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Morihisa Y, Urai S, Iwagami H, Shimoyama M, Ogino S, Terashita T, Morimura H, Akamatsu T, Uenoyama Y, Yamashita Y. Primary Retroperitoneal Mucinous Cystadenocarcinoma during Long-term Administration of Infliximab for the Treatment of Crohn's Disease. Intern Med 2023; 62:3619-3624. [PMID: 37164674 PMCID: PMC10781556 DOI: 10.2169/internalmedicine.1593-23] [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: 01/10/2023] [Accepted: 03/23/2023] [Indexed: 05/12/2023] Open
Abstract
We herein report a rare case of primary retroperitoneal mucinous cystadenocarcinoma (PRMC) in a 60-year-old man. The patient, who had been treated with infliximab for Crohn's disease of the colon for 13 years, was referred to our hospital for lower back pain. Contrast-enhanced computed tomography (CT) and magnetic resonance imaging revealed multiple cystic lesions in the right retroperitoneum, the calcification of the cyst, and bone lesions. Bone and CT-assisted biopsies of the retroperitoneal lesions revealed poorly differentiated adenocarcinoma. The patient was diagnosed with PRMC with bone metastases using immunohistochemical staining and positron emission tomography/CT.
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Affiliation(s)
- Yoshiki Morihisa
- Department of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Japan
| | - Shunji Urai
- Department of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Japan
| | - Hiroyoshi Iwagami
- Department of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Japan
| | - Masayuki Shimoyama
- Department of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Japan
| | - Shinya Ogino
- Department of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Japan
| | - Tomoko Terashita
- Department of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Japan
| | - Hiroki Morimura
- Department of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Japan
| | - Takuji Akamatsu
- Department of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Japan
| | - Yoshito Uenoyama
- Department of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Japan
| | - Yukitaka Yamashita
- Department of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Japan
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Nakano S, Iwagami H, Morihisa Y, Konishi T, Nakatani Y, Akamatsu T, Yamashita Y. Underwater endoscopic mucosal resection using a detachable snare for a pedunculated lesion located in the greater curvature of the upper gastric body. Endoscopy 2023; 55:E519-E520. [PMID: 36894148 PMCID: PMC9998221 DOI: 10.1055/a-2032-3807] [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: 03/11/2023]
Affiliation(s)
- Shogo Nakano
- Department of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Hiroyoshi Iwagami
- Department of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Yoshiki Morihisa
- Department of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Takafumi Konishi
- Department of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Yasuki Nakatani
- Department of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Takuji Akamatsu
- Department of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Yukitaka Yamashita
- Department of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
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Iwagami H, Shimoyama M, Terashita T, Konishi T, Nakatani Y, Akamatsu T, Tsujimura T. Effective traction using a clip with rubber band and grasping forceps in endoscopic laryngopharyngeal surgery. Endoscopy 2023; 55:E566-E567. [PMID: 36958353 PMCID: PMC10036207 DOI: 10.1055/a-2045-7726] [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: 03/25/2023]
Affiliation(s)
- Hiroyoshi Iwagami
- Department of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Masayuki Shimoyama
- Department of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Tomoko Terashita
- Department of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Takafumi Konishi
- Department of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Yasuki Nakatani
- Department of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Takuji Akamatsu
- Department of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Takashi Tsujimura
- Department of Otorhinolaryngology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
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Seta T, Iwagami H, Agatsuma N, Noma A, Ikenouchi M, Kubo K, Akamatsu T, Uenoyama Y, Ito D, Yamashita Y, Nakayama T. Efficacy of antimicrobial therapy in patients with uncomplicated acute colonic diverticulitis: an updated systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2023; 35:1097-1106. [PMID: 37577799 DOI: 10.1097/meg.0000000000002622] [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: 08/15/2023]
Abstract
The need for antimicrobial therapy for uncomplicated acute diverticulitis of the colon remains controversial. We conducted a systematic review of the efficacy of antimicrobial agents against this disease, including new randomized controlled trials (RCTs) reported in recent years, and evaluated their efficacy using a meta-analytic approach. RCTs were searched using PubMed, EMBASE, Google Scholar, Cochrane Library, Ichushi-Web, and eight registries. Keywords were 'colonic diverticulitis', 'diverticulitis', 'antimicrobial agents', ''antibiotics, 'complication', 'abscess', 'gastrointestinal perforation', 'gastrointestinal obstruction', 'diverticular hemorrhage', and 'fistula'. Studies with antimicrobial treatment in the intervention group and placebo or no treatment in the control group were selected by multiple reviewers using uniform inclusion criteria, and data were extracted. Prevention of any complication was assessed as the primary outcome, and efficacy was expressed as risk ratio (RR) and risk difference (RD). A meta-analysis was performed using 5 RCTs of the 21 studies that were eligible for scrutiny in the initial search and which qualified for final inclusion. Three of these studies were not included in the previous meta-analysis. Subjects included 1039 in the intervention group and 1040 in the control group. Pooled RR = 0.86 (95% confidence interval, 0.58-1.28) and pooled RD = -0.01 (-0.03 to 0.01) for the effect of antimicrobial agents in reducing any complications. Recurrences, readmissions, and surgical interventions did not significantly show the efficacies of using antimicrobial agents. A meta-analysis of recently reported RCTs did not provide evidence that antimicrobial therapy improves clinical outcomes in uncomplicated acute diverticulitis of the colon.
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Affiliation(s)
- Takeshi Seta
- Departments of Gastroenterology
- Hepatology and Digestive Cancer Center, Japanese Red Cross Wakayama Medical Center, Wakayama
- Department of Health Informatics, Graduate School of Medicine & School of Public Health, Kyoto University
| | - Hiroyoshi Iwagami
- Departments of Gastroenterology
- Hepatology and Digestive Cancer Center, Japanese Red Cross Wakayama Medical Center, Wakayama
| | - Nobukazu Agatsuma
- Departments of Gastroenterology
- Hepatology, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto
| | - Atsushi Noma
- Department of Gastroenterological Surgery and Digestive Cancer Center, Japanese Red Cross Wakayama Medical Center, Wakayama
| | - Maiko Ikenouchi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo Medical University, Hyogo
| | - Kenji Kubo
- Department of Infectious Diseases and Emergency Medicine, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Takuji Akamatsu
- Departments of Gastroenterology
- Hepatology and Digestive Cancer Center, Japanese Red Cross Wakayama Medical Center, Wakayama
| | - Yoshito Uenoyama
- Departments of Gastroenterology
- Hepatology and Digestive Cancer Center, Japanese Red Cross Wakayama Medical Center, Wakayama
| | - Daisuke Ito
- Department of Gastroenterological Surgery and Digestive Cancer Center, Japanese Red Cross Wakayama Medical Center, Wakayama
| | - Yukitaka Yamashita
- Departments of Gastroenterology
- Hepatology and Digestive Cancer Center, Japanese Red Cross Wakayama Medical Center, Wakayama
| | - Takeo Nakayama
- Department of Health Informatics, Graduate School of Medicine & School of Public Health, Kyoto University
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Iwagami H, Akamatsu T, Matsuyama K, Hanawa Y, Tonomura K, Chikugo E, Ogino S, Morimura H, Shimoyama M, Terashita T, Nakano S, Wakita M, Edagawa T, Konishi T, Matsumoto H, Nakatani Y, Urai S, Seta T, Uenoyama Y, Yamashita Y. Dexmedetomidine is safe and effective for reducing intraprocedural pain in colorectal endoscopic submucosal dissection. DEN Open 2023; 3:e223. [PMID: 36992692 PMCID: PMC10041156 DOI: 10.1002/deo2.223] [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] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 02/08/2023] [Accepted: 02/26/2023] [Indexed: 03/29/2023]
Abstract
Objectives Endoscopic submucosal dissection (ESD) is effective for the resection of colorectal intramucosal lesions. This study was performed to examine the safety and effectiveness of using dexmedetomidine (DEX) in the anesthesia regimen of patients with colorectal lesions undergoing ESD. Methods We retrospectively examined 287 consecutive patients who underwent ESD for colorectal lesions in our institution from January 2015 to December 2021. Outcomes including the frequency of intraprocedural pain and adverse events were compared between the DEX and no DEX groups. Moreover, univariate and multivariate analyses were conducted for each clinical factor of intraprocedural pain. Intraprocedural pain was defined as patient-reported abdominal pain or body movement during the procedure. Results The incidence of intraprocedural pain was significantly lower in the DEX than in the no DEX group (7% vs. 17%, p = 0.02). The incidence of hypotension was also significantly higher in the DEX group (7% vs. 0%, p = 0.01), but no cerebrovascular or cardiac ischemic events occurred. In the univariate analyses, the diameter of the resected specimen, procedure time, no use of DEX, and total midazolam dose was associated with intraprocedural pain. The midazolam dose and DEX administration were significantly negatively correlated and the diameter of resected specimen and procedure time were significantly positively correlated. Multivariate logistic regression showed that no use of DEX was independently associated with intraprocedural pain (p = 0.02). Conclusions Adding DEX to the anesthesia regimen in patients undergoing colorectal ESD appears to be safe and effective for reducing intraprocedural pain.
