted: 02/20/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND AND AIM Gastrointestinal stromal tumors (GISTs) are treated as malignant gastric subepithelial lesions (SELs), and resection is recommended. However, small gastric SELs < 20 mm with no malignant features are monitored without histopathological examination, and the frequency of malignancy is unknown. This study aimed to clarify the clinicopathological findings and clinical course of gastric SELs < 20 mm measured by endoscopic ultrasound (EUS). METHODS This retrospective cohort study included consecutive patients with small gastric SELs < 20 mm diagnosed using EUS at a tertiary referral center between 2009 and 2021. The clinical course after diagnosis using EUS-guided fine-needle aspiration (EUS-FNA) was reviewed. RESULTS Among 333 patients with small gastric SELs, 104 patients with 105 lesions underwent EUS-FNA. The pathological diagnosis was confirmed in 87 patients. GISTs were the most common pathology (47%). Among the 87 patients, 43 underwent therapeutic interventions, including tumor resection and chemotherapy. In groups of tumor resection, the pathological tumor size on the resected specimen was significantly larger than the size measured by EUS (19.5 mm vs 15.0 mm, P < 0.001), and 37% of resected SELs were 20 mm or over. No recurrence was observed after tumor resection during a mean follow-up period of 40 months. CONCLUSIONS Approximately 40% of small gastric SELs were malignant tumors, such as GIST, with most of them requiring treatment. Additionally, considering that the EUS measurement is 5 mm smaller than the pathological tumor diameter, further examinations, such as systematic EUS-FNA, may be required for SEL, including those smaller than 20 mm.
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Affiliation(s)
- Ryosuke Kobayashi
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Kingo Hirasawa
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Yuichiro Ozeki
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Atsushi Sawada
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Masafumi Nishio
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Chiko Sato
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Haruo Miwa
- Department of Gastroenterology, Yokohama City University Medical Center, Yokohama, Japan
| | - Takashi Kaneko
- Department of Gastroenterology, Yokohama City University Medical Center, Yokohama, Japan
| | - Kazuya Sugimori
- Department of Gastroenterology, Yokohama City University Medical Center, Yokohama, Japan
| | - Shin Maeda
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Ozeki Y, Hirasawa K, Sawada A, Ikeda R, Nishio M, Fukuchi T, Kobayashi R, Sato C, Maeda S. Impact of endoscopy intervals on metachronous gastric cancer after endoscopic submucosal dissection: Comparison between 1 year and half-a-year. Dig Endosc 2024; 36:332-340. [PMID: 37209401 DOI: 10.1111/den.14599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 05/16/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVES Japanese guidelines recommend posttreatment endoscopy once or twice a year after endoscopic submucosal dissection (ESD) for early gastric cancer. However, the impact of endoscopy intervals on metachronous gastric cancer (MGC) remains unclear, especially the difference between 1-year and half-a-year intervals. We aimed to investigate this difference. METHODS This study retrospectively investigated 2429 patients who underwent gastric ESD between May 2001 and June 2019 at our hospital. Patients who developed MGC were classified based on those who underwent the previous endoscopy within at least 7 months (short-interval group) and within 8-13 months (regular-interval group). Propensity score matching (PSM) was used to adjust for possible confounders. The primary outcome was the proportion of MGC beyond curative ESD criteria established in the guidelines. RESULTS A total of 216 eligible patients developed MGC. The short- and regular-interval groups included 43 and 173 patients, respectively. Overall, no patients in the short-interval group had MGC beyond curative ESD criteria, while 27 patients in the regular-interval group did. The proportion of MGC beyond curative ESD criteria was significantly lower in the short-interval group than in the regular-interval group before (P = 0.003) and after (P = 0.028) PSM. Although not significant, the short-interval group tended to have a higher stomach preservation rate than the regular-interval group (P = 0.093). CONCLUSION Our study indicated a possible benefit of biannual surveillance endoscopy in the early post-ESD period.
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Affiliation(s)
- Yuichiro Ozeki
- Division of Endoscopy, Yokohama City University Medical Center, Kanagawa, Japan
| | - Kingo Hirasawa
- Division of Endoscopy, Yokohama City University Medical Center, Kanagawa, Japan
| | - Atsushi Sawada
- Division of Endoscopy, Yokohama City University Medical Center, Kanagawa, Japan
| | - Ryosuke Ikeda
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Masafumi Nishio
- Division of Endoscopy, Yokohama City University Medical Center, Kanagawa, Japan
| | - Takehide Fukuchi
- Division of Endoscopy, Yokohama City University Medical Center, Kanagawa, Japan
| | - Ryosuke Kobayashi
- Division of Endoscopy, Yokohama City University Medical Center, Kanagawa, Japan
| | - Chiko Sato
- Division of Endoscopy, Yokohama City University Medical Center, Kanagawa, Japan
| | - Shin Maeda
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
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Nishio M, Hirasawa K, Saigusa Y, Atsusaka R, Azuma D, Ozeki Y, Sawada A, Ikeda R, Fukuchi T, Kobayashi R, Sato C, Ogashiwa T, Inayama Y, Kunisaki R, Maeda S. Predictors of severe submucosal fibrosis during endoscopic submucosal dissection in patients with ulcerative colitis: Retrospective cohort study. Dig Endosc 2024; 36:172-181. [PMID: 37070407 DOI: 10.1111/den.14570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 04/16/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVES Severe submucosal fibrosis is a crucial technical difficulty encountered during endoscopic submucosal dissection (ESD) in patients with ulcerative colitis (UC). We aimed to identify predictors of severe submucosal fibrosis in patients with UC. METHODS We retrospectively included 55 tumors resected using ESD from 48 consecutive patients with UC. We analyzed the clinicopathological characteristics and treatment outcomes between the F0/1 (none to mild submucosal fibrosis) group (n = 28) and F2 (severe submucosal fibrosis) group (n = 27). RESULTS No significant difference was found between the F0/1 and F2 groups in en bloc resection rate (100% vs. 96%, P = 0.49), the R0 resection rate (100% vs. 93%, P = 0.24), and the dissection speed (0.18 vs. 0.13 cm2 /min, P = 0.07). Intraoperative perforation was more common in the F2 group (30%) than in the F0/1 group (8%; P = 0.01). Multivariable analysis showed that a longer duration of UC (≥10 years; odds ratio [OR] 6.11; 95% confidence interval [CI] 1.20-31.03; P = 0.03) and scarring of background mucosa of the tumor (OR 39.61; 95% CI 3.91-400.78; P < 0.01) were independent predictors of severe submucosal fibrosis. CONCLUSION Long UC duration and scarring background mucosa were predictors of severe submucosal fibrosis associated with perforation during ESD.
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Affiliation(s)
- Masafumi Nishio
- Division of Endoscopy, Yokohama City University Medical Center, Kanagawa, Japan
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Kanagawa, Japan
| | - Kingo Hirasawa
- Division of Endoscopy, Yokohama City University Medical Center, Kanagawa, Japan
| | - Yusuke Saigusa
- Departments of Biostatistics, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Reo Atsusaka
- Division of Endoscopy, Yokohama City University Medical Center, Kanagawa, Japan
| | - Daisuke Azuma
- Division of Endoscopy, Yokohama City University Medical Center, Kanagawa, Japan
| | - Yuichiro Ozeki
- Division of Endoscopy, Yokohama City University Medical Center, Kanagawa, Japan
| | - Atsushi Sawada
- Division of Endoscopy, Yokohama City University Medical Center, Kanagawa, Japan
| | - Ryosuke Ikeda
- Division of Endoscopy, Yokohama City University Medical Center, Kanagawa, Japan
| | - Takehide Fukuchi
- Division of Endoscopy, Yokohama City University Medical Center, Kanagawa, Japan
| | - Ryosuke Kobayashi
- Division of Endoscopy, Yokohama City University Medical Center, Kanagawa, Japan
| | - Chiko Sato
- Division of Endoscopy, Yokohama City University Medical Center, Kanagawa, Japan
| | - Tsuyoshi Ogashiwa
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Kanagawa, Japan
| | - Yoshiaki Inayama
- Division of Diagnostic Pathology, Yokohama City University Medical Center, Kanagawa, Japan
| | - Reiko Kunisaki
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Kanagawa, Japan
| | - Shin Maeda
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
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Yasaka K, Sato C, Hirakawa H, Fujita N, Kurokawa M, Watanabe Y, Kubo T, Abe O. Impact of deep learning on radiologists and radiology residents in detecting breast cancer on CT: a cross-vendor test study. Clin Radiol 2024; 79:e41-e47. [PMID: 37872026 DOI: 10.1016/j.crad.2023.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/13/2023] [Accepted: 09/29/2023] [Indexed: 10/25/2023]
Abstract
AIM To investigate the effect of deep learning on the diagnostic performance of radiologists and radiology residents in detecting breast cancers on computed tomography (CT). MATERIALS AND METHODS In this retrospective study, patients undergoing contrast-enhanced chest CT between January 2010 and December 2020 using equipment from two vendors were included. Patients with confirmed breast cancer were categorised as the training (n=201) and validation (n=26) group and the testing group (n=30) using processed CT images from either vendor. The trained deep-learning model was applied to test group patients with (30 females; mean age = 59.2 ± 15.8 years) and without (19 males, 21 females; mean age = 64 ± 15.9 years) breast cancer. Image-based diagnostic performance of the deep-learning model was evaluated with the area under the receiver operating characteristic curve (AUC). Two radiologists and three radiology residents were asked to detect malignant lesions by recording a four-point diagnostic confidence score before and after referring to the result from the deep-learning model, and their diagnostic performance was evaluated using jackknife alternative free-response receiver operating characteristic analysis by calculating the figure of merit (FOM). RESULTS The AUCs of the trained deep-learning model on the validation and test data were 0.976 and 0.967, respectively. After referencing with the result of the deep learning model, the FOMs of readers significantly improved (reader 1/2/3/4/5: from 0.933/0.962/0.883/0.944/0.867 to 0.958/0.968/0.917/0.947/0.900; p=0.038). CONCLUSION Deep learning can help radiologists and radiology residents detect breast cancer on CT.
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Affiliation(s)
- K Yasaka
- Department of Radiology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - C Sato
- Department of Radiology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - H Hirakawa
- Department of Radiology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - N Fujita
- Department of Radiology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - M Kurokawa
- Department of Radiology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Y Watanabe
- Department of Radiology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - T Kubo
- Department of Radiology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - O Abe
- Department of Radiology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Fukuchi T, Hirasawa K, Ikeda R, Nishio M, Kobayashi R, Sato C, Maeda S. A nerve-preserving strategy for endoscopic submucosal dissection of superficial pharyngeal cancers. Endoscopy 2023; 55:E910-E911. [PMID: 37442178 PMCID: PMC10344627 DOI: 10.1055/a-2109-0561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Affiliation(s)
- Takehide Fukuchi
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Kingo Hirasawa
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Ryosuke Ikeda
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Masafumi Nishio
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Ryosuke Kobayashi
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Chiko Sato
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Shin Maeda
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Sawada A, Hirasawa K, Sato C, Sato S, Sato T, Sugimori K, Kunisaki C, Maeda S. Endoscopic Resection with One-Port Placement: A Newly Developed Technique for the Safe Management of Advanced Endoscopic Resection for Gastric Gastrointestinal Stromal Tumors. Digestion 2023; 104:460-467. [PMID: 37647880 DOI: 10.1159/000532012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 07/05/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION Endoscopic full-thickness resection (EFTR) without laparoscopic assistance (pure EFTR) is an emerging, less invasive treatment for gastrointestinal stromal tumors (GISTs). However, the technique has seldom been performed outside China because of concerns regarding pneumoperitoneum, maintenance of endoscopic view, and endoscopic suturing. This study aimed to evaluate the efficacy and safety of endoscopic resection with one-port placement (EROPP) for gastric GISTs. METHODS This retrospective study included 17 patients with gastric GISTs originating from the muscularis propria who underwent EROPP between 2019 and 2022. One camera port was inserted in the umbilicus before initiating the endoscopic procedure to maintain intra-abdominal pressure, which was monitored and adjusted via this port. While allowing for conversion to laparoscopic surgery if needed, EFTR was performed as follows: (1) circumferential incision of the mucosal and submucosal layers around the lesion was performed by typical endoscopic submucosal dissection; (2) an intentional perforation and subsequent seromuscular resection was made using dental floss and an endo-clip for traction; and (3) closure of the gastric full-thickness defect was performed with an over-the-scope clip (OTSC) after peroral retrieval of the specimen. We retrospectively assessed the short-term outcomes and safety. RESULTS All procedures were completed successfully without conversion to laparoscopic surgery. The median size of the resected tumors was 23 mm (range, 8-35 mm), the median resection time was 36 min (range, 22-95 min), and closure time was 18 min (range, 10-45 min). The rates of en bloc and complete resection were 100% and 88%, respectively. In 2 cases, another port was added to aspirate the leaking fluid or check the condition of the endoscopic closure. All gastric defects were endoscopically closed, mainly using OTSCs. The recovery course for all patients was uneventful, and no adverse events were reported. CONCLUSIONS EROPP is a safe and minimally invasive treatment for gastric GISTs and appears to be suitable for introducing EFTR procedures.
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Affiliation(s)
- Atsushi Sawada
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Kingo Hirasawa
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Chiko Sato
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Sho Sato
- Department of Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Tsutomu Sato
- Department of Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Kazuya Sugimori
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Chikara Kunisaki
- Department of Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Shin Maeda
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Ikeda R, Hirasawa K, Ozeki Y, Sawada A, Nishio M, Fukuchi T, Sato C, Maeda S. Cervical esophageal adenocarcinoma of intestinal type in ectopic gastric mucosa. DEN Open 2023; 3:e141. [PMID: 35898822 PMCID: PMC9307747 DOI: 10.1002/deo2.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/17/2022] [Accepted: 05/24/2022] [Indexed: 12/03/2022]
Abstract
A 45‐year‐old man underwent esophagogastroduodenoscopy because of symptoms of laryngopharyngeal discomfort. We found a protruded reddish lesion adjacent to the ectopic gastric mucosa (EGM) in the cervical esophagus, and a biopsy revealed that it was a tubular adenocarcinoma. We diagnosed the patient with intramucosal cancer and performed endoscopic submucosal dissection. Esophageal endoscopic submucosal dissection was performed under general anesthesia using a conventional procedure. The resected tumor measured 23 × 14 mm and was adjacent to the EGM. Histologically, the tumor cells showed moderately well‐differentiated adenocarcinoma confined to the muscularis mucosa with no lymphovascular infiltration. Immunohistochemically, the tumor cells were positive for intestinal markers, namely MUC2 and CD10, and negative for gastric markers, namely MUC5AC and MUC6. The patient had no post‐endoscopy submucosal dissection stenosis and remained disease‐free without local recurrence. EGM of the cervical esophagus develops from the columnar epithelium during embryonic development. There are few reports on endoscopic submucosal dissection for mucosal cancer. Of these, immunostaining was performed in three cases. All were positive for MUC5AC and MUC6 and negative for MUC2 and CD10. Usually, EGM shows gastric type epithelium, but occasional cases with intestinal metaplasia, which show positivity for MUC2 and CD10, have been reported. Therefore, we consider this to be an extremely rare case of esophageal adenocarcinoma arising from intestinal metaplasia within the EGM.