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Affiliation(s)
- Hiroyoshi Iwagami
- Department of Gastroenterology and HepatologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Takuji Akamatsu
- Department of Gastroenterology and HepatologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Kazuki Matsuyama
- Department of Gastroenterology and HepatologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Yusuke Hanawa
- Department of Gastroenterology and HepatologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Kohei Tonomura
- Department of Gastroenterology and HepatologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Eiki Chikugo
- Department of Gastroenterology and HepatologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Shinya Ogino
- Department of Gastroenterology and HepatologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Hiroki Morimura
- Department of Gastroenterology and HepatologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Masayuki Shimoyama
- Department of Gastroenterology and HepatologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Tomoko Terashita
- Department of Gastroenterology and HepatologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Shogo Nakano
- Department of Gastroenterology and HepatologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Midori Wakita
- Department of Gastroenterology and HepatologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Takeya Edagawa
- Department of Gastroenterology and HepatologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Takafumi Konishi
- Department of Gastroenterology and HepatologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Hisakazu Matsumoto
- Department of Gastroenterology and HepatologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Yasuki Nakatani
- Department of Gastroenterology and HepatologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Shunji Urai
- Department of Gastroenterology and HepatologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Takeshi Seta
- Department of Gastroenterology and HepatologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Yoshito Uenoyama
- Department of Gastroenterology and HepatologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Yukitaka Yamashita
- Department of Gastroenterology and HepatologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
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Morihisa Y, Iwagami H, Akamatsu T, Nakano S, Wakita M, Edagawa T, Konishi T, Nakatani Y, Yamashita Y. Two cases of esophageal basaloid squamous cell carcinoma which achieved long-term survival by endoscopic submucosal dissection and additional chemoradiotherapy. DEN Open 2023; 3:e211. [PMID: 36742281 PMCID: PMC9889968 DOI: 10.1002/deo2.211] [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] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 02/05/2023]
Abstract
Herein, we report two rare basaloid squamous cell carcinoma (BSCC) cases. Esophagogastroduodenoscopy revealed a submucosal tumor-like lesion and a biopsied specimen showed a finding suspected of BSCC in both cases. Both lesions underwent endoscopic submucosal dissection with en bloc resection, and long-term survival was achieved using additional chemoradiotherapy. The standard treatment for BSCC has not been determined, and there are few reports of esophageal BSCC treated using endoscopic resection. Endoscopic submucosal dissection and additional chemoradiotherapy for superficial BSCC may be effective treatment options.
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Affiliation(s)
- Yoshiki Morihisa
- Department of Gastroenterology and HepatologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Hiroyoshi Iwagami
- Department of Gastroenterology and HepatologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Takuji Akamatsu
- Department of Gastroenterology and HepatologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Shogo Nakano
- Department of Gastroenterology and HepatologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Midori Wakita
- Department of Gastroenterology and HepatologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Takeya Edagawa
- Department of Gastroenterology and HepatologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Takafumi Konishi
- Department of Gastroenterology and HepatologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Yasuki Nakatani
- Department of Gastroenterology and HepatologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Yukitaka Yamashita
- Department of Gastroenterology and HepatologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
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Iwagami H, Akamatsu T, Ogino S, Morimura H, Shimoyama M, Terashita T, Nakano S, Wakita M, Edagawa T, Konishi T, Nakatani Y, Yamashita Y. Longly-attached cap can contribute to en bloc underwater endoscopic mucosal resection of 20-30 mm colorectal intramucosal lesions. Endosc Int Open 2022; 10:E1562-E1569. [PMID: 36531672 PMCID: PMC9754868 DOI: 10.1055/a-1961-1684] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 10/13/2022] [Indexed: 10/17/2022] Open
Abstract
Background and study aims Underwater endoscopic mucosal resection (UEMR) is effective for colorectal intramucosal lesions. The aim of this study was to evaluate whether a longly-attached cap in UEMR improves the en bloc resection rate for 20-30 mm lesions. Patients and methods We performed a retrospective study at a tertiary institute. Candidates for the study were systematically retrieved from an endoscopic and pathological database from October 2016 to December 2020. We assessed the procedural outcomes with UEMR for lesions ≥ 20 mm in size and the clinical factors contributing to en bloc resection. Results A total of 52 colorectal lesions that underwent UEMR were included. The median procedure time was 271 (66-1264) seconds. The en bloc resection rate and R0 resection rate were 75 % and 73 %, respectively. Intraprocedural perforation occurred in one (1.9 %) case, but no bleeding occurred. Delayed bleeding occurred in one (1.9%) case, but no delayed perforation occurred. Regarding tumor size, macroscopic type, tumor location, and the presence or absence of a history of abdominal operation, there was no significant difference between the en bloc resection and piecemeal resection groups. The visibility of the whole lesion, a longly-attached cap, and sessile serrated lesions were more frequently observed in the en bloc resection group than in the piecemeal resection group ( P < 0.001, P = 0.01, and P = 0.04, respectively). Multivariate analysis showed that a longly-attached cap was the only independent factor associated with en bloc resection ( P = 0.02). Conclusions A longly-attached cap might contribute to en bloc resection.
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Affiliation(s)
- Hiroyoshi Iwagami
- Department of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Takuji Akamatsu
- Department of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Shinya Ogino
- Department of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Hiroki Morimura
- Department of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Masayuki Shimoyama
- Department of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Tomoko Terashita
- Department of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Shogo Nakano
- Department of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Midori Wakita
- Department of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Takeya Edagawa
- Department of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Takafumi Konishi
- Department of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Yasuki Nakatani
- Department of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Yukitaka Yamashita
- Department of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
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Nakano S, Minaga K, Tani Y, Tonomura K, Hanawa Y, Morimura H, Terashita T, Matsumoto H, Iwagami H, Nakatani Y, Akamatsu T, Uenoyama Y, Maeda C, Ono K, Watanabe T, Yamashita Y. Primary Hepatic Neuroendocrine Carcinoma with Thrombocytopenia Due to Diffuse Bone Marrow and Splenic Infiltration: An Autopsy Case. Intern Med 2022; 61:3361-3368. [PMID: 35400708 PMCID: PMC9751712 DOI: 10.2169/internalmedicine.9465-22] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
An 82-year-old man with fever and back pain was referred to our hospital and was thus found to be thrombocytopenic. A bone marrow biopsy revealed the diffuse infiltration of poorly differentiated neuroendocrine carcinoma (NEC). Computed tomography revealed a large hepatic mass. Considering the risk of bleeding due to thrombocytopenia, a needle biopsy was not performed. The patient rapidly deteriorated and died 10 days after presentation. An autopsy confirmed the diagnosis of primary hepatic NEC, with diffuse metastasis to the spleen, bone marrow, and systemic lymph nodes. This is an extremely rare case of NEC presenting with thrombocytopenia due to extensive bone marrow and splenic infiltration.
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Affiliation(s)
- Shogo Nakano
- Department of Gastroenterology, Japan Red Cross Wakayama Medical Center, Japan
| | - Kosuke Minaga
- Department of Gastroenterology, Japan Red Cross Wakayama Medical Center, Japan
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Japan
| | - Yasuhiro Tani
- Department of Gastroenterology, Japan Red Cross Wakayama Medical Center, Japan
| | - Kohei Tonomura
- Department of Gastroenterology, Japan Red Cross Wakayama Medical Center, Japan
| | - Yusuke Hanawa
- Department of Gastroenterology, Japan Red Cross Wakayama Medical Center, Japan
| | - Hiroki Morimura
- Department of Gastroenterology, Japan Red Cross Wakayama Medical Center, Japan
| | - Tomoko Terashita
- Department of Gastroenterology, Japan Red Cross Wakayama Medical Center, Japan
| | - Hisakazu Matsumoto
- Department of Gastroenterology, Japan Red Cross Wakayama Medical Center, Japan
| | - Hiroyoshi Iwagami
- Department of Gastroenterology, Japan Red Cross Wakayama Medical Center, Japan
| | - Yasuki Nakatani
- Department of Gastroenterology, Japan Red Cross Wakayama Medical Center, Japan
| | - Takuji Akamatsu
- Department of Gastroenterology, Japan Red Cross Wakayama Medical Center, Japan
| | - Yoshito Uenoyama
- Department of Gastroenterology, Japan Red Cross Wakayama Medical Center, Japan
| | - Chikara Maeda
- Department of Radiology, Japan Red Cross Wakayama Medical Center, Japan
| | - Kazuo Ono
- Department of Pathology, Japan Red Cross Wakayama Medical Center, Japan
| | - Tomohiro Watanabe
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Japan
| | - Yukitaka Yamashita
- Department of Gastroenterology, Japan Red Cross Wakayama Medical Center, Japan
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Iwagami H, Seta T, Nakano S, Wakita M, Konishi T, Matsumoto H, Nakatani Y, Akamatsu T, Urai S, Uenoyama Y, Yamashita Y, Nakayama T. Association between antispasmodics and detection of lesions by screening esophagogastroduodenoscopy. JGH Open 2022; 6:792-798. [PMID: 36406644 PMCID: PMC9667398 DOI: 10.1002/jgh3.12828] [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: 06/30/2022] [Revised: 09/08/2022] [Accepted: 09/26/2022] [Indexed: 11/17/2022]
Abstract
Background and Aim Whether administration of antispasmodics as a component of premedication contributes to detection of lesions by screening esophagogastroduodenoscopy (EGDS) remains unclear. Our primary aim was to investigate this possibility. Methods The cohort in this retrospective study comprised consecutive asymptomatic individuals who had undergone screening EGDS as part of a health check‐up at the Japanese Red Cross Wakayama Medical Center from October 2015 to September 2020. The investigated lesions comprised esophageal squamous cell carcinoma or adenocarcinoma, gastric adenoma or adenocarcinoma, and duodenal adenoma or adenocarcinoma. Results Targeted lesions were detected in 72 of 31 484 participants (0.23%), 18 260 and 13 224 of whom had received and not received pre‐procedure antispasmodics, respectively. The rates of detection of lesions in these groups were 0.21% (38/18260) and 0.26% (34/13224), respectively (P = 0.40). Multivariate logistic regression analysis showed no association between administration of antispasmodics and rates of detection of targeted lesions [P = 0.24, Odds ratio (95% CI): 1.46 (0.78–2.75)]. Conclusions Antispasmodics, which were administered to more than half of the study cohort, did not improve the rate of detection of targeted lesions.