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Affiliation(s)
- Ryosuke Ikeda
- Endoscopy Division Yokohama City University Medical Center Kanagawa Japan
| | - Kingo Hirasawa
- Endoscopy Division Yokohama City University Medical Center Kanagawa Japan
| | - Yuichiro Ozeki
- Endoscopy Division Yokohama City University Medical Center Kanagawa Japan
| | - Atsushi Sawada
- Endoscopy Division Yokohama City University Medical Center Kanagawa Japan
| | - Masafumi Nishio
- Endoscopy Division Yokohama City University Medical Center Kanagawa Japan
| | - Takehide Fukuchi
- Endoscopy Division Yokohama City University Medical Center Kanagawa Japan
| | - Chiko Sato
- Endoscopy Division Yokohama City University Medical Center Kanagawa Japan
| | - Shin Maeda
- Department of Gastroenterology Yokohama City University Graduate School of Medicine Kanagawa Japan
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Nishio M, Hirasawa K, Chiba S, Ozeki Y, Sawada A, Ikeda R, Fukuchi T, Kobayashi R, Sato C, Inayama Y, Kunisaki R, Maeda S. Endoscopic resection is feasible for high-grade dysplasia in patients with ulcerative colitis. Scand J Gastroenterol 2023; 58:101-106. [PMID: 36200368 DOI: 10.1080/00365521.2022.2107878] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Endoscopic resection (ER) is feasible for treating well-circumscribed dysplasia in patients with ulcerative colitis (UC). However, long-term prognosis of ER for high-grade dysplasia (HGD) in patients with UC remains unclear. We aimed to evaluate the long-term prognoses of ER for HGD compared with low-grade dysplasia (LGD) and verify the feasibility of ER and follow-up with surveillance colonoscopy for HGD. METHODS An observational, single-center retrospective study included 38 and 22 patients with LGD and HGD who were followed-up with surveillance colonoscopy after ER. We evaluated the cumulative incidence rate of metachronous HGD or colorectal cancer (CRC) and identified the characteristics of metachronous dysplasia. RESULTS The median follow-up period was 56 months, and surveillance colonoscopies were performed 3.6 times (mean). The 5-year cumulative incidence rate of HGD/CRC was relatively high in HGD (24.6%) than in LGD (13.7%), but the difference was not significant (p = .16). In HGD cases, six metachronous dysplasia lesions (two LGD and four HGD) were detected 11.6-40.5 months after ER. However, these patients did not progress to CRC. All metachronous lesions were well-circumscribed and with no invisible dysplasia surrounding them; they were 'endoscopically resectable' lesions. Two of the four metachronous HGD lesions were treated endoscopically and two, by colectomy. No synchronous HGD or CRC was detected in the colectomy specimens. CONCLUSIONS Our results suggest that ER and follow-up with surveillance colonoscopy is feasible in patients with HGD when histological complete resection is achieved.
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Affiliation(s)
- Masafumi Nishio
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Kingo Hirasawa
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Sawako Chiba
- Division of Diagnostic Pathology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yuichiro Ozeki
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Atsushi Sawada
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Ryosuke Ikeda
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Takehide Fukuchi
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Ryosuke Kobayashi
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Chiko Sato
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Yoshiaki Inayama
- Division of Diagnostic Pathology, Yokohama City University Medical Center, Yokohama, Japan
| | - Reiko Kunisaki
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Shin Maeda
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Ozeki Y, Hirasawa K, Sawada A, Ikeda R, Nishio M, Fukuchi T, Kobayashi R, Sato C, Maeda S. Learning curve analysis for duodenal endoscopic submucosal dissection: A single-operator experience. J Gastroenterol Hepatol 2022; 37:2131-2137. [PMID: 36066185 DOI: 10.1111/jgh.15995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/31/2022] [Accepted: 09/04/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND AIMS Superficial duodenal epithelial tumors are emerging targets for endoscopic submucosal dissection (ESD). However, it is unknown how competence is achieved in duodenal ESD. This study aimed to elucidate the learning curve for duodenal ESD. METHODS This retrospective observational study included 100 consecutive patients who underwent duodenal ESD by a single endoscopist between March 2014 and September 2021. The primary outcome was to define the learning curve for duodenal ESD by an endoscopist with sufficient non-duodenal ESD experience. Cumulative sum (CUSUM) curve analysis was used to assess the learning curve in terms of procedural speed. Comparative analyses of phases identified using the CUSUM method were performed. RESULTS In total, 98 patients were included in the analysis. Evaluation of the cumulative sum curve revealed four distinct phases in the graph: phase I, cases 1-25 (learning phase); phase II, cases 26-47 (proficiency phase); phase III, cases 48-72 (mastery phase); and phase IV, cases 73-98 (after introduction of general anesthesia). The median procedural speed was significantly faster in phase II than in phase I (11.1 mm2 /min vs 7.0 mm2 /min, P = .002). Clinically significant intraoperative perforation tended to decrease through phase II to phase IV (22.7%, 12.0%, and 3.8% in phases II, III, and IV, respectively). Delayed perforation occurred only in phases I and II. CONCLUSIONS Duodenal ESD requires 25 cases to gain proficiency and 50 to achieve mastery even for an endoscopist with extensive non-duodenal ESD experience.
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Affiliation(s)
- Yuichiro Ozeki
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Kingo Hirasawa
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Atsushi Sawada
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Ryosuke Ikeda
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Masafumi Nishio
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Takehide Fukuchi
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Ryosuke Kobayashi
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Chiko Sato
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Shin Maeda
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Esaki M, Yoshida M, Takizawa K, Notsu A, Nonaka S, Shichijo S, Suzuki S, Sato C, Komori H, Minagawa T, Oda I, Uedo N, Hirasawa K, Matsumoto K, Sumiyoshi T, Abe S, Gotoda T, Ono H. Comparison of treatment outcomes between endoscopic submucosal dissection with the needle-type knife and insulated-tip knife for superficial esophageal neoplasms. Dis Esophagus 2022; 36:6747073. [PMID: 36190185 DOI: 10.1093/dote/doac067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 06/14/2022] [Accepted: 09/02/2022] [Indexed: 12/11/2022]
Abstract
Our study aimed to compare the treatment outcomes between endoscopic submucosal dissection (ESD) with an insulated-tip knife (ESD-IT) and a needle-type knife (ESD-N) for large superficial esophageal neoplasms, as no study of this kind has been previously reported. We used the dataset of a multicenter, randomized controlled trial that compared conventional ESD (C-ESD) and traction-assisted ESD (TA-ESD) for superficial esophageal neoplasms. We compared the procedural outcomes between ESD-IT and ESD-N in a post hoc analysis and conducted sub-analyses based on traction assistance and electrical knife type. We included 223 (EST-IT, n = 169; ESD-N, n = 54) patients with no significant differences in baseline characteristics. The operator handover rate due to ESD difficulties was significantly higher in ESD-N (ESD-IT = 0.6% vs. ESD-N = 13.0%, P = 0.001), while the injection volume was significantly higher in ESD-IT than in ESD-N (40.0 vs. 20.5 mL, P < 0.001). Other outcomes were comparable between both groups (procedural time: 51.0 vs. 49.5 minute, P = 0.89; complete resection: 90.5% vs. 90.7%, P > 0.99; and complication rate: 1.8% vs. 3.7%, P = 0.60 for ESD-IT and ESD-N, respectively). In the sub-analyses, the handover rate was significantly lower with TA-ESD than with C-ESD for ESD-N (3.2% vs. 26.1%, P = 0.034), and a significantly smaller injection volume was used in TA-ESD than in C-ESD for ESD-IT (31.5 vs. 47.0 mL, P < 0.01). ESD with either endoscopic device achieved favorable treatment outcomes with low complication rates. The handover rate in ESD-N and the injection volume in ESD-IT improved with the traction method.
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Affiliation(s)
- Mitsuru Esaki
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.,Department of Medicine and Bioregulatory Science, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
| | - Masao Yoshida
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kohei Takizawa
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Akifumi Notsu
- Clinical Research Center, Shizuoka Cancer Center, Shizuoka, Japan
| | - Satoru Nonaka
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Satoki Shichijo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Sho Suzuki
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Chiko Sato
- Division of Endoscopy, Yokohama City University Medical Center, Kanagawa, Japan
| | - Hiroyuki Komori
- Department of Gastroenterology, Juntendo University, Tokyo, Japan
| | | | - Ichiro Oda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.,Department of Internal Medicine, Kawasaki Rinko General Hospital, Kawasaki, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Kingo Hirasawa
- Division of Endoscopy, Yokohama City University Medical Center, Kanagawa, Japan
| | - Kenshi Matsumoto
- Department of Gastroenterology, Juntendo University, Tokyo, Japan
| | | | - Seiichiro Abe
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Takuji Gotoda
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroyuki Ono
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
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11
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Hmadeh S, Trimaille A, Matsushita K, Zobairi F, Sato C, Kindo M, Hoang T, Marchandot B, Toti F, Zibara K, Hamade E, Schini Kerth V, Kauffenstein G, Morel O. Enrichment in procoagulant microparticles in calcified human aortic valve – role in valvular endothelium alterations and enhanced thrombogenicity. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Aortic stenosis (AS) is characterized by endothelial dysfunction (ED), inflammatory cell infiltration, myofibroblastic and osteoblastic differentiation. Subclinical leaflet thrombosis was recently linked to higher rates of stroke and transient ischemic attack after transcatheter aortic valve implantation (TAVI). Procoagulant microparticles (MPs) are associated with ED, inflammation and clot formation. There is limited evidence regarding intra-valvular MPs content and their potential biological effects. This question is particularly relevant in TAVI in which the residing native valve could constitute a source of thrombotic activity enhancing leaflet thrombosis and valve dysfunction.
Purpose
Therefore, we hypothesized that MPs trapped within the native aortic valve contribute to valvular dysfunction including enhanced thrombogenicity.
Methods
Human valves were collected from patients undergoing surgical valve replacement for AS or aortic insufficiency (AI). Pro-thrombotic, pro-inflammatory, and ED markers were identified in the calcified vs non-calcified part of the valves by Western-blot. Calcium content was measured through colorimetric method. MPs were extracted from human pathological valves, and quantified through their prothrombinase activity. Primary cultures of porcine valvular endothelial cells (VEC) were treated with the MPs (10 nmol/L) or thrombin (1U/ml) for 24hrs. Phenotypic change was appreciated through gene expression pattern assessed by RT-qPCR. IL-8 secretion was measured by ELISA.
Results
The phenotype of the AS valve was characterized through increased expression of thrombogenic (tissue factor, thrombomodulin, PAI-1), adhesive (VCAM-1, ICAM-1) and inflammatory (COX-1, COX-2) molecules in the calcified part of the valve. Moreover, MPs content was increased in the calcified vs non-calcified part of the valve or AI valves. MPs levels was correlated with valvular calcium content (R=0.3862: p<0.001). Tissue factor was increased in MPs extracted from AS vs AI. The biological effect of MPs was tested on VEC in-vitro. Results showed dramatic increase in expression of inflammatory cytokines (CXCL10, CCL11, CXCL8, MCP1) adhesion molecules (VCAM-1, ICAM-1, SELP, SELE) and proangiogenic factors (VEGFR2, ANGPTL4) in VEC exposed to MPs (24h) from AS vs AI. Enhanced secretory phenotype was evidenced through IL-8 determination in the supernatant of VEC stimulated with MPs from AS valve.
Conclusion
Calcified aortic valve is a potent reservoir of MPs, acting as a pro-thrombogenic source per se and promoting a switch of VEC phenotype toward prothrombotic, proinflammatory and proangiogenic pattern. These data suggest that MPs released from the native valve constitute an important source of mediators involved in enhanced thrombogenicity and valvular remodeling.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): GERCA-Groupe Etudes Reali Commercia Avignon
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Affiliation(s)
- S Hmadeh
- INSERM, UMR 1260 , Strasbourg , France
| | - A Trimaille
- Civil Hospital/ Nouvel Hopital Civil , Strasbourg , France
| | | | - F Zobairi
- INSERM, UMR 1260 , Strasbourg , France
| | - C Sato
- INSERM, UMR 1260 , Strasbourg , France
| | - M Kindo
- Civil Hospital/ Nouvel Hopital Civil , Strasbourg , France
| | - T Hoang
- Civil Hospital/ Nouvel Hopital Civil , Strasbourg , France
| | - B Marchandot
- Civil Hospital/ Nouvel Hopital Civil , Strasbourg , France
| | - F Toti
- INSERM, UMR 1260 , Strasbourg , France
| | - K Zibara
- Lebanese University , Beirut , Lebanon
| | - E Hamade
- Lebanese University , Beirut , Lebanon
| | | | | | - O Morel
- Civil Hospital/ Nouvel Hopital Civil , Strasbourg , France
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12
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Nakata M, Shimbo T, Kihara A, Sato C, Hori A, Yoshioka H, Yoshida K, Nihei K. Optimisation of Radiation Therapy in Bladder Preservation Therapy for Patients With Clinical Stage T2N0M0 Bladder Cancer. Clin Oncol (R Coll Radiol) 2022; 34:e430-e436. [PMID: 35715341 DOI: 10.1016/j.clon.2022.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 05/01/2022] [Accepted: 05/23/2022] [Indexed: 11/18/2022]
Abstract
AIMS A novel bladder preservation therapy, the OMC (Osaka Medical College) regimen, which combines radiation therapy with balloon-occluded arterial infusion of anticancer agents, is a treatment option for patients with muscle-invasive bladder cancer (MIBC). We retrospectively analysed the effects of changes in radiation dose and irradiation field on treatment efficacy and adverse events.The purpose of this study is to use the results of this study to help determine a course of radiation therapy for bladder preservation therapy of cT2N0M0 MIBC. MATERIALS AND METHODS We examined 352 patients with clinical stage T2N0M0 (cT2N0M0) MIBC classified into the following groups based on the irradiation method: group A, the whole pelvis (50 Gy/25 fractions) + local bladder (10 Gy/5 fractions); group B, the small pelvis (50 Gy/25 fractions) + local bladder (10 Gy/5 fractions); group C, the whole pelvis (40 Gy/20 fractions) + local bladder (10 Gy/5 fractions). RESULTS The complete response rate, 3-year overall survival and progression-free survival rates in group A were 92.9%, 94.9% and 82.1%, respectively; in group B were 87.2%, 86.7% and 76.7%, respectively; and in group C were 95.2%, 92.6% and 71.1%, respectively. No significant differences between the groups were noted. The incidence of ≥grade 3 urinary tract and gastrointestinal toxicities were not significantly different among the groups (group A: 7.8%, 1.7%; B, 11.1%, 0%; C, 7.1%, 1.8%, respectively). The 3-year progression-free rates of the common iliac lymph node (CILN) region in patients who received whole-pelvis and small-pelvis irradiation were 99.0 and 89.0% (P < 0.01), respectively, with the latter group having significantly high lymph node recurrence in the CILN region. CONCLUSIONS Our findings showed that the optimal radiation therapy for patients with cT2N0M0 MIBC undergoing the OMC regimen is whole-pelvis irradiation including the CILN region, with a total dose of 50 Gy/25 fractions.