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Affiliation(s)
- Hiroyoshi Iwagami
- Department of Gastroenterology and Hepatology Japanese Red Cross Wakayama Medical Center Wakayama Japan
- Department of Health Informatics Graduate School of Medicine & School of Public Health, Kyoto University Kyoto Japan
| | - Takeshi Seta
- Department of Gastroenterology and Hepatology Japanese Red Cross Wakayama Medical Center Wakayama Japan
- Department of Health Informatics Graduate School of Medicine & School of Public Health, Kyoto University Kyoto Japan
| | - Shogo Nakano
- Department of Gastroenterology and Hepatology Japanese Red Cross Wakayama Medical Center Wakayama Japan
| | - Midori Wakita
- Department of Gastroenterology and Hepatology Japanese Red Cross Wakayama Medical Center Wakayama Japan
| | - Takafumi Konishi
- Department of Gastroenterology and Hepatology Japanese Red Cross Wakayama Medical Center Wakayama Japan
| | - Hisakazu Matsumoto
- Department of Gastroenterology and Hepatology Japanese Red Cross Wakayama Medical Center Wakayama Japan
| | - Yasuki Nakatani
- Department of Gastroenterology and Hepatology Japanese Red Cross Wakayama Medical Center Wakayama Japan
| | - Takuji Akamatsu
- Department of Gastroenterology and Hepatology Japanese Red Cross Wakayama Medical Center Wakayama Japan
| | - Shunji Urai
- Department of Gastroenterology and Hepatology Japanese Red Cross Wakayama Medical Center Wakayama Japan
| | - Yoshito Uenoyama
- Department of Gastroenterology and Hepatology Japanese Red Cross Wakayama Medical Center Wakayama Japan
| | - Yukitaka Yamashita
- Department of Gastroenterology and Hepatology Japanese Red Cross Wakayama Medical Center Wakayama Japan
| | - Takeo Nakayama
- Department of Health Informatics Graduate School of Medicine & School of Public Health, Kyoto University Kyoto Japan
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Affiliation(s)
- Hiroyoshi Iwagami
- Departments of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan.
| | - Takeya Edagawa
- Departments of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Yukitaka Yamashita
- Departments of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
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Iwagami H, Akamatsu T, Yamashita Y. Case of chronic disseminated intravascular coagulation associated with abdominal aortic aneurysm with repeated bleeding after cold snare polypectomy. Dig Endosc 2022; 34:247. [PMID: 34674392 DOI: 10.1111/den.14176] [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] [Received: 05/28/2021] [Revised: 10/15/2021] [Accepted: 10/19/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Hiroyoshi Iwagami
- Departments of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Takuji Akamatsu
- Departments of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Yukitaka Yamashita
- Departments of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
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12
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Iwagami H, Hanawa Y, Akamatsu T. Esophageal pyogenic granuloma resected by polypectomy using a detachable snare. JGH Open 2021; 5:1398-1400. [PMID: 34950784 PMCID: PMC8674537 DOI: 10.1002/jgh3.12674] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 06/14/2023]
Abstract
Pyogenic granuloma (PG) is a benign inflammatory vascular lesion rarely seen in the gastrointestinal tract and a possible cause of bleeding. Polypectomy using a detachable snare for esophageal PG with active bleeding is an effective treatment.
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Affiliation(s)
- Hiroyoshi Iwagami
- Department of Gastroenterology and HepatologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Yusuke Hanawa
- Department of Gastroenterology and HepatologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Takuji Akamatsu
- Department of Gastroenterology and HepatologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
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13
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Kono M, Kanesaka T, Ishihara R, Kitamura M, Shoji A, Inoue T, Matsueda K, Miyake M, Waki K, Shimamoto Y, Fukuda H, Iwagami H, Matsuura N, Nakahira H, Shichijo S, Maekawa A, Yamamoto S, Takeuchi Y, Higashino K, Uedo N, Michida T, Nakatsuka SI, Fujiwara Y. Delineating the extent of esophageal squamous cell carcinoma. Esophagus 2021; 18:790-796. [PMID: 34052934 DOI: 10.1007/s10388-021-00854-w] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/24/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Lugol chromoendoscopy has been conventionally used for the detection and delineation of esophageal squamous cell carcinoma (SCC). However, the boundaries of some lesions are unclear even with Lugol chromoendoscopy, and there is a risk of residual lesions or over-excision. This study aimed to evaluate the utility of narrow-band imaging (NBI) for the delineation of esophageal SCC in endoscopic resection. METHODS Among 367 esophageal SCCs endoscopically resected between January and December 2019 at our institute, this retrospective study included consecutive lesions, which were first marked with NBI, followed by Lugol chromoendoscopy. The proportion of residual cancer, which was defined as histologically proven cancer confirmed adjacent to the scar within 1 year after endoscopic resection, was evaluated. To evaluate whether the marks added by Lugol chromoendoscopy after NBI marking were more reliable, we evaluated the presence of cancer in the iodine-unstained area outside the NBI-determined marks, i.e., the cancerous area missed by NBI. The presence of cancer in the iodine-stained areas inside the NBI-determined marks, i.e., the cancerous area missed by Lugol, was also evaluated. These were compared to assess the risk of residual cancer in endoscopic resection with NBI and Lugol chromoendoscopy. RESULTS Among 304 lesions, 2 (0.7%) residual cancers were detected. The cancerous area missed by NBI and the cancerous area missed by Lugol were identified in 18 (6%) and 43 (14%) lesions, respectively (P = 0.001). CONCLUSIONS NBI might be acceptable for delineating the extent of esophageal SCCs that are difficult to delineate with Lugol chromoendoscopy.
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Affiliation(s)
- Mitsuhiro Kono
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka, 541-8567, Japan
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Takashi Kanesaka
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka, 541-8567, Japan.
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan.
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Masanori Kitamura
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
| | - Ayaka Shoji
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Takahiro Inoue
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Katsunori Matsueda
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Muneaki Miyake
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Kotaro Waki
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Yusaku Shimamoto
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Hiromu Fukuda
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Hiroyoshi Iwagami
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Noriko Matsuura
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Hiroko Nakahira
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Satoki Shichijo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Akira Maekawa
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Sachiko Yamamoto
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Koji Higashino
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Tomoki Michida
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Shin-Ichi Nakatsuka
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
| | - Yasuhiro Fujiwara
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
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14
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Fukuda H, Takeuchi Y, Shoji A, Miyake M, Matsueda K, Inoue T, Waki K, Shimamoto Y, Kono M, Iwagami H, Nakahira H, Matsuura N, Shichijo S, Maekawa A, Kanesaka T, Yamamoto S, Higashino K, Uedo N, Ishihara R. Curative value of underwater endoscopic mucosal resection for submucosally invasive colorectal cancer. J Gastroenterol Hepatol 2021; 36:2471-2478. [PMID: 33788311 DOI: 10.1111/jgh.15513] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Received: 08/12/2020] [Revised: 01/13/2021] [Accepted: 03/26/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Occasionally, colorectal tumors without characteristics of deep submucosal invasion are found to be invasive upon pathological evaluation after endoscopic resection (ER). Because the resection depth for underwater endoscopic mucosal resection (UEMR) has not been clarified, we evaluated the feasibility of UEMR for pathologically invasive colorectal cancer (pT1-CRC). METHODS We retrospectively investigated data on the backgrounds and outcomes of patients with pT1-CRC who underwent UEMR between January 2014 and June 2019 at our institute. As a reference standard, the backgrounds and outcomes of pT1-CRCs that had undergone conventional EMR (CEMR) were also investigated. RESULTS Thirty-one patients (median age, 68 years [range, 32-88 years]; 22 men [71%]) were treated with UEMR. Median lesion size was 17 mm (range, 6-50 mm). The endoscopic complete resection rate was 100%. The overall en bloc resection rate was 77%, and the VM0, HM0, and R0 resection rates were 81%, 58%, and 55%, respectively. In cases of pT1a (invasion <1000 μm)-CRC (n = 14), the en bloc, VM0, and R0 resection rates were 92%, 100%, and 71%, respectively. Seventeen patients (five with risk factors for lymph node metastasis and 12 without) were followed up, and no local recurrence and distant metastasis were observed during the follow-up period (median follow-up period, 18 months [range, 6-62 months]) after UEMR. The outcomes of UEMR seemed to be comparable with those of CEMR (n = 32). CONCLUSIONS The VM0 rate of UEMR for pT1-CRC, especially for pT1a-CRC, without characteristics of deep submucosal invasion seems feasible.
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Affiliation(s)
- Hiromu Fukuda
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Ayaka Shoji
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Muneaki Miyake
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Katsunori Matsueda
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takahiro Inoue
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Kotaro Waki
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yusaku Shimamoto
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Mitsuhiro Kono
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroyoshi Iwagami
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroko Nakahira
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriko Matsuura
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Satoki Shichijo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Akira Maekawa
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takashi Kanesaka
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Sachiko Yamamoto
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Koji Higashino
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
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15
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Ohmori M, Yamasaki Y, Iwagami H, Nakahira H, Matsuura N, Shichijo S, Maekawa A, Kanesaka T, Yamamoto S, Higashino K, Uedo N, Ishihara R, Okada H, Takeuchi Y. Propensity score-matched analysis of endoscopic resection for recurrent colorectal neoplasms: A pilot study. J Gastroenterol Hepatol 2021; 36:2568-2574. [PMID: 33843099 DOI: 10.1111/jgh.15519] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Received: 09/03/2020] [Revised: 04/01/2021] [Accepted: 04/04/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIM Local residual/recurrent colorectal lesions after endoscopic resection (ER) are difficult to treat with conventional ER. Underwater endoscopic mucosal resection (UEMR) and endoscopic submucosal dissection (ESD) are reportedly effective. We investigated the appropriate indications of ESD and UEMR for recurrent colorectal lesions. METHODS This single-center, retrospective, observational study was conducted at a tertiary cancer institute. Patients who underwent UEMR or ESD for residual/recurrent colorectal lesions after ER from October 2013 to February 2019 were enrolled. Propensity score matching was performed between the UEMR and ESD groups to compare the clinical characteristics, treatment, and outcomes. RESULTS In total, 30 UEMRs and 21 ESDs were performed. Median (range) diameter of the lesions was 8 mm (2-22 mm) in UEMR and 15 mm (2-58 mm) in ESD. Median procedure time in UEMR was significantly shorter than that of ESD (4 min [2-15 min] vs 70 min [17-193 min], P < 0.001). En bloc and complete resection rates of ESD were significantly higher than that of UEMR (73% vs 100%, 41% vs 81%, respectively). No adverse events occurred with UEMR, but there were two cases (10%) of delayed perforation with ESD. Neither group reported recurrence after treatment. Propensity score-matched cases showed significantly shorter procedure time and hospitalization period in UEMR than in ESD. CONCLUSIONS The outcomes of UEMR and ESD were comparable. UEMR could be a useful salvage therapy for small local residual/recurrent colorectal lesions after ER with shorter procedure time and hospitalization period.