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Affiliation(s)
- M Nakata
- Department of Radiation Oncology, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - T Shimbo
- Department of Radiation Oncology, Osaka Medical and Pharmaceutical University, Osaka, Japan.
| | - A Kihara
- Department of Radiation Oncology, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - C Sato
- Department of Radiation Oncology, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - A Hori
- Department of Radiation Oncology, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - H Yoshioka
- Department of Radiation Oncology, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - K Yoshida
- Department of Radiology, Kansai Medical University Medical Center, Osaka, Japan
| | - K Nihei
- Department of Radiation Oncology, Osaka Medical and Pharmaceutical University, Osaka, Japan
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13
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Nishio M, Hirasawa K, Ozeki Y, Sawada A, Ikeda R, Fukuchi T, Kobayashi R, Sato C, Ogashiwa T, Inayama Y, Kunisaki R, Maeda S. Magnifying endoscopy is useful for tumor border diagnosis in ulcerative colitis patients. Dig Liver Dis 2022; 54:812-818. [PMID: 35379586 DOI: 10.1016/j.dld.2022.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 02/09/2022] [Accepted: 03/07/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Endoscopic resection (ER) is feasible for well-circumscribed tumors in patients with ulcerative colitis (UC); however, the specific manner for diagnosis of the tumor border is unclear. We evaluated the efficacy of magnifying endoscopy (ME) for the diagnosis of tumor borders in UC. METHODS We analyzed endoscopically or surgically resected tumors in UC patients in whom both chromoendoscopy (CE) and ME were performed, retrospectively. We classified the tumors based on tumor border visibility and evaluated tumor's characteristics and ER outcomes. RESULTS We examined 100 tumors from 76 UC patients (66 distinct and 34 indistinct on CE). In 22 (65%) indistinct tumors on CE, ME improved the tumor border visibility. Compared with distinct tumors on CE, nonpolypoid and large tumors were more common in indistinct tumors on CE. In indistinct tumors even on ME, flat or depressed morphologies and type V pit were more frequently than in other groups. Sixty-five distinct tumors on CE and 18 distinct tumors on ME alone were treated endoscopically, and their R0 resection rate were 91% and 95% (p > 0.99). CONCLUSIONS ME can improve the tumor border visibility in UC, and ER is feasible for tumors whose border can be visualized on ME.
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Affiliation(s)
- Masafumi Nishio
- Division of Endoscopy, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan; Inflammatory Bowel Disease Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
| | - Kingo Hirasawa
- Division of Endoscopy, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan.
| | - Yuichiro Ozeki
- Division of Endoscopy, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
| | - Atsushi Sawada
- Division of Endoscopy, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
| | - Ryosuke Ikeda
- Division of Endoscopy, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
| | - Takehide Fukuchi
- Division of Endoscopy, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
| | - Ryosuke Kobayashi
- Division of Endoscopy, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
| | - Chiko Sato
- Division of Endoscopy, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
| | - Tsuyoshi Ogashiwa
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
| | - Yoshiaki Inayama
- Division of Diagnostic Pathology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
| | - Reiko Kunisaki
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
| | - Shin Maeda
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan
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14
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Matsushita K, Marchandot B, Hess S, Kibler M, Sato C, Heger J, Truong D, Trimaille A, Sattler L, Grunebaum L, Reydel Dedieu A, Jesel L, Ohlmann P, Morel O. Primary hemostatic disorders drive early and late major bleedings of patients with atrial fibrillation after transcatheter aortic valve replacement. Archives of Cardiovascular Diseases Supplements 2022. [DOI: 10.1016/j.acvdsp.2021.09.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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15
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Matsushita K, Marchandot B, Hess S, Kibler M, Sato C, Heger J, Truong DP, Trimaille A, Sattler L, Grunebaum L, Reydel A, Jesel L, Ohlmann P, Morel O. Primary hemostatic disorders drive early and late major bleedings of patients with atrial fibrillation after transcatheter aortic valve replacement. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Patients with atrial fibrillation (AF) are likely to have multiple co-morbidities and receive anticoagulants after TAVR, which lead to a poor prognosis including bleeding events. Closure time adenosine diphosphate (CT-ADP) is a primary hemostasis point-of-care test used as a surrogate marker of high molecular weight (HMW) multimers defect of Von Willebrand factor (VWF). Our prior studies suggest that prolongation of CT-ADP (>180 seconds) after TAVR is a major determinant of early and late major/life-threatening bleeding complications (MLBCs).
Purpose
To evaluate the impact of post-procedural CT-ADP >180sec on bleeding events in AF patients.
Methods
We included 878 patients from our prospective TAVR registry between 2010 and 2019. Bleeding complications were assessed according to the VARC-2 (Valve Academic Research Consortium-2) criteria. Major adverse cardiac and cerebrovascular events (MACCE) was defined as a composite of all-cause death, myocardial infarction, stroke, and heart failure hospitalization within 1-year after TAVR. Ongoing primary haemostasis disorder was defined by post-procedure CT-ADP >180sec. Primary endpoint was the occurrence of MLBCs during the first year and the second endpoint was 1-year MACCE.
Results
Patients with AF had a higher incidence of all-cause mortality (15% vs. 8%, p=0.002), MACCE (29% vs. 20%, p=0.002), and MLBCs (20% vs. 12%, p=0.001) within 1-year compared to non-AF patients. When the cohort was split into 4 subgroups according to AF and CT-ADP >180sec, patients with AF and CT-ADP >180sec had the highest risk of MLBCs (log-rank test; p<0.001) (Figure). Multivariate Cox regression analysis confirmed that the patients with AF and CT-ADP >180sec had 4.6-fold higher risk of MLBCs within 1 year compared to non-AF patients with CT-ADP ≤180sec (hazard ratio: 4.60; 95% confidence interval: 2.18 - 9.68; p<0.001).
Conclusion
Among TAVR patients, AF with post-procedural CT-ADP >180 sec was identified as a strong independent predictor of MLBCs at 1-year follow-up. Our study suggest that persistent primary haemostasis disorders contribute to a higher risk of bleeding events particularly in AF patients and may be considered for a tailored and risk-adjusted antithrombotic therapy after TAVR.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Dr Matsushita received a grant from Edwards Lifesciences.
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Affiliation(s)
- K Matsushita
- University Hospital of Strasbourg, Strasbourg, France
| | - B Marchandot
- University Hospital of Strasbourg, Strasbourg, France
| | - S Hess
- University Hospital of Strasbourg, Strasbourg, France
| | - M Kibler
- University Hospital of Strasbourg, Strasbourg, France
| | - C Sato
- University Hospital of Strasbourg, Strasbourg, France
| | - J Heger
- University Hospital of Strasbourg, Strasbourg, France
| | - D P Truong
- University Hospital of Strasbourg, Strasbourg, France
| | - A Trimaille
- University Hospital of Strasbourg, Strasbourg, France
| | - L Sattler
- University Hospital of Strasbourg, Strasbourg, France
| | - L Grunebaum
- University Hospital of Strasbourg, Strasbourg, France
| | - A Reydel
- University Hospital of Strasbourg, Strasbourg, France
| | - L Jesel
- University Hospital of Strasbourg, Strasbourg, France
| | - P Ohlmann
- University Hospital of Strasbourg, Strasbourg, France
| | - O Morel
- University Hospital of Strasbourg, Strasbourg, France
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16
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Matsushita K, Sato C, Bruckert C, Gong D, Hmadeh S, Fakih W, Remila L, Auger C, Jesel L, Ohlmann P, Kauffenstein G, Schini-Kerth V, Morel O. Protective effects of dapagliflozin on vascular remodeling in the carotid artery following balloon injury – potential role of angiotensin and purinergic signaling. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Sodium-glucose co-transporter 2 (SGLT2) inhibitors have been shown to reduce the risk of cardiovascular events independently of glycemic control. The possibility that SGLT2 inhibitors improve endothelial regeneration and vascular restenosis is unknown.
Purpose
To examine whether dapagliflozin, a selective SGLT2 inhibitor, could prevent neointima thickening induced by balloon injury and, if so, to determine the underlying mechanisms. The effect of dapagliflozin was compared to that of losartan, an angiotensin type 1 receptor (AT1R) antagonist.
Methods
Saline, dapagliflozin (1.5 mg/kg/day), or losartan (30 mg/kg/day) were administered orally for 5 weeks to male Wistar rats. Balloon injury of the left carotid artery was performed 1 week after starting the treatment and sacrificed 4 weeks later. Vascular reactivity was assessed on left (injured) and right (healthy) carotid artery rings. The extent of neointima was assessed by histomorphometric analysis, changes of target factors by immunofluorescence, RT-qPCR and histochemistry.
Results
Dapagliflozin and losartan treatments reduced neointima thickening by 32% and 27%, respectively. Blunted contractile responses to phenylephrine and relaxations to acetylcholine and down-regulation of eNOS were observed in the injured artery. These effects were not modified by the dapagliflozin or the losartan treatments. RT-qPCR investigations indicated an increased in gene expression of inflammatory (IL-1beta, ITGAM, VCAM-1), oxidative (p47phox, p22phox) and fibrotic (TGF-beta1) markers and a decreased of eNOS in the injured carotid. However, these changes were not affected by the pharmacological treatments. By contrast, significant increased levels of AT1R angiotensin receptor and NTPDase1 (CD39) ectonucleotidase were observed in the restenotic carotid artery of the dapagliflozin group. Histochemical analysis evidenced important NTPDase1 activity in the neointima.
Conclusions
Dapagliflozin effectively reduced neointimal thickening. As the contribution of AT1R and P2Y2 ATP receptor in smooth muscle cell proliferation and neointima formation has been reported in the literature, the present data suggest that dapagliflozin prevents restenosis through interfering with angiotensin and/or extracellular nucleotides signaling. SGLT2 transporter represent potential new target for limiting vascular restenosis.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): This work was supported by AstraZeneca
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Affiliation(s)
- K Matsushita
- University of Strasbourg, UMR1260 INSERM, Nanomédecine Régénérative, Faculté de Pharmacie, Strasbourg, France
| | - C Sato
- University of Strasbourg, UMR1260 INSERM, Nanomédecine Régénérative, Faculté de Pharmacie, Strasbourg, France
| | - C Bruckert
- University of Strasbourg, UMR1260 INSERM, Nanomédecine Régénérative, Faculté de Pharmacie, Strasbourg, France
| | - D Gong
- University of Strasbourg, UMR1260 INSERM, Nanomédecine Régénérative, Faculté de Pharmacie, Strasbourg, France
| | - S Hmadeh
- University of Strasbourg, UMR1260 INSERM, Nanomédecine Régénérative, Faculté de Pharmacie, Strasbourg, France
| | - W Fakih
- University of Strasbourg, UMR1260 INSERM, Nanomédecine Régénérative, Faculté de Pharmacie, Strasbourg, France
| | - L Remila
- University of Strasbourg, UMR1260 INSERM, Nanomédecine Régénérative, Faculté de Pharmacie, Strasbourg, France
| | - C Auger
- University of Strasbourg, UMR1260 INSERM, Nanomédecine Régénérative, Faculté de Pharmacie, Strasbourg, France
| | - L Jesel
- University Hospital of Strasbourg, Strasbourg, France
| | - P Ohlmann
- University Hospital of Strasbourg, Strasbourg, France
| | - G Kauffenstein
- University of Strasbourg, UMR1260 INSERM, Nanomédecine Régénérative, Faculté de Pharmacie, Strasbourg, France
| | - V Schini-Kerth
- University of Strasbourg, UMR1260 INSERM, Nanomédecine Régénérative, Faculté de Pharmacie, Strasbourg, France
| | - O Morel
- University Hospital of Strasbourg, Strasbourg, France
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17
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Ozeki Y, Hirasawa K, Ikeda R, Onodera S, Sawada A, Nishio M, Fukuchi T, Kobayashi R, Sato C, Taguri M, Maeda S. Safety and efficacy of water pressure endoscopic submucosal dissection for colorectal tumors with submucosal fibrosis (with video). Gastrointest Endosc 2021; 94:607-617.e2. [PMID: 33798542 DOI: 10.1016/j.gie.2021.03.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/21/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Colorectal neoplasms with submucosal fibrosis are the most challenging targets of endoscopic resection. Water pressure endoscopic submucosal dissection (WP-ESD) is a recently introduced procedure that has several advantages over conventional endoscopic submucosal dissection (C-ESD). This study aimed to assess the efficacy and safety of WP-ESD for fibrotic colorectal neoplasms. METHODS This retrospective observational study investigated 133 colorectal neoplasms expected to have submucosal fibrosis that were resected by WP-ESD or C-ESD between April 2012 and April 2020. Eighty-seven lesions after endoscopic or surgical treatment, 18 with biopsy scar with fold convergence and 28 in patients with ulcerative colitis, were included. The differences in treatment outcomes, including procedure time and adverse event proportions, between the WP-ESD and C-ESD groups were analyzed. The clinical course after perforation using WP-ESD was also evaluated, including postprocedural multidetector CT findings obtained immediately after WP-ESD. RESULTS Severe submucosal fibrosis was observed in 96 lesions (72.2%). The median procedure time was significantly shorter in the WP-ESD group than in the C-ESD group (43.5 minutes [interquartile range {IQR}, 32.8-73] vs 72 minutes [IQR, 45-105]; P = .0041). The multivariate analysis revealed WP-ESD as an independent factor for a short procedure time (odds ratio, 2.90; 95% confidence interval, 1.28-6.55). The proportions of post-ESD electrocoagulation syndrome (11.6% vs 13.1%) and perforation (20.4% vs 22.8%) were similar between the groups. Four of 11 patients with perforation who underwent WP-ESD showed fluid collection on postprocedural multidetector CT images. CONCLUSIONS WP-ESD can shorten procedure time for treating fibrotic colorectal neoplasms.