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Affiliation(s)
- Masayasu Ohmori
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan.,Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Yasushi Yamasaki
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan.,Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Hiroyoshi Iwagami
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroko Nakahira
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriko Matsuura
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Satoki Shichijo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Akira Maekawa
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takashi Kanesaka
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Sachiko Yamamoto
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Koji Higashino
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
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16
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Matsueda K, Uedo N, Kitamura M, Iwagami H, Shichijo S, Maekawa A, Kanesaka T, Takeuchi Y, Higashino K, Ishihara R. Pre-ampullary location and size ≥10 mm are independent predictors for high-grade superficial non-ampullary duodenal epithelial tumors. J Gastroenterol Hepatol 2021; 36:1605-1613. [PMID: 33125738 DOI: 10.1111/jgh.15317] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 05/14/2020] [Revised: 08/28/2020] [Accepted: 10/24/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIM The incidence of identified superficial non-ampullary duodenal epithelial tumors (SNADETs) has been increasing with recent advances in endoscopic diagnosis. Nevertheless, the clinical features of SNADETs with malignant potential remain unclear. The aim of the present study was to clarify the clinical characteristics of high-grade SNADETs. METHODS A total of 328 SNADETs that had been endoscopically or surgically resected between January 2013 and April 2019 were identified from an endoscopic and pathological database. Clinical characteristics were compared between mucosal low-grade neoplasm (n = 154) and mucosal high-grade neoplasm/submucosal carcinoma (HGN/SMC, n = 174). RESULTS In univariate analysis, tumor size, pre-ampullary tumor location, red color, and rough/nodular surface were significantly associated with HGN/SMC. In multivariate analysis (odds ratio [95% confidence interval]), large (≥10 mm) tumor size (odds ratio: 4.5, 95% confidence interval: 2.6-7.7, P < 0.001) and pre-ampullary tumor location (odds ratio: 2.1, 95% confidence interval: 1.3-3.5, P = 0.004) were independent predictors for HGN/SMC. Analysis of histological phenotypes revealed that the proportion of tumors that were HGN/SMC was much greater for gastric-type tumors (21/23 lesions, 91%) than for intestinal-type tumors (150/302 lesions, 50%) (P < 0.001) and that all gastric-type tumors were located in the pre-ampullary portion. CONCLUSIONS Pre-ampullary location and large tumor size are independent predictors for HGN/SMC SNADETs. Pre-ampullary tumor location is significantly associated with gastric histological phenotype. These findings may help in decision making for endoscopic treatment, active indication for pre-ampullary tumor or tumor ≥10 mm, and understanding the pathophysiology of SNADETs.
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Affiliation(s)
- Katsunori Matsueda
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Masanori Kitamura
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroyoshi Iwagami
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Satoki Shichijo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Akira Maekawa
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takashi Kanesaka
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Koji Higashino
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
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17
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Inoue S, Kono M, Fukuda H, Shimamoto Y, Nakagawa K, Ohmori M, Iwagami H, Matsuno K, Iwatsubo T, Nakahira H, Matsuura N, Shichijo S, Maekawa A, Kanesaka T, Yamamoto S, Takeuchi Y, Higashino K, Uedo N, Kitamura M, Nakatsuka S, Kunimasa K, Kumagai T, Isei T, Ishihara R. Magnifying endoscopy with crystal violet staining for immune checkpoint inhibitor-associated colitis. J Gastroenterol Hepatol 2021; 36:1180-1186. [PMID: 32888202 DOI: 10.1111/jgh.15246] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/05/2020] [Accepted: 08/25/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND AIM There exists no evidence on the relationship between endoscopic and histologic findings. Furthermore, even after multiple biopsy specimens were obtained, histologic examination usually fails to show the characteristic features of immune checkpoint inhibitor-associated colitis. In this study, we explored the endoscopic and histologic findings of immune checkpoint inhibitor-associated colitis. METHODS Patients diagnosed with immune checkpoint inhibitor-associated colitis at our hospital between March 2018 and December 2018 were retrospectively assessed. The degree of mucosal inflammation was evaluated using endoscopic inflammation grade (inactive, mild, moderate, or severe disease) and further observed using magnifying endoscopy with crystal violet staining. Pit structures were classified into three types: regularly arranged pits with circular or elliptical shape (R type), irregularly arranged pits with inhomogeneous size and morphology (IR type), and pits with reduced density or pits that partially disappeared (AD type). RESULTS Eleven patients (median age, 71 years; range, 44-83 years) were diagnosed with immune checkpoint inhibitor-associated colitis. All characteristic histologic findings, including crypt distortion, crypt abscesses, and apoptotic bodies, were observed at sites with moderate-to-severe endoscopic inflammation but not at sites with inactive-to-mild endoscopic inflammation. Characteristic histologic features were observed in 0%, 50%, and 100% of R-type, IR-type, and AD-type mucosa, respectively. CONCLUSIONS We revealed the possible utility of endoscopic images for selecting suitable target sites for biopsy and showed that endoscopic findings could reduce the time lag associated with tissue diagnosis and sampling errors due to biopsy.
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Affiliation(s)
- Shuntaro Inoue
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Mitsuhiro Kono
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiromu Fukuda
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yusaku Shimamoto
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Kentaro Nakagawa
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Masayasu Ohmori
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroyoshi Iwagami
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Kenshi Matsuno
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Taro Iwatsubo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroko Nakahira
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriko Matsuura
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Satoki Shichijo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Akira Maekawa
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takashi Kanesaka
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Sachiko Yamamoto
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Koji Higashino
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Masanori Kitamura
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
| | - Shinichi Nakatsuka
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
| | - Kei Kunimasa
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Toru Kumagai
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Taiki Isei
- Department of Dermatological Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
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18
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Iwagami H, Uedo N, Yip HC, Shichijo S, Kanesaka T, Maekawa A, Yamamoto S, Higashino K, Takeuchi Y, Ishihara R, Nakatsuka SI. Ultra-magnifying narrow-band imaging for endoscopic diagnosis of gastric intestinal metaplasia: a pilot image analysis study. Endosc Int Open 2021; 9:E522-E529. [PMID: 33816772 PMCID: PMC7969138 DOI: 10.1055/a-1352-2500] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 11/24/2020] [Indexed: 12/15/2022] Open
Abstract
Background and study aims Narrow-band imaging (NBI) with or without magnification has recently been used for diagnosis of gastric intestinal metaplasia (GIM). Endocytoscopy is a newly developed endoscopic technique that enables ultra-high (500 ×) magnification of the digestive tract mucosa. This study aimed to analyze the ultra-magnifying NBI characteristics of GIM. Patients and methods This was a retrospective observational study conducted in a cancer referral center. Patients who underwent ultra-magnifying NBI of the gastric mucosa using endocytoscopy were eligible. A soft black cap was used for non-contact observation. We compared the characteristic findings of GIM by ultra-magnifying NBI of metaplastic and non-metaplastic mucosae. A reference standard for GIM in this study was conventional magnifying NBI findings of GIM. Results We obtained 28 images of metaplastic mucosa and 32 of non-metaplastic mucosa from 38 patients. Ultra-magnifying NBI revealed the cobblestone-like cellular structure in the marginal crypt epithelium of metaplastic and non-metaplastic mucosa. Diagnostic values (sensitivity, specificity, accuracy and kappa value [95 % confidence interval]) for the heterogeneous cellular structure and rough contour of the marginal crypt epithelium were 82 % (68 %-96 %), 94 % (85 %-100 %), 88 % (80 %-96 %), and 0.70, and 86 % (73 %-99 %), 94 % (85 %-100 %), 90 % (82 %-98 %), and 0.71, respectively. Conclusions The characteristic ultrastructural features of GIM were identified by ultra-magnifying NBI, warranting validation of diagnostic value in a prospective study.
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Affiliation(s)
- Hiroyoshi Iwagami
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hon-Chi Yip
- Division of Upper Gastro-intestinal and Metabolic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Satoki Shichijo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takashi Kanesaka
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Akira Maekawa
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Sachiko Yamamoto
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Koji Higashino
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Shin-ichi Nakatsuka
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
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19
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Shichijo S, Uedo N, Kanesaka T, Ohta T, Nakagawa K, Shimamoto Y, Ohmori M, Arao M, Iwatsubo T, Suzuki S, Matsuno K, Iwagami H, Inoue S, Matsuura N, Maekawa A, Nakahira H, Yamamoto S, Takeuchi Y, Higashino K, Ishihara R, Fukui K, Ito Y, Narahara H, Ishiguro S, Iishi H. Long-term outcomes after endoscopic submucosal dissection for differentiated-type early gastric cancer that fulfilled expanded indication criteria: A prospective cohort study. J Gastroenterol Hepatol 2021; 36:664-670. [PMID: 32663347 PMCID: PMC7983953 DOI: 10.1111/jgh.15182] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 11/25/2019] [Revised: 06/21/2020] [Accepted: 06/27/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIM Endoscopic resection for early gastric cancer (EGC) is widely performed. However, there is still a paucity of strong evidence regarding long-term outcomes after endoscopic submucosal dissection (ESD) for the expanded indication criteria of the Japanese guidelines (ver. 2010). METHODS Endoscopic submucosal dissection was performed in patients with EGC that met the expanded indication criteria: (i) cT1a, differentiated-type EGC of 2 to 5 cm, ulcer negative or (ii) cT1a, differentiated-type EGC of ≤3 cm, ulcer positive. Patients whose pathological examination fulfilled the curative resection criteria were then enrolled in this cohort study: negative vertical margin, negative lymphovascular invasion, and (i) pT1a, differentiated-type, and ulcer negative; (ii) pT1a, differentiated-type, ≤3 cm, and ulcer positive; or (iii) pT1b1 (<500-μm submucosal invasion), differentiated-type, and ≤3 cm. Patients with only a positive horizontal margin as a noncurative factor were included for follow-up. RESULTS From September 2003 to February 2012, a total of 356 patients underwent ESD, and 214 were enrolled in the survival analysis. One hundred twenty patients (56%) had >2 cm in diameter and ulcer-negative lesions, and 94 (44%) had ≤3 cm and ulcer-positive lesions. The vital status at 5 years after ESD was confirmed in all (100%) patients. No local or metastatic recurrence was detected; however, 26 metachronous gastric cancers developed, and 1 patient died of metachronous gastric cancer. The 5-year disease-specific and overall survival rates were 99.5% (95% confidence interval [CI], 97.2%-100%) and 93.9% (95% CI, 89.8%-96.4%), respectively. CONCLUSION ESD for EGC that fulfills the expanded criteria is feasible and shows favorable long-term outcomes.
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Affiliation(s)
- Satoki Shichijo
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Noriya Uedo
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Takashi Kanesaka
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Takashi Ohta
- Division of GastroenterologyKansai Rosai HospitalAmagasakiJapan
| | - Kentaro Nakagawa
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Yusaku Shimamoto
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Masayasu Ohmori
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Masamichi Arao
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Taro Iwatsubo
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Sho Suzuki
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Kenshi Matsuno
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Hiroyoshi Iwagami
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Shuntaro Inoue
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Noriko Matsuura
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Akira Maekawa
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Hiroko Nakahira
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Sachiko Yamamoto
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Yoji Takeuchi
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Koji Higashino
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Ryu Ishihara
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Keisuke Fukui
- Center for Cancer Control and StatisticsOsaka International Cancer InstituteOsakaJapan,Department of Medical Statistics, Research & Development CenterOsaka Medical CollegeOsakaJapan
| | - Yuri Ito
- Center for Cancer Control and StatisticsOsaka International Cancer InstituteOsakaJapan,Department of Medical Statistics, Research & Development CenterOsaka Medical CollegeOsakaJapan
| | - Hiroyuki Narahara
- Department of GastroenterologyHyogo Prefectural Nishinomiya HospitalNishinomiyaJapan
| | | | - Hiroyasu Iishi
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan,Department of GastroenterologyItami City HospitalItamiJapan
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20
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Iwagami H, Ishihara R, Yamamoto S, Matsuura N, Shoji A, Matsueda K, Inoue T, Miyake M, Waki K, Fukuda H, Shimamoto Y, Kono M, Nakahira H, Shichijo S, Maekawa A, Kanesaka T, Takeuchi Y, Higashino K, Noriya Uedo. Esophageal metal stent for malignant obstruction after prior radiotherapy. Sci Rep 2021; 11:2134. [PMID: 33483558 PMCID: PMC7822838 DOI: 10.1038/s41598-021-81763-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 12/24/2020] [Indexed: 11/09/2022] Open
Abstract
The association between severe adverse events (SAEs) and prior radiotherapy or stent type remains controversial. Patients with esophageal or esophagogastric junctional cancer who underwent stent placement (2005–2019) were enrolled in this retrospective study conducted at a tertiary cancer institute in Japan. The exclusion criteria were follow-up period of < 1 month and insufficient data on stent type or cancer characteristics. We used Mann–Whitney’s U test for quantitative data and Fisher’s exact test for categorical data. Multivariate analysis was performed using a logistic regression model. 107 stents were placed. Low radial-force stents (L group) were used in 51 procedures and high radial-force stents (H group) in 56 procedures. SAEs developed after nine procedures, the median interval from stent placement being 6 days (range, 1–141 days). SAEs occurred more frequently in the H (14%: 8/56) than in the L group (2%: 1/51) (P = 0.03). In patients who had undergone prior radiotherapy, SAEs were more frequent in the H (36%: 4/11) than in the L group (0%: 0/13) (P = 0.03). Re-obstruction and migration occurred after 16 and three procedures, respectively; these rates did not differ significantly between groups (P = 0.59, P = 1, respectively). Low radial-force stents may reduce the risk of SAEs after esophageal stenting.
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Affiliation(s)
- Hiroyoshi Iwagami
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan.
| | - Sachiko Yamamoto
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Noriko Matsuura
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Ayaka Shoji
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Katsunori Matsueda
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Takahiro Inoue
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Muneaki Miyake
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Kotaro Waki
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Hiromu Fukuda
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Yusaku Shimamoto
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Mitsuhiro Kono
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Hiroko Nakahira
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Satoki Shichijo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Akira Maekawa
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Takashi Kanesaka
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Koji Higashino
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
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21
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Iwagami H, Ishihara R, Aoyama K, Fukuda H, Shimamoto Y, Kono M, Nakahira H, Matsuura N, Shichijo S, Kanesaka T, Kanzaki H, Ishii T, Nakatani Y, Tada T. Artificial intelligence for the detection of esophageal and esophagogastric junctional adenocarcinoma. J Gastroenterol Hepatol 2021; 36:131-136. [PMID: 32511793 DOI: 10.1111/jgh.15136] [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: 03/24/2020] [Revised: 05/03/2020] [Accepted: 06/05/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM Conventional endoscopy for the early detection of esophageal and esophagogastric junctional adenocarcinoma (E/J cancer) is limited because early lesions are asymptomatic, and the associated changes in the mucosa are subtle. There are no reports on artificial intelligence (AI) diagnosis for E/J cancer from Asian countries. Therefore, we aimed to develop a computerized image analysis system using deep learning for the detection of E/J cancers. METHODS A total of 1172 images from 166 pathologically proven superficial E/J cancer cases and 2271 images of normal mucosa in esophagogastric junctional from 219 cases were used as the training image data. A total of 232 images from 36 cancer cases and 43 non-cancerous cases were used as the validation test data. The same validation test data were diagnosed by 15 board-certified specialists (experts). RESULTS The sensitivity, specificity, and accuracy of the AI system were 94%, 42%, and 66%, respectively, and that of the experts were 88%, 43%, and 63%, respectively. The sensitivity of the AI system was favorable, while its specificity for non-cancerous lesions was similar to that of the experts. Interobserver agreement among the experts for detecting superficial E/J was fair (Fleiss' kappa = 0.26, z = 20.4, P < 0.001). CONCLUSIONS Our AI system achieved high sensitivity and acceptable specificity for the detection of E/J cancers and may be a good supporting tool for the screening of E/J cancers.
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Affiliation(s)
- Hiroyoshi Iwagami
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | | | - Hiromu Fukuda
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yusaku Shimamoto
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Mitsuhiro Kono
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroko Nakahira
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriko Matsuura
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Satoki Shichijo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takashi Kanesaka
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiromitsu Kanzaki
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Tatsuya Ishii
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Yasuki Nakatani
- Department of Gastroenterology and Hepatology, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
| | - Tomohiro Tada
- Engineering, AI Medical Service Inc., Tokyo, Japan.,Department of Gastroenterology, Tada Tomohiro Institute of Gastroenterology and Proctology, Saitama, Japan
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22
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Iwatsubo T, Ishihara R, Yamasaki Y, Tonai Y, Hamada K, Kato M, Suzuki S, Kono M, Fukuda H, Shimamoto Y, Nakagawa K, Ohmori M, Arao M, Matsuno K, Iwagami H, Inoue S, Nakahira H, Matsuura N, Shichijo S, Maekawa A, Kanesaka T, Takeuchi Y, Higashino K, Uedo N, Higuchi K. Narrow band imaging under less-air condition improves the visibility of superficial esophageal squamous cell carcinoma. BMC Gastroenterol 2020; 20:389. [PMID: 33213383 PMCID: PMC7678292 DOI: 10.1186/s12876-020-01534-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 03/24/2020] [Accepted: 11/10/2020] [Indexed: 11/10/2022] Open
Abstract
Background The current virtual chromoendoscopy equipment cannot completely detect superficial squamous cell carcinoma (SCC) in the esophagus, despite its development in the recent years. Thus, in this study, we aimed to elucidate the appropriate air volume during endoscopic observation to improve the visibility of esophageal SCC. Methods This retrospective study included a total of 101 flat type esophageal SCCs identified between April 2017 and January 2019 at the Department of Gastrointestinal Oncology, Osaka International Cancer Institute. Video images of narrow band imaging (NBI) under both less-air and standard-air conditions were recorded digitally. Videos were evaluated by five endoscopists. Relative visibility between less-air and standard-air conditions of the brownish area, brownish color change of the epithelium, and dilated intrapapillary capillary loop (IPCL) were graded as 5 (definitely better under less-air condition) to 1 (definitely worse under less-air condition), with 3 indicating average visibility (equivalent to standard-air observation). Results The mean (standard deviation) visibility score of the brownish area, brownish color change of the epithelium, and dilated IPCLs under less-air condition were 3.94 (0.58), 3.73 (0.57), and 4.13 (0.60), respectively, which were significantly better than that under standard-air condition (p < 0.0001). Esophageal SCC evaluated as ≥ 4 in the mean visibility score of the brownish area, brownish color change of the epithelium, and dilated IPCLs accounted for 50% (51/101 lesions), 34% (34/101 lesions), and 67% (68/101 lesions), respectively. Conclusions The present results suggested that NBI with less air might improve the visibility of flat type esophageal SCC compared with NBI with standard air. Less-air NBI observation may facilitate the detection of flat type esophageal SCC. Trial registration The present study is a non-intervention trial.