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Affiliation(s)
- Yuichiro Ozeki
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Kingo Hirasawa
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Ryosuke Ikeda
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Sho Onodera
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Atsushi Sawada
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Masafumi Nishio
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Takehide Fukuchi
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Ryosuke Kobayashi
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Chiko Sato
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Masataka Taguri
- School of Data Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Shin Maeda
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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18
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Hirasawa K, Ozeki Y, Sawada A, Sato C, Ikeda R, Nishio M, Fukuchi T, Kobayashi R, Makazu M, Taguri M, Maeda S. Appropriate endoscopic treatment selection and surveillance for superficial non-ampullary duodenal epithelial tumors. Scand J Gastroenterol 2021; 56:342-350. [PMID: 33382001 DOI: 10.1080/00365521.2020.1867896] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Superficial nonampullary duodenal epithelial tumors (SNADETs) have become frequently detected and referred for endoscopic resection (ER). However, optimal treatment methods and long-term outcomes after ER of SNADETs have not been fully elucidated. We aimed to clarify them by analyzing our large cohort of patients with SNADETs. MATERIALS AND METHODS We enrolled 190 consecutive tumors from 189 patients undergoing ER between January 2004 and September 2019. Cases were stratified into endoscopic submucosal dissection (ESD), conventional endoscopic mucosal resection, (CEMR) and underwater endoscopic mucosal resection (UEMR). Baseline characteristics and short-term outcomes were compared between the groups. Long-term outcomes were also investigated with a median follow-up of 36 months. RESULTS ESD significantly exceeded CEMR (96.4% vs. 52.9%; p = .0026) and UEMR (96.4% vs. 50.0%; p = .0008) in complete resection rates for 11- to 20-mm lesions; the differences were not significant for lesions ≤10 mm. Local recurrence only occurred in patients with an incomplete resection. Only patients with submucosal invasion died from the primary neoplasms. The 3- and 5-year disease-free survivals were 91.3% and 83.5%. CONCLUSIONS While tumors ≤10 mm seem to be good indications for endoscopic mucosal resection, ESD should be considered for larger tumors to better achieve complete resection. Patients with submucosal invasive carcinomas have a great risk of cancer death. Therefore, a close follow-up and an additional treatment are desirable.
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Affiliation(s)
- Kingo Hirasawa
- Endoscopy Division, Yokohama City University Medical Center, Yokohama, Japan
| | - Yuichiro Ozeki
- Endoscopy Division, Yokohama City University Medical Center, Yokohama, Japan
| | - Atsushi Sawada
- Endoscopy Division, Yokohama City University Medical Center, Yokohama, Japan
| | - Chiko Sato
- Endoscopy Division, Yokohama City University Medical Center, Yokohama, Japan
| | - Ryosuke Ikeda
- Endoscopy Division, Yokohama City University Medical Center, Yokohama, Japan
| | - Masafumi Nishio
- Endoscopy Division, Yokohama City University Medical Center, Yokohama, Japan
| | - Takehide Fukuchi
- Endoscopy Division, Yokohama City University Medical Center, Yokohama, Japan
| | - Ryosuke Kobayashi
- Endoscopy Division, Yokohama City University Medical Center, Yokohama, Japan
| | - Makomo Makazu
- Endoscopy Division, Yokohama City University Medical Center, Yokohama, Japan
| | - Masataka Taguri
- Department of Data Science, Yokohama City University School of Data Science, Yokohama, Japan
| | - Shin Maeda
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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19
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Nishio M, Hirasawa K, Ozeki Y, Sawada A, Ikeda R, Fukuchi T, Kobayashi R, Makazu M, Sato C, Kunisaki R, Maeda S. An endoscopic treatment strategy for superficial tumors in patients with ulcerative colitis. J Gastroenterol Hepatol 2021; 36:498-506. [PMID: 32754980 DOI: 10.1111/jgh.15207] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/25/2020] [Accepted: 07/29/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIM Endoscopic resection is feasible for superficial tumors in patients with ulcerative colitis; however, endoscopic resection options have not been evaluated comprehensively. We evaluated the efficacy and safety of endoscopic submucosal dissection and endoscopic mucosal resection, and decision making regarding endoscopic resection options for patients with ulcerative colitis. METHODS Endoscopically treated tumors from patients with ulcerative colitis were analyzed retrospectively. We evaluated en bloc and R0 resection, adverse events, local tumor recurrence, and metachronous lesion occurrence rates. RESULTS We examined 102 tumors (mean size, 12 mm; non-polypoid, 55 tumors) from 74 patients with ulcerative colitis, of whom, 39 and 63 underwent endoscopic submucosal dissection and endoscopic mucosal resection, respectively. The R0 resection rate was significantly higher for endoscopic submucosal dissection (97%) than for endoscopic mucosal resection (80%) (P = 0.0015). For 11-20-mm tumors, the R0 resection rate was significantly higher for endoscopic submucosal dissection (94%) than for endoscopic mucosal resection (55%) (P = 0.0027); the endoscopic submucosal dissection and endoscopic mucosal resection R0 rates did not differ for ≤ 10-mm tumors. The non-polypoid tumor R0 resection rates were significantly higher for endoscopic submucosal dissection (100%) than for endoscopic mucosal resection (65%) (P < 0.001) and did not differ regarding the polypoid tumor R0 resection rates (75% vs 86%, P = 0.49). Four patients experienced intraoperative perforation during endoscopic submucosal dissection. No local recurrences occurred. Metachronous high-grade dysplasia occurred in three patients during surveillance. CONCLUSIONS In patients with ulcerative colitis, endoscopic submucosal dissection is suitable for ≥ 11-mm and non-polypoid tumors, whereas endoscopic mucosal resection is acceptable for ≤ 10-mm tumors.
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Affiliation(s)
- Masafumi Nishio
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Kingo Hirasawa
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Yuichiro Ozeki
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Atsushi Sawada
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Ryosuke Ikeda
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Takehide Fukuchi
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Ryosuke Kobayashi
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Makomo Makazu
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Chiko Sato
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Reiko Kunisaki
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Shin Maeda
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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20
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Lachmet-Thébaud L, Marchandot B, Matsushita K, Sato C, Dagrenat C, Greciano S, De Poli F, Leddet P, Carmona A, Jimenez C, Heger J, Reydel A, Ohlmann P, Jesel L, Morel O. Residual systemic inflammatory burden is a major determinant of myocardial recovery and late cardiovascular outcome in Takotsubo patients. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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21
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Ikeda R, Hirasawa K, Sato C, Sawada A, Nishio M, Fukuchi T, Kobayashi R, Makazu M, Kaneko H, Maeda S. Incidence of metachronous gastric cancer after endoscopic submucosal dissection associated with eradication status of Helicobacter pylori. Eur J Gastroenterol Hepatol 2021; 33:17-24. [PMID: 32483085 DOI: 10.1097/meg.0000000000001788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE This study compared the clinicopathological features and treatment outcomes of patients with primary early gastric cancers (EGCs) who had undergone Helicobacter pylori eradication and endoscopic submucosal dissection (ESD) with those of patients who were H. pylori-positive and had undergone ESD. Additionally, we investigated the incidence of metachronous cancer in these patients. METHODS We retrospectively analyzed 1849 EGCs in 1407 patients who underwent ESD whom 201 primary EGCs were detected after H. pylori eradication (eradication group) and 1648 primary EGCs were detected in patients infected with H. pylori (infection group). We evaluated the clinicopathological features and treatment outcomes of the first ESD. We next divided 938 patients whose follow-up periods were >1 year into three groups, an eradication group (n = 61), an infection group (n = 562), and an eradication after ESD group (n = 315). The groups' cumulative metachronous occurrence rates were determined. RESULTS The eradication group's median tumor size was significantly smaller, and the tumors were significantly more likely to be flat/depressed than those in the infection group. The groups did not differ regarding the treatment outcomes. The cumulative incidence of metachronous cancer was significantly higher in the eradication group than in the eradication after ESD group (P = 0.0454) and in the infection group than in the eradication after ESD group (P = 0.0233). CONCLUSION The treatment outcomes for EGC in the eradication group were favorable. The higher incidence of metachronous cancer in the eradication group suggests that careful endoscopic follow-up examinations are required.
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Affiliation(s)
- Ryosuke Ikeda
- Endoscopy Division, Yokohama City University Medical Center
| | - Kingo Hirasawa
- Endoscopy Division, Yokohama City University Medical Center
| | - Chiko Sato
- Endoscopy Division, Yokohama City University Medical Center
| | - Atsushi Sawada
- Endoscopy Division, Yokohama City University Medical Center
| | | | | | | | - Makomo Makazu
- Endoscopy Division, Yokohama City University Medical Center
| | - Hiroaki Kaneko
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Shin Maeda
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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22
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Trimaille A, Curtiaud A, Marchandot B, Matsushita K, Sato C, Leonard-Lorant I, Sattler L, Grunebaum L, Ohana M, Von Hunolstein J, Andres E, Goichot B, Danion F, Kaeuffer C, Poindron V, Ohlmann P, Jesel L, Morel O. Venous thromboembolism in non-critically ill patients with COVID-19 infection. Archives of Cardiovascular Diseases Supplements 2021. [PMCID: PMC7803092 DOI: 10.1016/j.acvdsp.2020.10.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background Systemic coagulation activation and thrombotic complications are frequent among critically ill patients with COVID-19. Limited data are available in non-intensive care unit (ICU) patients. Purpose To determine the incidence, risk factors and prognosis of venous thromboembolism (VTE) in non-ICU COVID-19 patients. Methods We studied consecutive COVID-19 patients admitted to general ward at Strasbourg Hospital, France (25.02.2020–19.04.2020). The primary outcome was any VTE complication. The secondary outcome was the composite of death or transfer to ICU. Results Among the 289 patients included (62.2 ± 17.0 years, 59.2% male), VTE occurred in 49 (17.0%). Padua prediction score for VTE was similar between VTE and non-VTE patients. VTE imaging tests were performed in 100 (34.6%) patients and VTE diagnosed in median 7 (3–11) days after admission. On-admission, time from symptom onset to admission (OR 1.07, CI 95% [1.00–1.16], P = 0.045), Improve score (OR 1.37, [1.02–1.83], P = 0.032), leukocyte count (OR 1.16, [1.06–1.27], P = 0.001) and lack of thromboprophylaxis (OR 27.85, CI 95% [9.35–82.95], P < 0.001) were independent predictors of VTE. The incidence of the composite of death or ICU transfer was 31.0% and more frequent among patients with VTE (47.9% vs. 27.9%, P = 0.01). Fever (OR 5.37, CI 95% [1.44–19.97], P = 0.012), VTE (OR 3.44, CI 95% [1.63–7.25], P = 0.001), lymphopenia (OR 0.32, 95% CI [0.15–0.71]; P = 0.005) and extent of COVID-19 evaluated by chest CT severity (OR 1.56, 95% CI [1.12–2.16]; P = 0.007) were independently associated with in-hospital death or transfer to ICU (Table 1, Fig. 1). Conclusions The 17.0% incidence of VTE in non-ICU patients with COVID-19 was associated with worse outcomes. Given the high incidence of VTE in ward patients, there is an urgent need to investigate the optimal anticoagulation regimen.
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23
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Nishio M, Hirasawa K, Teranishi JI, Maeda K, Ozeki Y, Sawada A, Ikeda R, Fukuchi T, Kobayashi R, Makazu M, Sato C, Inayama Y, Maeda S. Small intestinal thrombotic microangiopathy following kidney transplantation diagnosed by balloon-assisted enteroscopy. Ann Gastroenterol 2020; 34:119-121. [PMID: 33414631 PMCID: PMC7774655 DOI: 10.20524/aog.2020.0561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/09/2020] [Indexed: 11/11/2022] Open
Abstract
Thrombotic microangiopathy (TMA) is a serious complication following kidney transplantation. Although intestinal TMA is a major organ injury and causes abdominal pain, diarrhea and bloody stools, the clinical and endoscopic characteristics of small intestinal TMA remain unclear. Here, we report a drug-induced small intestinal TMA, which did not meet the laboratory-defined TMA criteria but was diagnosed by balloon-assisted enteroscopy (BAE). A 32-year-old woman who underwent kidney transplantation at the age of 10 years complained of abdominal pain, diarrhea and bloody stools one month after starting everolimus (EVE) as an immunosuppressant. Although she did not meet the diagnostic criteria for TMA serologically, BAE revealed a circumferential ulcer in the jejunum, and the pathological findings of a biopsy specimen showed microvascular thrombi, compatible with intestinal TMA. Her symptoms improved upon the discontinuation of EVE, demonstrating that EVE can cause drug-induced intestinal TMA. The present case suggests that BAE should be performed when abdominal pain, diarrhea, and bloody stools occur in patients receiving immunosuppressive medication following kidney transplantation, even if there is no evidence of TMA according to the laboratory definition.
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Affiliation(s)
- Masafumi Nishio
- Division of Endoscopy (Masafumi Nishio, Kingo Hirasawa, Yuichiro Ozeki, Atsushi Sawada, Ryosuke Ikeda, Takehide Fukuchi, Ryosuke Kobayashi, Makomo Makazu, Chiko Sato)
| | - Kingo Hirasawa
- Division of Endoscopy (Masafumi Nishio, Kingo Hirasawa, Yuichiro Ozeki, Atsushi Sawada, Ryosuke Ikeda, Takehide Fukuchi, Ryosuke Kobayashi, Makomo Makazu, Chiko Sato)
| | | | - Koki Maeda
- Division of Diagnostic Pathology (Koki Maeda, Yoshiaki Inayama)
| | - Yuichiro Ozeki
- Division of Endoscopy (Masafumi Nishio, Kingo Hirasawa, Yuichiro Ozeki, Atsushi Sawada, Ryosuke Ikeda, Takehide Fukuchi, Ryosuke Kobayashi, Makomo Makazu, Chiko Sato)
| | - Atsushi Sawada
- Division of Endoscopy (Masafumi Nishio, Kingo Hirasawa, Yuichiro Ozeki, Atsushi Sawada, Ryosuke Ikeda, Takehide Fukuchi, Ryosuke Kobayashi, Makomo Makazu, Chiko Sato)
| | - Ryosuke Ikeda
- Division of Endoscopy (Masafumi Nishio, Kingo Hirasawa, Yuichiro Ozeki, Atsushi Sawada, Ryosuke Ikeda, Takehide Fukuchi, Ryosuke Kobayashi, Makomo Makazu, Chiko Sato)
| | - Takehide Fukuchi
- Division of Endoscopy (Masafumi Nishio, Kingo Hirasawa, Yuichiro Ozeki, Atsushi Sawada, Ryosuke Ikeda, Takehide Fukuchi, Ryosuke Kobayashi, Makomo Makazu, Chiko Sato)
| | - Ryosuke Kobayashi
- Division of Endoscopy (Masafumi Nishio, Kingo Hirasawa, Yuichiro Ozeki, Atsushi Sawada, Ryosuke Ikeda, Takehide Fukuchi, Ryosuke Kobayashi, Makomo Makazu, Chiko Sato)
| | - Makomo Makazu
- Division of Endoscopy (Masafumi Nishio, Kingo Hirasawa, Yuichiro Ozeki, Atsushi Sawada, Ryosuke Ikeda, Takehide Fukuchi, Ryosuke Kobayashi, Makomo Makazu, Chiko Sato)
| | - Chiko Sato
- Division of Endoscopy (Masafumi Nishio, Kingo Hirasawa, Yuichiro Ozeki, Atsushi Sawada, Ryosuke Ikeda, Takehide Fukuchi, Ryosuke Kobayashi, Makomo Makazu, Chiko Sato)
| | | | - Shin Maeda
- Department of Gastroenterology (Shin Maeda), Yokohama City University Graduate School of Medicine, Yokohama, Japan
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24
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Ikeda R, Hirasawa K, Sato C, Ozeki Y, Sawada A, Nishio M, Fukuchi T, Kobayashi R, Makazu M, Taguri M, Maeda S. Third-look endoscopy prevents delayed bleeding after endoscopic submucosal dissection under antithrombotic therapy. World J Gastroenterol 2020; 26:6475-6487. [PMID: 33244206 PMCID: PMC7656207 DOI: 10.3748/wjg.v26.i41.6475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/22/2020] [Accepted: 10/20/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Postoperative delayed bleeding (PDB) after gastric endoscopic submucosal dissection (ESD) is the most common adverse event in patients receiving antithrombotics even with second-look endoscopy. Moreover, with the increasing prevalence of cardiovascular and cerebrovascular diseases in an aging population with associated lifestyle-related diseases, an increasing number of patients receive antithrombotics. Several attempts have been made to prevent PDB in aging population; however, a consensus has yet to be reached.