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Affiliation(s)
- Taro Iwatsubo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan.,Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan.
| | - Yasushi Yamasaki
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Yusuke Tonai
- Department of Gastroenterology, Sanda City Hospital, Hyogo, Japan
| | - Kenta Hamada
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Minoru Kato
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Sho Suzuki
- Division of Endoscopy and Center for Digestive Disease, Department of Gastroenterology and Hepatology, University of Miyazaki Hospital, Miyazaki, Japan
| | - Mitsuhiro Kono
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Hiromu Fukuda
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Yusaku Shimamoto
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Kentaro Nakagawa
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Masayasu Ohmori
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Masamichi Arao
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan.,Department of Gastroenterology, Takayama Red Cross Hospital, Gifu, Japan
| | - Kenshi Matsuno
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Hiroyoshi Iwagami
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Shuntaro Inoue
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Hiroko Nakahira
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Noriko Matsuura
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Satoki Shichijo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Akira Maekawa
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Takashi Kanesaka
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Koji Higashino
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Kazuhide Higuchi
- Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan
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23
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Nakahira H, Kanesaka T, Uedo N, Ohmori M, Iwagami H, Matsuura N, Shichijo S, Maekawa A, Yamamoto S, Takeuchi Y, Higashino K, Kitamura M, Nakatsuka S, Ishihara R. Risk of recurrence when cutting into intramucosal (pT1a) cancer from the cutting-plane side during gastric endoscopic submucosal dissection. Endoscopy 2020; 52:833-838. [PMID: 32583395 DOI: 10.1055/a-1173-8575] [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: 02/06/2023]
Abstract
BACKGROUND During endoscopic submucosal dissection (ESD), procedural difficulty and poor visibility of the cutting plane sometimes cause the operator to cut into the lesion from the cutting-plane side, making the vertical margin positive (VM1) or unclear (VMX). In the present study, we evaluated the risk of recurrence of gastric cancer with VM1 /VMX after ESD. METHODS In total, 1723 consecutive gastric cancers treated by ESD at Osaka International Cancer Institute from July 2012 to December 2017 were included in this retrospective cohort study. Among them, 231 submucosal or more deeply invasive gastric cancers were excluded because nontechnical factors may contribute to VM1 /VMX in such lesions. To quantify the risk of cutting into cancer from the cutting-plane side during ESD, the proportion of lesions with VM1 /VMX among the pT1a gastric cancers treated by ESD was calculated. The proportion of recurrence among these cases was calculated after exclusion of lesions with positive lymphovascular invasion or a positive horizontal margin in order to eliminate the obvious risk factors for recurrence. RESULTS Among 1492 pT1a gastric cancers treated by ESD, 28 lesions (1.9 %; 95 % confidence interval [CI] 1.3 % - 2.7 %) histologically showed VM1 /VMX. No local recurrence (0.0 %; 95 %CI 0.0 % - 12.2 %) occurred among 23 cases. The median follow-up period was 41 months (range 10 - 84 months). CONCLUSIONS No local recurrence was detected in pT1a gastric cancers after VM1 /VMX resection by ESD. Surveillance endoscopy could be adopted for such cases without additional surgery.
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Affiliation(s)
- Hiroko Nakahira
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takashi Kanesaka
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Masayasu Ohmori
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroyoshi Iwagami
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriko Matsuura
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Satoki Shichijo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Akira Maekawa
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Sachiko Yamamoto
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Koji Higashino
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Masanori Kitamura
- Department of Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
| | - Shinichi Nakatsuka
- Department of Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
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24
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Inoue S, Uedo N, Tabuchi T, Nakagawa K, Ohmori M, Iwagami H, Matsuno K, Iwatsubo T, Nakahira H, Matsuura N, Shichijo S, Maekawa A, Kanesaka T, Takeuchi Y, Higashino K, Ishihara R. Usefulness of epinephrine-added injection solution to reduce procedure time for gastric endoscopic submucosal dissection. Endosc Int Open 2020; 8:E1044-E1051. [PMID: 32743058 PMCID: PMC7373655 DOI: 10.1055/a-1192-4202] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/18/2020] [Indexed: 11/25/2022] Open
Abstract
Background and study aims Epinephrine-added submucosal injection solution is used to facilitate hemostasis of non-variceal upper gastrointestinal bleeding and to prevent delayed bleeding of large pedunculated colorectal lesions. However, its benefit in gastric endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) is unclear. The effectiveness of epinephrine-added injection solution for outcomes of gastric ESD was examined using propensity score matching analysis. Patients and methods A total of 1,599 patients with solitary EGC (83 with non-epinephrine-added solution and 1,516 with epinephrine-added solution) between 2011 and 2018 were enrolled. Propensity scores were calculated to balance the distribution of baseline characteristics: age, sex, tumor location, specimen size, presence of ulcer scar, tumor depth, histological tumor type, and operators' experience, and 1:3 matching was performed. En bloc resection rate, mean procedure time, delayed bleeding rate, and perforation rate were compared between the non-epinephrine (n = 79) and epinephrine (n = 237) groups. Results Mean procedure time was significantly shorter in the epinephrine group than in the non-epinephrine group (60 vs. 78 min, P < 0.001). No significant difference was found in the rate of en bloc resection (both 99 %), incidence of delayed bleeding (both 6 %), or perforation (0 vs. 0.8 %) between the two groups. In multiple linear regression analysis, use of epinephrine-added solution was independently associated with short procedure time ( P < 0.001) after adjustment for other covariates. Conclusion The results suggest that epinephrine-added injection solution is useful for reduction of gastric ESD procedure time, warranting validation in a randomized controlled trial.
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Affiliation(s)
- Shuntaro Inoue
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Kentaro Nakagawa
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Masayasu Ohmori
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroyoshi Iwagami
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Kenshi Matsuno
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Taro Iwatsubo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroko Nakahira
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriko Matsuura
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Satoki Shichijo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Akira Maekawa
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takashi Kanesaka
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Koji Higashino
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
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25
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Iwagami H, Kanesaka T, Ishihara R, Ohmori M, Matsuno K, Matsuura N, Nakahira H, Shichijo S, Maekawa A, Yamamoto S, Takeuchi Y, Higashino K, Uedo N, Nakatsuka S. Features of Esophageal Adenocarcinoma in Magnifying Narrow-Band Imaging. Dig Dis 2020; 39:89-95. [PMID: 32731221 DOI: 10.1159/000510561] [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: 04/18/2020] [Accepted: 07/29/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Several endoscopic classifications for esophageal adenocarcinoma have been proposed; however, gastric adenocarcinoma is much more common than esophageal or esophagogastric junctional (EGJ) adenocarcinoma in East Asian countries. We, therefore, investigated whether an endoscopic diagnostic algorithm for gastric adenocarcinoma could be used for esophageal or EGJ adenocarcinoma. METHODS One hundred eighteen consecutive patients who underwent endoscopic resection or surgery for intramucosal esophageal or EGJ adenocarcinoma, at the Osaka International Cancer Institute between January 2006 and December 2017, were included in this retrospective study. Their lesions were classified as Siewert type 1 or 2, and the presence of endoscopic magnifying narrow-band imaging findings for diagnosing gastric adenocarcinoma was evaluated. RESULTS We evaluated 125 adenocarcinomas in 118 patients (29 type 1 and 96 type 2). Demarcation lines (DLs) were seen in 7 (24%) type 1 and 53 (55%) type 2 lesions. Irregular mucosal patterns were present in 2 (7%) type 1 and 22 (23%) type 2 lesions. Irregular vascular patterns were present in 26 (90%) type 1 and 50 (52%) type 2 lesions. According to the magnifying endoscopy diagnostic algorithm for gastric adenocarcinoma, only 7 (24%) type 1 and 52 (54%) type 2 lesions were correctly diagnosed as cancers (p = 0.005). CONCLUSION The magnifying endoscopy diagnostic algorithm for gastric cancer may not be useful for esophageal or EGJ adenocarcinomas because of the low visibility of DLs, especially in Siewert type 1 adenocarcinoma.
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Affiliation(s)
- Hiroyoshi Iwagami
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takashi Kanesaka
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan,
| | - Masayasu Ohmori
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Kenshi Matsuno
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriko Matsuura
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroko Nakahira
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Satoki Shichijo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Akira Maekawa
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Sachiko Yamamoto
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Koji Higashino
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Shinichi Nakatsuka
- Department of Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
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26
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Iwagami H, Uedo N, Kitamura M. Case of esophageal superficial neuroendocrine carcinoma suggestive of transformation from squamous cell carcinoma. Dig Endosc 2020; 32:827. [PMID: 32248574 DOI: 10.1111/den.13678] [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: 02/08/2023]
Affiliation(s)
- Hiroyoshi Iwagami
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Masanori Kitamura
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
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27
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Iwagami H, Takeuchi Y, Yamasaki Y, Nakagawa K, Ohmori M, Matsuno K, Inoue S, Iwatsubo T, Nakahira H, Matsuura N, Shichijo S, Maekawa A, Kanesaka T, Higashino K, Uedo N, Ishihara R. Feasibility of underwater endoscopic mucosal resection and management of residues for superficial non-ampullary duodenal epithelial neoplasms. Dig Endosc 2020; 32:565-573. [PMID: 31550394 DOI: 10.1111/den.13541] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [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: 06/03/2019] [Revised: 09/16/2019] [Accepted: 09/19/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Underwater endoscopic mucosal resection (UEMR) is effective for superficial non-ampullary duodenal epithelial neoplasms (SNADEN). However, the incidence of residual lesion after UEMR, especially for large lesions (≥20 mm), and their prognosis remain unclear. We aimed to assess the incidence of residual lesions and further outcomes after UEMR for SNADEN. METHODS We carried out a retrospective study at a tertiary cancer institute. Candidates for the study were systematically retrieved from an endoscopic and pathological database from January 2013 to April 2018. RESULTS A total of 162 SNADEN resected with UEMR were analyzed. Median (range) procedure time was 5 (1-70) min. En bloc resection rates for large lesions (≥20 mm) and small lesions (<20 mm) were 14% and 79%, respectively. Intraprocedural bleeding occurred in one (0.6%) case, but no intraprocedural perforation occurred during the study. Delayed bleeding occurred in two (1.2%) cases and delayed perforation occurred in one (0.6%) case. A total of 157 (97%) lesions were followed up by at least one endoscopic examination. Of these lesions, residual lesions were recognized in seven cases (5%). Additional UEMR was carried out in five lesions and underwater cold snare polypectomy in one lesion. One lesion was observed without additional treatment. After salvage intervention, no cases experienced further residual lesions. CONCLUSION Although UEMR for SNADEN can be relevant when other efficacious procedures are unavailable, careful follow up for residual lesions is required especially after piecemeal resection for large lesions.