AIM To examine the efficacy of third-look endoscopy (TLE) for PDB prevention.
METHODS One hundred patients with early gastric neoplasms receiving antithrombotics were prospectively enrolled and subjected to ESD with TLE between February 2017 and July 2019. The primary endpoint was PDB rate, which was compared with our preset threshold. Furthermore, we divided the bleeding period into early-and late-onset PDB (E-PDB and L-PDB, respectively) and analyzed its rate. As a secondary analysis, we compared PDB rates with those of a historical control group, using propensity score matching, and calculated the PDB rates per antithrombotic agent use in each group.
RESULTS In total, 96 patients and 114 specimens were finally evaluated. The overall PDB rate was 7.9% (9/114) [90%CI: 4.7-13.1, P = 0.005], while the late-and early-onset PDB rates (L-PDB and E-PDB) were 5.3% [90%CI: 2.7-9.9, P < 0.0001] and 2.6% [90%CI: 1.1-6.4, P = 0.51], respectively. Propensity score matching generated 58 matched pairs for TLE and control groups. No differences were found in overall PDB incidence (10.3% vs 20.7%, P = 0.12), whereas L-PDB occurrence significantly differed (5.2% vs 17.2%, P = 0.04) between groups. Considering antithrombotics’ use, the overall PDB rate was higher for direct oral anticoagulants and multiple antithrombotics in the control group, while L-PDB incidence was lower in the TLE group for these agents (8.7% vs 23.1% and 5.0% vs 29.4%, respectively).
CONCLUSION TLE for gastric ESD reduces overall PDB, and especially L-PDB incidence, among patients receiving antithrombotics.
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Affiliation(s)
- Ryosuke Ikeda
- Endoscopy Division, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Kingo Hirasawa
- Endoscopy Division, Yokohama Medical University Center Hospital, Yokohama 232-0024, Japan
| | - Chiko Sato
- Endoscopy Division, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Yuichiro Ozeki
- Endoscopy Division, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Atsushi Sawada
- Endoscopy Division, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Masafumi Nishio
- Endoscopy Division, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Takehide Fukuchi
- Endoscopy Division, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Ryosuke Kobayashi
- Endoscopy Division, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Makomo Makazu
- Endoscopy Division, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Masataka Taguri
- Department of Data Science, Yokohama City University School of Data Science, Yokohama 236-0004, Japan
| | - Shin Maeda
- Division of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan
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25
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Matsushita K, Marchandot B, Kibler M, Sato C, Heger J, Peillex M, Trimaille A, Hess S, Grunebaum L, Ohana M, Reydel A, Jesel L, Ohlmann P, Morel O. P2Y12 inhibition by clopidogrel increases adverse clinical outcomes in patients undergoing transcatheter aortic valve replacement. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Current recommendations support short-term dual antiplatelet therapy (DAPT) for patients undergoing transcatheter aortic valve replacement (TAVR) despite no relevant study exploring the extent of platelet inhibition by clopidogrel.
Purpose
To assess whether P2Y12 inhibition by clopidogrel as evaluated by vasodilator-stimulated phosphoprotein flow cytometry test (VASP-FCT) impacts 1-year clinical outcomes in patients undergoing TAVR.
Methods
Patients were included in a prospective registry between February 2010 and May 2019. VASP-FCT was assessed 24h after the procedure. Responder to clopidogrel was defined by a platelet reactivity index ≤50%.
Results
Of 640 patients who underwent TAVR with preprocedural clopidogrel therapy, we enrolled 491 patients for whom VASP data were available. Responders were identified in 22% (n=110) of patients and low responders were 78% (n=381) of patients. Low body mass index, active cancer, and clopidogrel on admission were found to be independent predictors of responder. Mean transaortic pressure gradient was lower in the responder group at 1-month post-TAVR (9.9±4.4 mmHg vs. 11.2±5.8 mmHg, p=0.03) but was similar at 1-year (11.5±6.2 mmHg vs. 11.9±7.4 mmHg, p=0.74). By multivariate Cox regression analysis, patients responding to clopidogrel (hazard ratio [HR]: 2.19; 95% confidence interval [CI]: 1.04 to 3.64; p=0.04), prior PCI (HR: 2.12; 95% CI: 1.07 to 4.37; p=0.03), and mean transaortic pressure gradient at baseline (HR: 0.07; 95% CI: 0.01 to 0.70; p=0.02) were identified as independent predictors of 1-year adverse clinical outcomes, including all-cause death, myocardial infarction, stroke, and heart failure hospitalization.
Conclusions
Appropriate P2Y12 inhibition by clopidogrel is a major determinant of adverse clinical events after TAVR. In sum, the present data challenges the need of DAPT as a standard therapy during TAVR.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- K Matsushita
- University Hospital of Strasbourg, Strasbourg, France
| | - B Marchandot
- University Hospital of Strasbourg, Strasbourg, France
| | - M Kibler
- University Hospital of Strasbourg, Strasbourg, France
| | - C Sato
- University Hospital of Strasbourg, Strasbourg, France
| | - J Heger
- University Hospital of Strasbourg, Strasbourg, France
| | - M Peillex
- University Hospital of Strasbourg, Strasbourg, France
| | - A Trimaille
- University Hospital of Strasbourg, Strasbourg, France
| | - S Hess
- University Hospital of Strasbourg, Strasbourg, France
| | - L Grunebaum
- University Hospital of Strasbourg, Strasbourg, France
| | - M Ohana
- University Hospital of Strasbourg, Strasbourg, France
| | - A Reydel
- University Hospital of Strasbourg, Strasbourg, France
| | - L Jesel
- University Hospital of Strasbourg, Strasbourg, France
| | - P Ohlmann
- University Hospital of Strasbourg, Strasbourg, France
| | - O Morel
- University Hospital of Strasbourg, Strasbourg, France
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26
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Lachmet-Thebaud L, Marchandot B, Matsushita K, Sato C, Dagrenat C, Greciano S, De Poli F, Leddet P, Peillex M, Hess S, Carmona A, Reydel A, Ohlmann P, Jesel L, Morel O. Residual inflammation is a major determinant of myocardial recovery and cardiovascular outcome in takotsubo patients. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Recent insights have emphasized the importance of myocardial and systemic inflammation in Takotsubo Syndrome (TTS).
Objective
In a large registry of unselected patients, we sought to evaluate whether residual high inflammatory response (RHIR) could impact cardiovascular outcome after TTS.
Methods
Patients with TTS were retrospectively included between 2008 and 2018 in three general hospitals. 385 patients with TTS were split into three subgroups, according to tertiles of C-reactive protein (CRP) levels at discharge (CRP<5.2 mg/l, CRP range 5.2 to 19 mg/l, and CRP>19 mg/L). The primary endpoint was the impact of RHIR, defined as CRP>19 mg/L at discharge, on cardiac death or hospitalization for heart failure.
Results
Follow-up was obtained in 382 patients (99%) after a median of 747 days. RHIR patients were more likely to have a history of cancer or a physical trigger. Left ventricular ejection fraction (LVEF) at admission and at discharge were comparable between groups. By contrast, RHIR was associated with lower LVEF at follow-up (61.7 vs. 60.7 vs. 57.9%; p=0.004) and increased cardiac late mortality (0% vs. 0% vs. 10%; p=0.001). By multivariate Cox regression analysis, RHIR was an independent predictor of cardiac death or hospitalization for heart failure (hazard ratio: 1.97; 95% confidence interval: 1.11 to 3.49; p=0.02).
Conclusions
RHIR was associated with impaired LVEF recovery and was evidenced as an independent factor of cardiovascular events. All together these findings underline RHIR patients as a high-risk subgroup, to target in future clinical trials with specific therapies to attenuate RHIR.
Main results
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): GERCA (Groupe pour l'Enseignement, la prévention et la Recherche Cardiovasculaire en Alsace)
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Affiliation(s)
| | - B Marchandot
- Civil Hospital/Nouvel Hopital Civil, Strasbourg, France
| | - K Matsushita
- Civil Hospital/Nouvel Hopital Civil, Strasbourg, France
| | - C Sato
- Civil Hospital/Nouvel Hopital Civil, Strasbourg, France
| | - C Dagrenat
- Haguenau Hospital Centre, Cardiology, Haguenau, France
| | - S Greciano
- Civil Hospital of Colmar, Colmar, France
| | - F De Poli
- Haguenau Hospital Centre, Cardiology, Haguenau, France
| | - P Leddet
- Civil Hospital of Colmar, Colmar, France
| | - M Peillex
- Civil Hospital/Nouvel Hopital Civil, Strasbourg, France
| | - S Hess
- Civil Hospital/Nouvel Hopital Civil, Strasbourg, France
| | - A Carmona
- Civil Hospital/Nouvel Hopital Civil, Strasbourg, France
| | - A Reydel
- Civil Hospital/Nouvel Hopital Civil, Strasbourg, France
| | - P Ohlmann
- Civil Hospital/Nouvel Hopital Civil, Strasbourg, France
| | - L Jesel
- Civil Hospital/Nouvel Hopital Civil, Strasbourg, France
| | - O Morel
- Civil Hospital/Nouvel Hopital Civil, Strasbourg, France
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Matsushita K, Marchandot B, Kibler M, Sato C, Heger J, Peillex M, Trimaille A, Hess S, Grunebaum L, Ohana M, Reydel A, Jesel L, Ohlmann P, Morel O. Predictive impact of PVL assessments on clinical outcomes in patients undergoing TAVR. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Paravalvular leakage (PVL) following transcatheter aortic valve replacement (TAVR) is associated with greater mortality. In clinical practice, determining PVL severity after TAVR remains challenging and often requires multiparametric assessment.
Purpose
This study sought to evaluate the respective value of various modalities of PVL assessments, including transthoracic echocardiography (TTE), cine-angiography, aortic regurgitation index (ARI), and closure time with adenosine diphosphate (CT-ADP), in the prediction of adverse clinical outcomes.
Methods
We included 1044 patients from our prospective TAVR registry between February 2010 and May 2019. Major adverse cardiac and cerebrovascular events (MACCE) was defined as a composite of all-cause death, myocardial infarction, stroke, and heart failure hospitalization within 1-year. Established cutoff values of ARI (<25) and CT-ADP (>180 sec) were used to assess the presence of PVL after TAVR.
Results
Moderate to severe PVL occurred in 14.2% and 5.2% of patients as measured by TTE and angiography. The rate of patients with ARI <25 and CT-ADP >180 sec were 36.5% and 24.9%, respectively. Among the four modalities, PVL evaluated by angiography predicted poorer clinical outcomes (Log rank test; p=0.001), whereas TTE, ARI <25, and CT-ADP >180 sec were not associated with 1-year MACCE. By multivariate Cox regression analysis, moderate to severe PVL by angiography was an independent predictor of 1-year MACCE (hazard ratio: 1.96; 95% confidence interval: 1.22–3.00; p=0.007).
Conclusions
Paravalvular leakage measured by angiography was evidenced as the most meaningful modality in the prediction of adverse clinical outcomes. Future multicenter studies are warranted to ensure these findings in the current TAVR era.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- K Matsushita
- University Hospital of Strasbourg, Strasbourg, France
| | - B Marchandot
- University Hospital of Strasbourg, Strasbourg, France
| | - M Kibler
- University Hospital of Strasbourg, Strasbourg, France
| | - C Sato
- University Hospital of Strasbourg, Strasbourg, France
| | - J Heger
- University Hospital of Strasbourg, Strasbourg, France
| | - M Peillex
- University Hospital of Strasbourg, Strasbourg, France
| | - A Trimaille
- University Hospital of Strasbourg, Strasbourg, France
| | - S Hess
- University Hospital of Strasbourg, Strasbourg, France
| | - L Grunebaum
- University Hospital of Strasbourg, Strasbourg, France
| | - M Ohana
- University Hospital of Strasbourg, Strasbourg, France
| | - A Reydel
- University Hospital of Strasbourg, Strasbourg, France
| | - L Jesel
- University Hospital of Strasbourg, Strasbourg, France
| | - P Ohlmann
- University Hospital of Strasbourg, Strasbourg, France
| | - O Morel
- University Hospital of Strasbourg, Strasbourg, France
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28
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Matsushita K, Lachmet-Thebaud L, Marchandot B, Sato C, Dagrenat C, Greciano S, De Poli F, Leddet P, Trimaille A, Heger J, Reydel A, Trinh A, Ohlmann P, Jesel L, Morel O. Incomplete recovery of takotsubo cardiomyopathy is a major determinant of cardiovascular mortality. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Although there is an apparent rapid and spontaneous recovery of left ventricular ejection fraction (LVEF) in patients with takotsubo cardiomyopathy, recent studies have demonstrated the long-lasting functional impairment in those patients.
Purpose
We sought to evaluate the predictors of incomplete recovery in chronic phase and its impact on cardiovascular mortality after takotsubo cardiomyopathy.
Methods
Patients with takotsubo cardiomyopathy between 2008 and 2018 were retrospectively enrolled in three different institutions. Takotsubo cardiomyopathy was diagnosed according to the European Society of Cardiology Heart Failure Association criteria. After exclusion of in-hospital deaths, 407 patients were split into 2 subgroups according whether their LVEF were >50% (recovery group; n=333), or ≤50% (incomplete recovery group; n=74) at follow-up. The primary endpoint was the impact of incomplete recovery on cardiovascular mortality.
Results
Patients with incomplete recovery were more likely to be male, to have dementia, pacemaker, and supraventricular arrhythmia. C-reactive protein (CRP) levels on admission, at peak, and at discharge were significantly higher in patients with incomplete recovery. By multivariate logistic regression analysis, lower EF at discharge (odds ratio [OR]: 0.91; 95% confidence interval [CI]: 0.88 to 0.95; p<0.001) and higher CRP levels (OR: 5.56; 95% CI: 1.86 to 16.61; p<0.001) were independent predictors of incomplete recovery at follow-up. The cumulative event-free survival rate according to cardiovascular death was significantly lower in the incomplete recovery group (p<0.001; log-rank test).
Conclusions
We demonstrate that incomplete recovery after takotsubo cardiomyopathy is characterized by a residual systemic inflammation and an increased cardiac mortality at follow-up. Altogether, our findings underline patients with persistent inflammation as a high-risk subgroup, to target in future clinical trials with specific therapies to attenuate inflammation.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- K Matsushita
- University Hospital of Strasbourg, Strasbourg, France
| | | | - B Marchandot
- University Hospital of Strasbourg, Strasbourg, France
| | - C Sato
- University Hospital of Strasbourg, Strasbourg, France
| | - C Dagrenat
- Haguenau Hospital Centre, Haguenau, France
| | - S Greciano
- Civil Hospital of Colmar, Colmar, France
| | - F De Poli
- Haguenau Hospital Centre, Haguenau, France
| | - P Leddet
- Haguenau Hospital Centre, Haguenau, France
| | - A Trimaille
- University Hospital of Strasbourg, Strasbourg, France
| | - J Heger
- University Hospital of Strasbourg, Strasbourg, France
| | - A Reydel
- University Hospital of Strasbourg, Strasbourg, France
| | - A Trinh
- University Hospital of Strasbourg, Strasbourg, France
| | - P Ohlmann
- University Hospital of Strasbourg, Strasbourg, France
| | - L Jesel
- University Hospital of Strasbourg, Strasbourg, France
| | - O Morel
- University Hospital of Strasbourg, Strasbourg, France
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29
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Fukuchi T, Hirasawa K, Sato C, Makazu M, Kaneko H, Kobayashi R, Nishio M, Ikeda R, Sawada A, Taguri M, Maeda S. Factors influencing interruption of colorectal endoscopic submucosal dissection. Surg Endosc 2020; 35:5497-5507. [PMID: 33006029 DOI: 10.1007/s00464-020-08042-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 09/22/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND AIMS Although colorectal endoscopic submucosal dissection (ESD) has become a standardized procedure worldwide, the difficulty of the procedure is well known. However, there have been no studies assessing the causes of treatment interruption. The present study aimed to evaluate the factors involved in the interruption of colorectal ESD. METHODS We retrospectively analyzed 1116 consecutive superficial colorectal neoplasms of 1012 patients who were treated with ESD between August 2008 and September 2018. The clinicopathological characteristics and treatment outcomes were analyzed. RESULTS Interrupted ESD was reported in 14 lesions (1.3%) of the total study population. Univariate analysis of clinical characteristics indicated that age, 0-I macroscopic-type tumor, and tumor location on the left side colon were risk factors for interruption. Multivariate analysis revealed that 0-I macroscopic-type tumor was the sole preoperative independent risk factor for interruption. Univariate analysis revealed that the presence of muscle-retracting sign (MRS), deep submucosal tumor invasion, and intermediate invasive growth pattern represented the etiology of interruption. Multivariate analysis indicated that MRS can be a sole key sign for the interruption. Additionally, the resectability and curability of 0-I type tumors were significantly inferior to those of predominantly lateral spreading tumors. Observations of 0-I macroscopic-type tumors, MRS, and submucosal deep invasion were significantly more frequent in interrupted cases. Conventional endoscopic images without magnification endoscopy were more associated with interruption than irregular surfaces or Vi pit patterns in cases with 0-I type tumors. CONCLUSION ESD of 0-I type tumors is highly disruptive, and undiagnosable submucosal infiltration can reduce the curability.
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Affiliation(s)
- Takehide Fukuchi
- Division of Endoscopy, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Kingo Hirasawa
- Division of Endoscopy, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
| | - Chiko Sato
- Division of Endoscopy, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Makomo Makazu
- Division of Endoscopy, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Hiroaki Kaneko
- Department of Biostatistics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Ryosuke Kobayashi
- Division of Endoscopy, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Masafumi Nishio
- Division of Endoscopy, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Ryosuke Ikeda
- Division of Endoscopy, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Atsushi Sawada
- Division of Endoscopy, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Masataka Taguri
- Department of Biostatistics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Shin Maeda
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
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30
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Ozeki Y, Hirasawa K, Kobayashi R, Sato C, Tateishi Y, Sawada A, Ikeda R, Nishio M, Fukuchi T, Makazu M, Taguri M, Maeda S. Histopathological validation of magnifying endoscopy for diagnosis of mixed-histological-type early gastric cancer. World J Gastroenterol 2020; 26:5450-5462. [PMID: 33024396 PMCID: PMC7520603 DOI: 10.3748/wjg.v26.i36.5450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/07/2020] [Accepted: 09/08/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The undifferentiated-type (UDT) component profoundly affects the clinical course of early gastric cancers (EGCs). However, an accurate preoperative diagnosis of the histological types is unsatisfactory. To date, few studies have investigated whether the UDT component within mixed-histological-type (MT) EGCs can be recognized preoperatively.
AIM To clarify the histopathological characteristics of the endoscopically-resected MT EGCs for investigating whether the UDT component could be recognized preoperatively.
METHODS This was a single-center retrospective study. First, we attempted to clarify the histopathological characteristics of the endoscopically-resected MT EGCs with emphasis on the UDT component. Histopathological examination investigated each lesion’s UDT component: (1) Whole mucosal layer occupation of the UDT component; (2) UDT component exposure to the surface of the mucosa; and (3) existence of a clear border between the differentiated-type and UDT components. Then, preoperative endoscopic images with magnifying endoscopy with narrow-band imaging (ME-NBI) were examined to identify whether the endoscopic UDT component finding was recognizable within the area where it was present in the histopathological examination. The preoperative biopsy results and comparative relationships between endoscopic and histopathological findings were also examined.
RESULTS In the histopathological examination, the whole mucosal layer occupation of the UDT component and exposure of the UDT component to the mucosal surface were observed in 67.3% (33/49) and 79.6% (39/49) of samples, respectively. A clear distinction of the border between the differentiated-type and UDT components could not be drawn in 65.3% (32/49) of MT lesions. In the endoscopic examination, the preoperative endoscopic images showed that only 24.5% (12/49) of MT EGCs revealed the UDT component within the area where it was present histopathologically. Histopathological UDT predominance was the single significant factor associated with the presence of the endoscopic UDT component finding (61.5% vs 11.1%, P = 0.0009). Only 26.5% (13/49) of the lesions were diagnosed from the pretreatment biopsy as having a UDT component. Combined results of the pretreatment biopsy and ME-NBI showed the preoperative presence of the UDT component in 40.8% (20/49) of MT EGCs.
CONCLUSION Recognition of a UDT component within MT EGCs is difficult even when pretreatment biopsy and ME-NBI are combined. Endoscopic resection plays a significant role in both treatment and diagnosis.
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Affiliation(s)
- Yuichiro Ozeki
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Kingo Hirasawa
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Ryosuke Kobayashi
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Chiko Sato
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Yoko Tateishi
- Department of Pathology, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan
| | - Atsushi Sawada
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Ryosuke Ikeda
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Masafumi Nishio
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Takehide Fukuchi
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Makomo Makazu
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Masataka Taguri
- Department of Data Science, Yokohama City University School of Data Science, Yokohama 236-0004, Japan
| | - Shin Maeda
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan
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31
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Itsukage S, Kambe N, Ueki Y, Sato C, Nakano H. Hailey-Hailey disease with a novel variant, c.1978dupG, in the ATP2C1 gene. Clin Exp Dermatol 2020; 45:914-915. [PMID: 32441372 DOI: 10.1111/ced.14306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2020] [Indexed: 11/29/2022]
Affiliation(s)
- S Itsukage
- Departments of, Department of, Dermatology, Kansai Medical University, Hirakata, Osaka, Japan
| | - N Kambe
- Departments of, Department of, Dermatology, Kansai Medical University, Hirakata, Osaka, Japan.,Department of Dermatology, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
| | - Y Ueki
- Departments of, Department of, Dermatology, Kansai Medical University, Hirakata, Osaka, Japan
| | - C Sato
- Department of, Pathology and Laboratory Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - H Nakano
- Department of Dermatology, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan
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32
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Sato C, Hirasawa K, Tateishi Y, Ozeki Y, Sawada A, Ikeda R, Fukuchi T, Nishio M, Kobayashi R, Makazu M, Kaneko H, Inayama Y, Maeda S. Clinicopathological features of early gastric cancers arising in Helicobacter pylori uninfected patients. World J Gastroenterol 2020; 26:2618-2631. [PMID: 32523315 PMCID: PMC7265143 DOI: 10.3748/wjg.v26.i20.2618] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/25/2020] [Accepted: 05/13/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Persistent Helicobacter pylori (H. pylori) infection causes chronic inflammation, atrophy of the gastric mucosa, and a high risk of developing gastric cancer. In recent years, awareness of eradication therapy has increased in Japan. As H. pylori infections decrease, the proportion of gastric cancers arising from H. pylori uninfected gastric mucosa will increase. The emergence of gastric cancer arising in H. pylori uninfected patients though rarely reported, is a concern to be addressed and needs elucidation of its clinicopathological features.
AIM To evaluate the clinicopathological features of early gastric cancer in H. pylori-uninfected patients.
METHODS A total of 2462 patients with 3375 instances of early gastric cancers that were treated by endoscopic submucosal dissection were enrolled in our study between May 2000 and September 2019. Of these, 30 lesions in 30 patients were diagnosed as H. pylori-uninfected gastric cancer (HpUIGC). We defined a patient as H. pylori-uninfected using the following three criteria: (1) The patient did not receive treatment for H. pylori, which was determined by investigating medical records and conducting patient interviews; (2) Lack of endoscopic atrophy; and (3) The patient was negative for H. pylori after being tested at least twice using various diagnostic methods, including serum anti-H. pylori-IgG antibody, urease breath test, rapid urease test, and microscopic examination.
RESULTS The frequency of HpUIGC was 1.2% (30/2462) for the patients in our study. The study included 19 males and 11 females with a mean age of 59 years. The location of the stomach lesions was divided into three sections; upper third (U), middle third (M), lower third (L). Of the 30 lesions, 15 were U, 1 was M, and 14 were L. Morphologically, 17 lesions were protruded and flat elevated type (0-I, 0-IIa, 0-IIa + IIc), and 13 lesions were flat and depressed type (0-IIb, 0-IIc). The median tumor diameter was 8 mm (range 2-98 mm). Histological analysis revealed that 22 lesions (73.3%) were differentiated type.The HpUIGC lesions were classified into fundic gland type adenocarcinoma (7 cases), foveolar type well-differentiated adenocarcinoma (8 cases), intestinal phenotype adenocarcinoma (7 cases), and pure signet-ring cell carcinoma (8 cases). Among 30 HpUIGCs, 24 lesions (80%) were limited to the mucosa; wherein, the remaining 6 lesions showed submucosal invasion. One of the submucosal invasive lesions showed more than 500 μm invasion. The mucin phenotype analysis identified 7 HpUIGC with intestinal phenotype and 23 with gastric phenotype.
CONCLUSION We elucidated the clinicopathological characteristics of HpUIGC, revealing recognition not only undifferentiated-type but also differentiated-type. In addition, intestinal phenotype tumors were also observed and could be an important tip.
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Affiliation(s)
- Chiko Sato
- Endoscopy Division, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Kingo Hirasawa
- Endoscopy Division, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Yoko Tateishi
- Department of Histopathology, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan
| | - Yuichiro Ozeki
- Endoscopy Division, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Atsushi Sawada
- Endoscopy Division, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Ryosuke Ikeda
- Endoscopy Division, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Takehide Fukuchi
- Endoscopy Division, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Masafumi Nishio
- Endoscopy Division, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Ryosuke Kobayashi
- Endoscopy Division, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Makomo Makazu
- Endoscopy Division, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Hiroaki Kaneko
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan
| | - Yoshiaki Inayama
- Division of Pathological Diagnosis, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Shin Maeda
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan
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33
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Nishio M, Hirasawa K, Ozeki Y, Sawada A, Ikeda R, Fukuchi T, Kobayashi R, Makazu M, Sato C, Maeda S. Short- and long-term outcomes of endoscopic submucosal dissection for non-ampullary duodenal neuroendocrine tumors. Ann Gastroenterol 2020; 33:265-271. [PMID: 32382229 PMCID: PMC7196614 DOI: 10.20524/aog.2020.0477] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/11/2020] [Indexed: 02/07/2023] Open
Abstract
Background Endoscopic resection is recommended for non-ampullary duodenal neuroendocrine tumors (NAD-NETs) ≤10 mm in diameter and confined to the submucosal layer, without lymph node or distant metastasis. However, the efficacy and safety of endoscopic submucosal dissection (ESD) for NAD-NET remains unclear. The aim of this study was to assess the short-term efficacy and safety and the long-term outcomes of ESD for NAD-NET. Methods Eight patients with 8 NAD-NETs who underwent ESD between 2015 and 2018 were included. The indications for ESD were: i) tumor ≤10 mm in diameter; ii) NET G1; iii) confined to the submucosal layer; and iv) without lymph node or distant metastasis. We retrospectively assessed the short- and long-term outcomes and safety. Results The median patient age was 69 (48-76) years. All tumors were located in the duodenal bulb and showed 0-Is morphology. The median size was 6.4 (3-9.3) mm. The rates of en bloc resection, histologically free horizontal and vertical margins, and curative resection were 100%, 88%, and 88%, respectively. Intraoperative and postoperative perforation each occurred in 13% of patients, all of whom were treated conservatively and avoided emergent surgery. Delayed bleeding was not observed. No local, lymph node or distant recurrence was observed during a median follow-up period of 34 (18.5-62.5) months. Conclusions The rates of en bloc and curative resection, and histologically free margins were sufficiently high. Although intraoperative and postoperative perforations occurred, emergency surgery was not needed. The results show that ESD is an efficacious and safe treatment for NAD-NET.