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Affiliation(s)
- Hiroyoshi Iwagami
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yasushi Yamasaki
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Kentaro Nakagawa
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Masayasu Ohmori
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Kenshi Matsuno
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Shuntaro Inoue
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Taro Iwatsubo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroko Nakahira
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriko Matsuura
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Satoki Shichijo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Akira Maekawa
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takashi Kanesaka
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Koji Higashino
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
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28
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Shichijo S, Takeuchi Y, Kitamura M, Kono M, Shimamoto Y, Fukuda H, Nakagawa K, Ohmori M, Arao M, Iwatsubo T, Iwagami H, Matsuno K, Inoue S, Matsuura N, Nakahira H, Maekawa A, Kanesaka T, Higashino K, Uedo N, Fukui K, Ito Y, Nakatsuka SI, Ishihara R. Does cold snare polypectomy completely resect the mucosal layer? A prospective single-center observational trial. J Gastroenterol Hepatol 2020; 35:241-248. [PMID: 31389623 DOI: 10.1111/jgh.14824] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [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] [Received: 05/07/2019] [Revised: 07/29/2019] [Accepted: 08/03/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM The true incidence of incomplete muscularis mucosa resection with cold snare polypectomy (CSP) is unknown. We examined the incidence of incomplete muscularis mucosa resection both with and without cold snare defect protrusion (CSDP). METHODS We prospectively enrolled patients undergoing polypectomy for 4 to 9mm nonpedunculated polyps. We evaluated the presence of CSDP immediately following CSP and biopsied the CSDP or the center of the mucosal defect without CSDP. The presence of the muscularis mucosa and any residual polyp in the biopsies was evaluated histologically. The primary outcome was the incidence of incomplete mucosal layer resection defined as the presence of muscularis mucosa or residual polyp in the biopsies. RESULTS From August 2017 to October 2018, 188 patients were screened, and 357 polyps were included. CSDP was detected in 122/355 (34%) evaluated mucosal defects. Excluding five lesions requiring hemostasis immediately following CSP, 352 mucosal defects were biopsied. After excluding 102 biopsies containing normal mucosa, we evaluated 250 biopsies. The overall incidence of incomplete mucosal layer resection was 63% (159/250), 76% (68/90) with CSDP and 57% (91/159) without CSDP (P < 0.01). Both univariate and multivariate analyses showed that size (≥ 6 mm), resection time (≥ 5 s), and serrated lesions were risk factors for CSDP. CONCLUSIONS Cold snare defect protrusion (CSDP), which was present with 36%, was a good indicator for incomplete mucosal layer resection. Even in nonCSDP polypectomies, 57% of the mucosal layer was not removed completely. Thus, CSP should be used for intra-epithelial lesions only, and careful pretreatment evaluation is recommended.
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Affiliation(s)
- Satoki Shichijo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Masanori Kitamura
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
| | - Mitsuhiro Kono
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yusaku Shimamoto
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiromu Fukuda
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Kentaro Nakagawa
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Masayasu Ohmori
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Masamichi Arao
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Taro Iwatsubo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroyoshi Iwagami
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Kenshi Matsuno
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Shuntaro Inoue
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriko Matsuura
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroko Nakahira
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Akira Maekawa
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takashi Kanesaka
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Koji Higashino
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Keisuke Fukui
- Center for Cancer Control and Statistics, Osaka International Cancer Institute, Osaka, Japan.,Department of Medical Statistics, Research and Development Center, Osaka Medical College, Osaka, Japan
| | - Yuri Ito
- Center for Cancer Control and Statistics, Osaka International Cancer Institute, Osaka, Japan.,Department of Medical Statistics, Research and Development Center, Osaka Medical College, Osaka, Japan
| | - Shin-Ichi Nakatsuka
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
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29
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Nakahira H, Ishihara R, Aoyama K, Kono M, Fukuda H, Shimamoto Y, Nakagawa K, Ohmori M, Iwatsubo T, Iwagami H, Matsuno K, Inoue S, Matsuura N, Shichijo S, Maekawa A, Kanesaka T, Yamamoto S, Takeuchi Y, Higashino K, Uedo N, Matsunaga T, Tada T. Stratification of gastric cancer risk using a deep neural network. JGH Open 2019; 4:466-471. [PMID: 32514455 PMCID: PMC7273725 DOI: 10.1002/jgh3.12281] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 10/23/2019] [Accepted: 10/28/2019] [Indexed: 12/14/2022]
Abstract
Background and Aim Stratifying gastric cancer (GC) risk and endoscopy findings in high‐risk individuals may provide effective surveillance for GC. We developed a computerized image‐ analysis system for endoscopic images to stratify the risk of GC. Methods The system was trained using images taken during endoscopic examinations with non‐magnified white‐light imaging. Patients were classified as high‐risk (patients with GC), moderate‐risk (patients with current or past Helicobacter pylori infection or gastric atrophy), or low‐risk (patients with no history of H. pylori infection or gastric atrophy). After selection, 20,960, 17,404, and 68,920 images were collected as training images for the high‐, moderate‐, and low‐risk groups, respectively. Results Performance of the artificial intelligence (AI) system was evaluated by the prevalence of GC in each group using an independent validation dataset of patients who underwent endoscopic examination and H. pylori serum antibody testing. In total, 12,824 images from 454 patients were included in the analysis. The time required for diagnosing all the images was 345 seconds. The AI system diagnosed 46, 250, and 158 patients as low‐, moderate‐, and high risk, respectively. The prevalence of GC in the low‐, moderate‐, and high‐risk groups was 2.2, 8.8, and 16.4%, respectively (P = 0.0017). Three experienced endoscopists also successfully stratified the risk; however, interobserver agreement was not satisfactory (kappa value of 0.27, indicating fair agreement). Conclusion The current AI system detected significant differences in the prevalence of GC among the low‐, moderate‐, and high‐risk groups, suggesting its potential for stratifying GC risk.
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Affiliation(s)
- Hiroko Nakahira
- Department of Gastrointestinal Oncology Osaka International Cancer Institute Osaka Japan
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology Osaka International Cancer Institute Osaka Japan
| | | | - Mitsuhiro Kono
- Department of Gastrointestinal Oncology Osaka International Cancer Institute Osaka Japan
| | - Hiromu Fukuda
- Department of Gastrointestinal Oncology Osaka International Cancer Institute Osaka Japan
| | - Yusaku Shimamoto
- Department of Gastrointestinal Oncology Osaka International Cancer Institute Osaka Japan
| | - Kentaro Nakagawa
- Department of Gastrointestinal Oncology Osaka International Cancer Institute Osaka Japan
| | - Masayasu Ohmori
- Department of Gastrointestinal Oncology Osaka International Cancer Institute Osaka Japan
| | - Taro Iwatsubo
- Department of Gastrointestinal Oncology Osaka International Cancer Institute Osaka Japan
| | - Hiroyoshi Iwagami
- Department of Gastrointestinal Oncology Osaka International Cancer Institute Osaka Japan
| | - Kenshi Matsuno
- Department of Gastrointestinal Oncology Osaka International Cancer Institute Osaka Japan
| | - Shuntaro Inoue
- Department of Gastrointestinal Oncology Osaka International Cancer Institute Osaka Japan
| | - Noriko Matsuura
- Department of Gastrointestinal Oncology Osaka International Cancer Institute Osaka Japan
| | - Satoki Shichijo
- Department of Gastrointestinal Oncology Osaka International Cancer Institute Osaka Japan
| | - Akira Maekawa
- Department of Gastrointestinal Oncology Osaka International Cancer Institute Osaka Japan
| | - Takashi Kanesaka
- Department of Gastrointestinal Oncology Osaka International Cancer Institute Osaka Japan
| | - Sachiko Yamamoto
- Department of Gastrointestinal Oncology Osaka International Cancer Institute Osaka Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology Osaka International Cancer Institute Osaka Japan
| | - Koji Higashino
- Department of Gastrointestinal Oncology Osaka International Cancer Institute Osaka Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology Osaka International Cancer Institute Osaka Japan
| | - Takashi Matsunaga
- Department of Medical Informatics Osaka International Cancer Institute Osaka Japan
| | - Tomohiro Tada
- AI Medical Service Inc Tokyo Japan.,Tada Tomohiro Institute of Gastroenterology and Proctology Saitama Japan.,Department of Surgical Oncology, Graduate School of Medicine The University of Tokyo Tokyo Japan
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30
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Affiliation(s)
- Satoki Shichijo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroyoshi Iwagami
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Masayasu Ohmori
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Shuntaro Inoue
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
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31
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Shichijo S, Uedo N, Yanagimoto Y, Yamamoto K, Kono M, Fukuda H, Shimamoto Y, Nakagawa K, Ohmori M, Arao M, Iwatsubo T, Iwagami H, Inoue S, Matsuno K, Matsuura N, Nakahira H, Maekawa A, Kanesaka T, Takeuchi Y, Higashino K, Ohmori T, Ishihara R. Endoscopic full-thickness resection of gastric gastrointestinal stromal tumor: a Japanese case series. Ann Gastroenterol 2019; 32:593-599. [PMID: 31700236 PMCID: PMC6826078 DOI: 10.20524/aog.2019.0413] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 05/10/2019] [Accepted: 07/13/2019] [Indexed: 02/06/2023] Open
Abstract
Background: Gastrointestinal stromal tumors (GISTs) are potentially malignant and are indicated for resection. The standard treatment for resectable GISTs is surgery, although endoscopic resection has been reported outside Japan. This study retrospectively analyzed the results of endoscopic resection of GISTs in Japan. Method: We identified patients with GISTs treated only by endoscopic resection in our institute between January 2016 and December 2018, and analyzed their clinical and pathological characteristics. Results: During the study period, 8 GISTs were resected only by endoscopy: 7 were located in the upper third of the stomach and 1 in the middle. All were intraluminal growth type. Median (range) tumor diameter was 20 (10-35) mm. All tumors were resected en bloc with a median (range) operation time of 67.5 (50-166) min. Complete perforation occurred in 5 cases, but the serosa remained in 2 and the outer layer of the muscularis propria remained in 1. The defect was endoscopically closed with clip-and-endoloop purse-string suturing (n=3), simple endoclipping (n=2), or over-the-scope clipping (n=2), and 1 did not require closure because the outer longitudinal muscle was preserved. Oral feeding was commenced on postoperative day (POD) 3 (median; range 2-4), and the patient was discharged on POD 6 (median; range 4-11). No serious adverse event developed after the procedures. Conclusion: Endoscopic resection for selected cases of small intraluminal GISTs is feasible, making it a viable alternative treatment option to laparoscopic surgery.