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Affiliation(s)
- Masafumi Nishio
- Division of Endoscopy, Yokohama City University Medical Center (Masafumi Nishio, Kingo Hirasawa, Yuichiro Ozeki, Atsushi Sawada, Ryosuke Ikeda, Takehide Fukuchi, Ryosuke Kobayashi, Makomo Makazu, Chiko Sato)
| | - Kingo Hirasawa
- Division of Endoscopy, Yokohama City University Medical Center (Masafumi Nishio, Kingo Hirasawa, Yuichiro Ozeki, Atsushi Sawada, Ryosuke Ikeda, Takehide Fukuchi, Ryosuke Kobayashi, Makomo Makazu, Chiko Sato)
| | - Yuichiro Ozeki
- Division of Endoscopy, Yokohama City University Medical Center (Masafumi Nishio, Kingo Hirasawa, Yuichiro Ozeki, Atsushi Sawada, Ryosuke Ikeda, Takehide Fukuchi, Ryosuke Kobayashi, Makomo Makazu, Chiko Sato)
| | - Atsushi Sawada
- Division of Endoscopy, Yokohama City University Medical Center (Masafumi Nishio, Kingo Hirasawa, Yuichiro Ozeki, Atsushi Sawada, Ryosuke Ikeda, Takehide Fukuchi, Ryosuke Kobayashi, Makomo Makazu, Chiko Sato)
| | - Ryosuke Ikeda
- Division of Endoscopy, Yokohama City University Medical Center (Masafumi Nishio, Kingo Hirasawa, Yuichiro Ozeki, Atsushi Sawada, Ryosuke Ikeda, Takehide Fukuchi, Ryosuke Kobayashi, Makomo Makazu, Chiko Sato)
| | - Takehide Fukuchi
- Division of Endoscopy, Yokohama City University Medical Center (Masafumi Nishio, Kingo Hirasawa, Yuichiro Ozeki, Atsushi Sawada, Ryosuke Ikeda, Takehide Fukuchi, Ryosuke Kobayashi, Makomo Makazu, Chiko Sato)
| | - Ryosuke Kobayashi
- Division of Endoscopy, Yokohama City University Medical Center (Masafumi Nishio, Kingo Hirasawa, Yuichiro Ozeki, Atsushi Sawada, Ryosuke Ikeda, Takehide Fukuchi, Ryosuke Kobayashi, Makomo Makazu, Chiko Sato)
| | - Makomo Makazu
- Division of Endoscopy, Yokohama City University Medical Center (Masafumi Nishio, Kingo Hirasawa, Yuichiro Ozeki, Atsushi Sawada, Ryosuke Ikeda, Takehide Fukuchi, Ryosuke Kobayashi, Makomo Makazu, Chiko Sato)
| | - Chiko Sato
- Division of Endoscopy, Yokohama City University Medical Center (Masafumi Nishio, Kingo Hirasawa, Yuichiro Ozeki, Atsushi Sawada, Ryosuke Ikeda, Takehide Fukuchi, Ryosuke Kobayashi, Makomo Makazu, Chiko Sato)
| | - Shin Maeda
- Department of Gastoenterology, Yokohama City University Guraduate School of Medicine (Shin Maeda), Japan
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Ozeki Y, Hirasawa K, Sato C. Useful endoscopic resection technique for large pedunculated lesions in the duodenum using thread-traction method with a double-channel endoscope. Dig Endosc 2020; 32:e22-e23. [PMID: 31733074 DOI: 10.1111/den.13559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 10/04/2019] [Indexed: 02/08/2023]
Affiliation(s)
- Yuichiro Ozeki
- Division of Endoscopy, Yokohama City University Medical Center, Kanagawa, Japan
| | - Kingo Hirasawa
- Division of Endoscopy, Yokohama City University Medical Center, Kanagawa, Japan
| | - Chiko Sato
- Division of Endoscopy, Yokohama City University Medical Center, Kanagawa, Japan
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Yoshida M, Takizawa K, Nonaka S, Shichijo S, Suzuki S, Sato C, Komori H, Minagawa T, Oda I, Uedo N, Hirasawa K, Matsumoto K, Sumiyoshi T, Mori K, Gotoda T, Ono H, Takizawa K, Ono H, Mori K, Nonaka S, Oda I, Shichijo S, Uedo N, Suzuki S, Kusano C, Gotoda T, Sato C, Hirasawa K, Komori H, Takeda T, Matsumoto K, Minagawa T, Fujii R, Sumiyoshi T, Yamasaki Y, Minashi K, Nakajima T, Kurokawa Y. Conventional versus traction-assisted endoscopic submucosal dissection for large esophageal cancers: a multicenter, randomized controlled trial (with video). Gastrointest Endosc 2020; 91:55-65.e2. [PMID: 31445039 DOI: 10.1016/j.gie.2019.08.014] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 08/04/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Endoscopic submucosal dissection (ESD) is widely used as a minimally invasive treatment for large esophageal cancers, but prolonged procedure duration and life-threatening adverse events remain matters of concern. We aimed to determine whether traction-assisted ESD (TA-ESD) is superior to conventional ESD in terms of technical outcomes. METHODS A superiority, randomized, phase III trial was conducted at 7 institutions across Japan. Patients with large esophageal cancer (defined as tumor diameter >20 mm) were eligible for this study. Enrolled patients were randomly assigned to undergo conventional ESD or TA-ESD. The primary endpoint was ESD procedure duration. RESULTS Two hundred forty-one patients were recruited and randomized. On applying exclusion criteria, 117 and 116 patients who underwent conventional ESD and TA-ESD, respectively, were included in the baseline analysis. In 1 patient, conventional ESD was discontinued because of severe perforation. Thus, the final analysis included 116 patients per group (primary analysis). The ESD procedure duration was significantly shorter for TA-ESD than for conventional ESD (44.5 minutes vs 60.5 minutes, respectively; P < .001). Moreover, no adverse events were noted in the TA-ESD group. The rate of horizontal margin involvement did not differ between the groups (10.3% vs 6.9% for conventional ESD and TA-ESD, respectively; P = .484). CONCLUSIONS TA-ESD was superior to conventional ESD in terms of procedure duration and was not associated with any adverse events. TA-ESD should be considered the procedure of choice for large esophageal cancers. (Clinical trial registration number: UMIN000024080.).
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Affiliation(s)
- Masao Yoshida
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kohei Takizawa
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Satoru Nonaka
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Satoki Shichijo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Sho Suzuki
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Chiko Sato
- Division of Endoscopy, Yokohama City University Medical Center, Kanagawa, Japan
| | - Hiroyuki Komori
- Department of Gastroenterology, Juntendo University, Tokyo, Japan
| | | | - Ichiro Oda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Kingo Hirasawa
- Division of Endoscopy, Yokohama City University Medical Center, Kanagawa, Japan
| | - Kenshi Matsumoto
- Department of Gastroenterology, Juntendo University, Tokyo, Japan
| | | | - Keita Mori
- Clinical Trial Coordination Office, Shizuoka Cancer Center, Shizuoka, Japan
| | - Takuji Gotoda
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroyuki Ono
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
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Sato C, Wakabayashi K, Honda Y, Shibata K, Furuya T, Nishikura T, Ikeda N, Kikuchi M, Miyoshi F, Toshida T, Tanno K. P241Low exercise tolerance predicts critical myocardial ischemia in asymptomatic patients with diabetic mellitus. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C Sato
- Showa University Koto-Toyosu Hospital, Division of Cardiology, Cardiovascular Center, Tokyo, Japan
| | - K Wakabayashi
- Showa University Koto-Toyosu Hospital, Division of Cardiology, Cardiovascular Center, Tokyo, Japan
| | - Y Honda
- Fuji hospital, Division of Cardiology, Shizuoka, Japan
| | - K Shibata
- Showa University Koto-Toyosu Hospital, Division of Cardiology, Cardiovascular Center, Tokyo, Japan
| | - T Furuya
- Showa University Koto-Toyosu Hospital, Division of Cardiology, Cardiovascular Center, Tokyo, Japan
| | - T Nishikura
- Showa University Koto-Toyosu Hospital, Division of Cardiology, Cardiovascular Center, Tokyo, Japan
| | - N Ikeda
- Showa University Koto-Toyosu Hospital, Division of Cardiology, Cardiovascular Center, Tokyo, Japan
| | - M Kikuchi
- Showa University Koto-Toyosu Hospital, Division of Cardiology, Cardiovascular Center, Tokyo, Japan
| | - F Miyoshi
- Showa University Koto-Toyosu Hospital, Division of Cardiology, Cardiovascular Center, Tokyo, Japan
| | - T Toshida
- Showa University Koto-Toyosu Hospital, Division of Cardiology, Cardiovascular Center, Tokyo, Japan
| | - K Tanno
- Showa University Koto-Toyosu Hospital, Division of Cardiology, Cardiovascular Center, Tokyo, Japan
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Yoshida M, Takizawa K, Suzuki S, Koike Y, Nonaka S, Yamasaki Y, Minagawa T, Sato C, Takeuchi C, Watanabe K, Kanzaki H, Morimoto H, Yano T, Sudo K, Mori K, Gotoda T, Ono H. Conventional versus traction-assisted endoscopic submucosal dissection for gastric neoplasms: a multicenter, randomized controlled trial (with video). Gastrointest Endosc 2018; 87:1231-1240. [PMID: 29233673 DOI: 10.1016/j.gie.2017.11.031] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 11/20/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS The aim of this study was to clarify whether dental floss clip (DFC) traction improves the technical outcomes of endoscopic submucosal dissection (ESD). METHODS A superiority, randomized control trial was conducted at 14 institutions across Japan. Patients with single gastric neoplasm meeting the indications of the Japanese guidelines for gastric treatment were enrolled and assigned to receive conventional ESD or DFC traction-assisted ESD (DFC-ESD). Randomization was performed according to a computer-generated random sequence with stratification by institution, tumor location, tumor size, and operator experience. The primary endpoint was ESD procedure time, defined as the time from the start of the submucosal injection to the end of the tumor removal procedure. RESULTS Between July 2015 and September 2016, 640 patients underwent randomization. Of these, 316 patients who underwent conventional ESD and 319 patients who underwent DFC-ESD were included in our analysis. The mean ESD procedure time was 60.7 and 58.1 minutes for conventional ESD and DFC-ESD, respectively (P = .45). Perforation was less frequent in the DFC-ESD group (2.2% vs .3%, P = .04). For lesions located in the greater curvature of the upper or middle stomach, the mean procedure time was significantly shorter in the DFC-ESD group (104.1 vs 57.2 minutes, P = .01). CONCLUSIONS Our findings suggest that DFC-ESD does not result in shorter procedure time in the overall patient population, but it can reduce the risk of perforation. When selectively applied to lesions located in the greater curvature of the upper or middle stomach, DFC-ESD provides a remarkable reduction in procedure time.
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Affiliation(s)
- Masao Yoshida
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kohei Takizawa
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Sho Suzuki
- Department of Gastroenterology, Yuri-Kumiai General Hospital, Akita, Japan; Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yoshiki Koike
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Satoru Nonaka
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yasushi Yamasaki
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | | | - Chiko Sato
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Chihiro Takeuchi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ko Watanabe
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Hiromitsu Kanzaki
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroyuki Morimoto
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takafumi Yano
- Department of Gastroenterology, Kitasato University School of Medicine, Kanagawa, Japan
| | - Kosuke Sudo
- Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Keita Mori
- Clinical Trial Coordination Office, Shizuoka Cancer Center, Shizuoka, Japan
| | - Takuji Gotoda
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroyuki Ono
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
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Makazu M, Hirasawa K, Sato C, Ikeda R, Fukuchi T, Ishii Y, Kobayashi R, Kaneko H, Taguri M, Tateishi Y, Inayama Y, Maeda S. Histological verification of the usefulness of magnifying endoscopy with narrow-band imaging for horizontal margin diagnosis of differentiated-type early gastric cancers. Gastric Cancer 2018. [PMID: 28639135 DOI: 10.1007/s10120-017-0734-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although magnifying endoscopy with narrow-band imaging (ME-NBI) can help identify the horizontal margin (HM) of early gastric cancer (EGC), little is known about the factors that can clarify the HM by using ME-NBI. We aimed to characterize the pathological features of lesions in which the HM was identified using ME-NBI. METHODS The HMs of 639 differentiated-type EGCs treated with endoscopic submucosal dissection or surgery were analyzed using conventional endoscopy and ME-NBI. The number and width of the intervening parts (IP) and the number, width, and depth of the subepithelial capillaries (SEC) in cancerous and noncancerous areas were measured. RESULTS In 13 lesions (2.0%), more than 90% of the HM was not recognized with conventional endoscopy, but 11 of these lesions were detectable with ME-NBI (NBI group). The HMs of the other 626 lesions were mostly recognized using conventional endoscopy (WLI/CE group). In the NBI group, the IP width, standard deviation (SD), and number of IPs did not significantly differ between the cancerous and noncancerous areas. However, the SEC number was significantly larger and the depth was shallower in cancerous areas. In the WLI/CE group, the IP width and SD were significantly larger, but the IP number was significantly smaller in cancerous areas. The SEC depth was significantly shallower in cancerous areas. CONCLUSIONS Differences of IP width, SD, and IP number may be factors for identifying HMs with conventional endoscopy. Because NBI can better visualize vessel structures, the increased SEC number and shallow SECs may clarify the HM.
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Affiliation(s)
- Makomo Makazu
- Division of Endoscopy, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Kingo Hirasawa
- Division of Endoscopy, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
| | - Chiko Sato
- Division of Endoscopy, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Ryosuke Ikeda
- Division of Endoscopy, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Takehide Fukuchi
- Division of Endoscopy, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Yasuaki Ishii
- Division of Endoscopy, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Ryosuke Kobayashi
- Division of Endoscopy, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Hiroaki Kaneko
- Division of Endoscopy, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Masataka Taguri
- Department of Biostatistics, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Yoko Tateishi
- Department of Pathology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Yoshiaki Inayama
- Diagnostic Pathology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Shin Maeda
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
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Kobayashi R, Hirasawa K, Sato C, Makazu M, Kaneko H, Ikeda R, Fukuchi T, Sawada A, Ozeki Y, Taguri M, Takebayashi S, Maeda S. Utility of multi-detector computed tomography scans after colorectal endoscopic submucosal dissection: a prospective study. Gastrointest Endosc 2018; 87:818-826. [PMID: 29122602 DOI: 10.1016/j.gie.2017.10.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 10/23/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Several reports have described major adverse events after endoscopic submucosal dissection (ESD), such as perforation or bleeding. However, few studies have discussed the occurrence of post-ESD electrocoagulation syndrome (PEECS) after colorectal ESD. In addition, the occurrence of fever without abdominal pain in patients requires postoperative management similar to that required for PEECS. Therefore, we have defined post-ESD inflammatory syndrome (PEIS) composed of both PEECS and fever without abdominal pain. This study aimed to evaluate the correlation between the findings of multi-detector computed tomography (MDCT) imaging and PEIS in patients. METHODS Between January 2015 and October 2015, we performed colorectal ESD in 100 patients; after this, all patients underwent abdominal examinations by MDCT scans. Nine patients who experienced intraoperative perforations or penetrations were excluded; 91 patients were enrolled in our prospective study. MDCT findings in patients were classified according to the amount of extraluminal gas. The patients were divided into 2 groups based on the presence or absence of extraluminal gas and were assessed for co-occurring PEIS. RESULTS Among the 91 patients, extraluminal gas was observed in 31 (34%); of these, PEIS occurred in 14 (15%) patients. Patients with extraluminal gas had increased incidence of PEIS compared with patients without extraluminal gas (29% vs 8%, P = .014). CONCLUSIONS Extraluminal gas was detected by MDCT in many cases and significantly correlated with the occurrence of PEIS, even in cases without obvious intraoperative perforation or penetration. MDCT findings after ESD may be useful for predicting PEIS and appropriate perioperative management.
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Affiliation(s)
- Ryosuke Kobayashi
- Division of Endoscopy, Yokohama City University Medical Center, Minami-ku, Yokohama, Japan
| | - Kingo Hirasawa
- Division of Endoscopy, Yokohama City University Medical Center, Minami-ku, Yokohama, Japan
| | - Chiko Sato
- Division of Endoscopy, Yokohama City University Medical Center, Minami-ku, Yokohama, Japan
| | - Makomo Makazu
- Division of Endoscopy, Yokohama City University Medical Center, Minami-ku, Yokohama, Japan
| | - Hiroaki Kaneko
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan
| | - Ryosuke Ikeda
- Division of Endoscopy, Yokohama City University Medical Center, Minami-ku, Yokohama, Japan
| | - Takehide Fukuchi
- Division of Endoscopy, Yokohama City University Medical Center, Minami-ku, Yokohama, Japan
| | - Atsushi Sawada
- Division of Endoscopy, Yokohama City University Medical Center, Minami-ku, Yokohama, Japan
| | - Yuichiro Ozeki
- Division of Endoscopy, Yokohama City University Medical Center, Minami-ku, Yokohama, Japan
| | - Masataka Taguri
- Department of Biostatistics, Yokohama City University School of Medicine, Kanazawa-ku, Yokohama, Japan
| | - Shigeo Takebayashi
- Department of Diagnostic Radiology, Yokohama City University Medical Center, Minami-ku, Yokohama, Japan
| | - Shin Maeda
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan
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Yaguchi K, Makazu M, Hirasawa K, Sugimori M, Kobayashi R, Sato C, Ikeda R, Fukuchi T, Ishii Y, Kaneko H, Shibata W, Yamanaka S, Inayama Y, Maeda S. Familial Adenomatous Polyposis with Multiple Helicobacter-negative Early Gastric Cancers Treated by Endoscopic Submucosal Dissection. Intern Med 2017; 56:3283-3286. [PMID: 29021452 PMCID: PMC5790714 DOI: 10.2169/internalmedicine.8735-16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Stomach cancer rarely develops in patients with familial adenomatous polyposis (FAP), and Helicobacter pylori infection may increase the risk of FAP-related gastric cancer. We describe the case of a 64-year-old woman who developed multiple synchronous early gastric cancers without H. pylori infection. Nine cancer lesions were successfully treated by endoscopic submucosal dissection. An immunohistochemical analysis revealed that the tumors were positive for mucin (MUC)2, MUC6, and CDX2, but negative for MUC5AC, suggesting that the tumors were gastrointestinal mixed type. Periodical endoscopic surveillance is important for the detection of cancers at an early stage.
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Affiliation(s)
- Katsuki Yaguchi
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Japan
- Yokohama City University School of Medicine, Japan
| | - Makomo Makazu
- Gastroenterological Centre, Yokohama City University Medical Center, Japan
| | - Kingo Hirasawa
- Gastroenterological Centre, Yokohama City University Medical Center, Japan
| | - Makoto Sugimori
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Japan
| | - Ryosuke Kobayashi
- Gastroenterological Centre, Yokohama City University Medical Center, Japan
| | - Chiko Sato
- Gastroenterological Centre, Yokohama City University Medical Center, Japan
| | - Ryosuke Ikeda
- Gastroenterological Centre, Yokohama City University Medical Center, Japan
| | - Takehide Fukuchi
- Gastroenterological Centre, Yokohama City University Medical Center, Japan
| | - Yasuaki Ishii
- Gastroenterological Centre, Yokohama City University Medical Center, Japan
| | - Hiroaki Kaneko
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Japan
| | - Wataru Shibata
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Japan
| | - Shoji Yamanaka
- Department of Pathology, Yokohama City University Graduate School of Medicine, Japan
| | - Yoshiaki Inayama
- Department of Diagnostic Pathology, Yokohama City University Medical Center, Japan
| | - Shin Maeda
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Japan
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Kobayashi R, Hirasawa K, Ikeda R, de Fukuchi T, Ishii Y, Kaneko H, Makazu M, Sato C, Maeda S. The feasibility of colorectal endoscopic submucosal dissection for the treatment of residual or recurrent tumor localized in therapeutic scar tissue. Endosc Int Open 2017; 5:E1242-E1250. [PMID: 29218316 PMCID: PMC5718910 DOI: 10.1055/s-0043-118003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 07/18/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND AND STUDY AIMS Endoscopic submucosal dissection (ESD) is used to treat superficial colorectal tumors. Previous studies have reported the efficacy of ESD for treating residual or local recurrent colorectal tumors. This study sought to evaluate the efficacy of ESD in treating these lesions and to assess factors that prevent successful ESD. METHODS This retrospective study assessed 25 cases of residual or local recurrent lesions that were previously treated using EMR (18 lesions), TEM (5 lesions), ESD (1 lesion) or surgery (1 lesion), and 459 primary lesions treated using ESD between April 2008 and September 2015. Clinicopathological characteristics, treatment outcome and adverse events were compared between groups with or without scar tissue. Factors related to perforation and a prolonged treatment time, which indicate the likelihood of technical difficulties, were identified using multiple logistic regression analysis. RESULTS In residual or local recurrent lesions groups, patients experienced more perforations (32 % vs 4 %, P < 0.001) and required a longer treatment time (117 min vs 61 min, P < 0.001) compared with the primary lesions group. Both groups showed a similar curative resection rate. Emergency surgery was not needed in any case. Multiple logistic regression analysis indicated that tumor location and therapeutic scar tissue were high risk factors for perforation, and that large tumor size and therapeutic scar tissue were high risk factors for prolonged treatment time. CONCLUSIONS ESD for residual or local recurrent colorectal tumors is a technically challenging, but effective and minimally invasive treatment. When performed carefully with sufficient proficiency, it is a useful treatment option.
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Affiliation(s)
- Ryosuke Kobayashi
- Yokohama City University Medical Center – Gastroenterological Center, Yokohama, Kanagawa, Japan
| | - Kingo Hirasawa
- Yokohama City University Medical Center – Gastroenterological Center, Yokohama, Kanagawa, Japan,Corresponding author Kingo Hirasawa Yokohama City UniversityDivision of Endoscopy4-57 Urafune-choMinami-ku YokohamaYokohama 232-0024Japan+81-45-261-5656+81-45-253-5382
| | - Ryosuke Ikeda
- Yokohama City University Medical Center – Gastroenterological Center, Yokohama, Kanagawa, Japan
| | - Takeh de Fukuchi
- Yokohama City University Medical Center – Gastroenterological Center, Yokohama, Kanagawa, Japan
| | - Yasuaki Ishii
- Yokohama City University Medical Center – Gastroenterological Center, Yokohama, Kanagawa, Japan
| | - Hiroaki Kaneko
- Yokohama City University Medical Center – Gastroenterological Center, Yokohama, Kanagawa, Japan
| | - Makomo Makazu
- Yokohama City University Medical Center – Gastroenterological Center, Yokohama, Kanagawa, Japan
| | - Chiko Sato
- Yokohama City University Medical Center – Gastroenterological Center, Yokohama, Kanagawa, Japan
| | - Shin Maeda
- Yokohama City University, School of Medicine – Gastroenterology Division, Yokohama, Kanagawa, Japan
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Naganuma R, Sato S, Kudo A, Sato C, Uwatoko H, Shirai S, Nishimura H, Takahashi I, Matsushima M, Kano T, Yabe I, Houzen H, Sasaki H. Long term observation of Lambert-Eaton myasthenic syndrome patients treated with 3,4-diaminopyridine. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.1844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Kiguchi T, Sato C, Takai K, Nakai Y, Kaneko Y, Matsuki M. CT findings in 11 patients with TAFRO syndrome: a variant of multicentric Castleman's disease. Clin Radiol 2017. [DOI: 10.1016/j.crad.2017.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Sato C, Tsuchida T, Kuroshima K, Ura S, Yoshida K, Yabe I, Sasaki H. Clinical features of patients with epilepsy who were admitted to the emergency department of our hospital. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.1929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kuroshima K, Tsuchida T, Sato C, Ura S, Yoshida K, Shimoyama S, Sakai T, Konuma Y, Kohda K. Clinical importance of changes in MRI during early stage of human herpesvirus-6 encephalitis after hematopoietic stem cell transplantation. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.3407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yamada K, Ohno T, Kitamura T, Ohno Y, Sato C, Kanai H, Kamimoto K. Neuroradiologic evaluation of ischemic or non-ischemic lesions of transient global amnesia. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.2908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sato T, Sato C, Kadowaki A, Watanabe H, Ho L, Ishida J, Yamaguchi T, Kimura A, Fukamizu A, Penninger J, Reversade B, Ito H, Imai Y, Kuba K. 5922A novel APJ ligand, ELABELA/Apela/Toddler, protects from pressure overload- and Angiotensin II-induced cardiac hypertrophy and fibrosis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.5922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sato C, Hirasawa K, Koh R, Ikeda R, Fukuchi T, Kobayashi R, Kaneko H, Makazu M, Maeda S. Postoperative bleeding in patients on antithrombotic therapy after gastric endoscopic submucosal dissection. World J Gastroenterol 2017; 23:5557-5566. [PMID: 28852315 PMCID: PMC5558119 DOI: 10.3748/wjg.v23.i30.5557] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 06/26/2017] [Accepted: 07/12/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To investigated the relationship between postoperative bleeding following gastric endoscopic submucosal dissection (ESD) and individual antithrombotic agents.
METHODS A total of 2488 gastric neoplasms in 2148 consecutive patients treated between May 2001 and June 2016 were studied. The antithrombotic agents were categorized into antiplatelet agents, anticoagulants, and other antithrombotic agents, and we included combination therapies [e.g., dual antiplatelet therapy (DAPT)]. The risk factors associated with post-ESD bleeding, namely, antithrombotic agents overall, individual antithrombotic agents, withdrawal or continuation of antithrombotic agents, and bleeding onset period (during the first six days or thereafter), were analyzed using univariate and multivariate analyses.
RESULTS The en bloc resection and complete curative resection rates were 99.2% and 91.9%, respectively. Postoperative bleeding occurred in 5.1% cases. Bleeding occurred in 10.3% of the patients administered antithrombotic agents. Being male (P = 0.007), specimen size (P < 0.001), and antithrombotic agent used (P < 0.001) were independent risk factors for postoperative bleeding. Heparin bridging therapy (HBT) (P = 0.002) and DAPT/multidrug combinations (P < 0.001) were independent risk factors associated with postoperative bleeding. The bleeding rate of the antithrombotic agent continuation group was significantly higher than that of the withdrawal group (P < 0.01). Bleeding within postoperative day (POD) 6 was significantly higher in warfarin (P = 0.015), and bleeding after POD 7 was significantly higher in DAPT/multidrug combinations (P = 0.007). No thromboembolic events were reported.
CONCLUSION We must closely monitor patients administered HBT and DAPT/multidrug combinations after gastric ESD, particularly those administered multidrug combinations after discharge.
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Sato C, Ota M, Yano T. Cytotoxic effect caused by the combination of vitamin E homologs on prostate cancer cells. Journal of Nutrition & Intermediary Metabolism 2017. [DOI: 10.1016/j.jnim.2017.04.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Nakano T, Sato C, Yamada M, Nakagawa A, Yamamoto H, Fujishima F, Tominaga T, Satomi S, Ohuchi N. A laser-induced pulsed water jet for layer-selective submucosal dissection of the esophagus. Laser Ther 2016; 25:185-191. [PMID: 27853343 DOI: 10.5978/islsm.16-or-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background and aims: Conventional water jet devices have been used for injecting fluid to lift up lesions during endoscopic submucosal dissection or endoscopic mucosal resection procedures. However, these devices cannot dissect the submucosal layer effectively. Here we aim to elucidate the dissection capability of a laser-induced pulsed water jet and to clarify the mechanism of dissection with layer selectivity. Materials (Subjects) and methods: Pulsed water jets were ejected from a stainless nozzle by accelerating saline using the energy of a pulsed holmium: yttrium-aluminum-garnet laser. The impact force (strength) of the jet was evaluated using a force meter. Injection of the pulsed jet into the submucosal layer was documented by high-speed imaging. The physical properties of the swine esophagus were evaluated by measuring the breaking strength. Submucosal dissection of the swine esophagus was performed and the resection bed was evaluated histologically. Results: Submucosal dissection of the esophagus was accomplished at an impact force of 1.11-1.47 N/pulse (laser energy: 1.1-1.5 J/pulse; standoff distance: 60 mm). Histological specimens showed clear dissection at the submucosal layer without thermal injury. The mean static breaking strength of the submucosa (0.11 ± 0.04 MPa) was significantly lower than that of the mucosa (1.32 ± 0.18 MPa), and propria muscle (1.45 ± 0.16 MPa). Conclusions: The pulsed water jet device showed potential for achieving selective submucosal dissection. It could achieve mucosal, submucosal, and muscle layer selectivity owing to the varied breaking strengths.
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Affiliation(s)
- T Nakano
- Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, Sendai, Miyagi 980-8574, Japan
| | - C Sato
- Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, Sendai, Miyagi 980-8574, Japan
| | - M Yamada
- Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, Sendai, Miyagi 980-8574, Japan
| | - A Nakagawa
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi 980-8574, Japan
| | - H Yamamoto
- Department of Cardiovascular medicine, Tohoku University Graduate School of medicine, Sendai, Miyagi, 980-8574, Japan
| | - F Fujishima
- Department of Pathology, Tohoku University Hospital, Sendai, Miyagi 980-8574, Japan
| | - T Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi 980-8574, Japan
| | - S Satomi
- Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, Sendai, Miyagi 980-8574, Japan
| | - N Ohuchi
- Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, Sendai, Miyagi 980-8574, Japan
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