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Affiliation(s)
- Satoki Shichijo
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Noriya Uedo
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Yoshitomo Yanagimoto
- Department of Gastroenterological Surgery (Yoshitomo Yanagimoto, Kazuyoshi Yamamoto, Takeshi Ohmori), Osaka International Cancer Institute, Japan
| | - Kazuyoshi Yamamoto
- Department of Gastroenterological Surgery (Yoshitomo Yanagimoto, Kazuyoshi Yamamoto, Takeshi Ohmori), Osaka International Cancer Institute, Japan
| | - Mitsuhiro Kono
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Hiromu Fukuda
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Yusaku Shimamoto
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Kentaro Nakagawa
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Masayasu Ohmori
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Masamichi Arao
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Taro Iwatsubo
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Hiroyoshi Iwagami
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Shuntaro Inoue
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Kenshi Matsuno
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Noriko Matsuura
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Hiroko Nakahira
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Akira Maekawa
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Takashi Kanesaka
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Koji Higashino
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Takeshi Ohmori
- Department of Gastroenterological Surgery (Yoshitomo Yanagimoto, Kazuyoshi Yamamoto, Takeshi Ohmori), Osaka International Cancer Institute, Japan
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
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Matsuno K, Ishihara R, Ohmori M, Iwagami H, Shichijyo S, Maekawa A, Kanesaka T, Yamamoto S, Takeuchi Y, Higashino K, Uedo N, Matsunaga T, Morishima T, Miyashiro I. Time trends in the incidence of esophageal adenocarcinoma, gastric adenocarcinoma, and superficial esophagogastric junction adenocarcinoma. J Gastroenterol 2019; 54:784-791. [PMID: 30927083 DOI: 10.1007/s00535-019-01577-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [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: 12/18/2018] [Accepted: 03/21/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND In Japan, the incidence of esophageal adenocarcinoma (EAC) and esophagogastric junction (EGJ) adenocarcinoma is expected to increase and that of gastric adenocarcinoma (GAC) is expected to decrease due to Westernization of the diet and the decreasing prevalence of Helicobacter pylori infection. However, few reports about these trends have included the latest data, and no reports about the time trend in the incidence of EGJ adenocarcinoma have focused on the etiologies (gastric cardia adenocarcinoma or EAC, including Barrett's adenocarcinoma). We therefore investigated the time trends in the incidence of these cancers by including the latest data. METHODS First, we investigated the time trends in EAC and GAC using population-based cancer registry data in Osaka Prefecture (1985-2014). We then investigated the time trend in superficial EGJ adenocarcinoma with clinicopathological features at Osaka International Cancer Institute (2006-2017). RESULTS From 1985 to 2014 in Osaka Prefecture, the incidence of EAC gradually increased in both sexes, while that of GAC in men did not significantly change and that in women decreased. The ratio of the EAC/GAC incidence increased 3.5 times in men and 1.8 times in women. In the secondary time trend survey for EGJ adenocarcinoma, the numbers of patients with endoscopic Barrett's esophagus and those without gastric mucosal atrophy increased, and the number of patients with lesions located above the EGJ line and histologically diagnosed as Barrett's adenocarcinoma increased. CONCLUSIONS The incidence of EAC and superficial EGJ adenocarcinoma with characteristics similar to those of EAC, including Barrett's adenocarcinoma, might be increasing.
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Affiliation(s)
- Kenshi Matsuno
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
- Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan.
| | - Masayasu Ohmori
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Hiroyoshi Iwagami
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Satoki Shichijyo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Akira Maekawa
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Takashi Kanesaka
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Sachiko Yamamoto
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Koji Higashino
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Takashi Matsunaga
- Department of Medical Informatics, Osaka International Cancer Institute, Osaka, Japan
| | | | - Isao Miyashiro
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
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33
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Fukuda H, Ishihara R, Shimamoto Y, Kono M, Nakagawa K, Ohmori M, Matsuno K, Iwagami H, Inoue S, Iwatsubo T, Nakahira H, Matsuura N, Shichijo S, Maekawa A, Kanesaka T, Takeuchi Y, Higashino K, Uedo N, Kitamura M, Nakatsuka S. Effect of horizontal margin status and risk of local recurrence after endoscopic submucosal dissection for superficial esophageal cancer. JGH Open 2019; 4:160-165. [PMID: 32280759 PMCID: PMC7144764 DOI: 10.1002/jgh3.12233] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/19/2019] [Accepted: 06/05/2019] [Indexed: 12/17/2022]
Abstract
Background and Aim Endoscopic submucosal dissection (ESD) sometimes results in en bloc resection with a positive or inconclusive horizontal margin (HM1 or HMX, respectively) on histological evaluation. The specific risk for such situations is unclear. We therefore investigated the outcome of ESD with HM1 or HMX. Methods This single‐center retrospective study was performed at Osaka International Cancer Institute. A total of 886 esophageal squamous cell carcinoma lesions in 749 patients treated from April 2005 to June 2015 were evaluated according to the following inclusion criteria: en bloc resection with no residual lesion, HM1 or HMX status, no prior treatment, and no additional treatment. We classified HM1 and HMX into type A, in which cancer was exposed on the HM, and type B, in which the HM status was unclear because of mechanical or thermal damage. We further classified type B according to the distance between the cancer and the edge of the specimen: type B1, <1 mm and type B2, ≥1 mm. Results The resection margin was judged as HM1 or HMX in 5.0% (39/767; 95% confidence interval, 3.5–6.6%) of the en bloc resected specimens. Of 39 lesions, 30 fulfilled the inclusion criteria. Local recurrence developed in 8 of 30 lesions (26.7%). The local recurrence rates for types A, B1, and B2 were 40% (6/15 lesions), 28.5% (2/7 lesions), and 0.0% (0/8 lesions), respectively. Conclusions Although a statistical analysis was not conducted because of the limited events, the pathological HM status may be a useful predictor of local recurrence.
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Affiliation(s)
- Hiromu Fukuda
- Department of Gastrointestinal Oncology Osaka International Cancer Institute Osaka Japan
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology Osaka International Cancer Institute Osaka Japan
| | - Yusaku Shimamoto
- Department of Gastrointestinal Oncology Osaka International Cancer Institute Osaka Japan
| | - Mitsuhiro Kono
- Department of Gastrointestinal Oncology Osaka International Cancer Institute Osaka Japan
| | - Kentaro Nakagawa
- Department of Gastrointestinal Oncology Osaka International Cancer Institute Osaka Japan
| | - Masayasu Ohmori
- Department of Gastrointestinal Oncology Osaka International Cancer Institute Osaka Japan
| | - Kenshi Matsuno
- Department of Gastrointestinal Oncology Osaka International Cancer Institute Osaka Japan
| | - Hiroyoshi Iwagami
- Department of Gastrointestinal Oncology Osaka International Cancer Institute Osaka Japan
| | - Shuntaro Inoue
- Department of Gastrointestinal Oncology Osaka International Cancer Institute Osaka Japan
| | - Taro Iwatsubo
- Department of Gastrointestinal Oncology Osaka International Cancer Institute Osaka Japan
| | - Hiroko Nakahira
- Department of Gastrointestinal Oncology Osaka International Cancer Institute Osaka Japan
| | - Noriko Matsuura
- Department of Gastrointestinal Oncology Osaka International Cancer Institute Osaka Japan
| | - Satoki Shichijo
- Department of Gastrointestinal Oncology Osaka International Cancer Institute Osaka Japan
| | - Akira Maekawa
- Department of Gastrointestinal Oncology Osaka International Cancer Institute Osaka Japan
| | - Takashi Kanesaka
- Department of Gastrointestinal Oncology Osaka International Cancer Institute Osaka Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology Osaka International Cancer Institute Osaka Japan
| | - Koji Higashino
- Department of Gastrointestinal Oncology Osaka International Cancer Institute Osaka Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology Osaka International Cancer Institute Osaka Japan
| | - Masanori Kitamura
- Department of Pathology Osaka International Cancer Institute Osaka Japan
| | - Shinichi Nakatsuka
- Department of Pathology Osaka International Cancer Institute Osaka Japan
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34
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Iwagami H, Kanesaka T, Ishihara R, Uedo N. Underwater endoscopic mucosal resection for remaining early gastric cancer after endoscopic submucosal dissection. Endoscopy 2019; 51:E229-E230. [PMID: 30995684 DOI: 10.1055/a-0875-3429] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 12/10/2022]
Affiliation(s)
- Hiroyoshi Iwagami
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takashi Kanesaka
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
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35
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Iwatsubo T, Ishihara R, Nakagawa K, Ohmori M, Iwagami H, Matsuno K, Inoue S, Nakahira H, Matsuura N, Shichijo S, Maekawa A, Kanesaka T, Yamamoto S, Takeuchi Y, Higashino K, Uedo N, Higuchi K. Pharyngeal observation via transoral endoscopy using a lip cover-type mouthpiece. J Gastroenterol Hepatol 2019; 34:1384-1389. [PMID: 30561830 DOI: 10.1111/jgh.14574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/13/2018] [Revised: 12/12/2018] [Accepted: 12/12/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIM Simultaneous and metachronous head and neck cancers are likely to develop in patients with current or previous esophageal cancer. The Valsalva maneuver facilitates the visualization of the hypopharyngeal area during endoscopic observation, but it requires transnasal endoscopy. We developed a novel Valsalva maneuver using transoral endoscopy with a lip cover-type mouthpiece. METHODS Between March 2018 and July 2018, 107 patients with current or previous esophageal cancer who were scheduled to undergo upper gastrointestinal endoscopy were included in our pilot study. We performed the Valsalva maneuver using our newly developed mouthpiece and transoral endoscopy in the patients and evaluated the hypopharyngeal region, including the postcricoid area and the posterior wall of the hypopharynx. The outcome measure was procedural success rate, which was graded as "complete," "incomplete," and "none." RESULTS Observation of the hypopharyngeal area was "complete" in 81 patients (76%) using the Valsalva maneuver. However, in 25 patients and in 1 patient, observation was "incomplete" and "none," respectively. Seven lesions were newly detected in seven patients during the study period. CONCLUSIONS The Valsalva maneuver using transoral endoscopy with a lip cover-type mouthpiece is feasible for the visualization of the postcricoid area and the posterior wall of the hypopharynx. Particularly, this technique would contribute to early detection of head and neck cancers.
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Affiliation(s)
- Taro Iwatsubo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan.,Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Kentaro Nakagawa
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Masayasu Ohmori
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroyoshi Iwagami
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Kenshi Matsuno
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Shuntaro Inoue
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroko Nakahira
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriko Matsuura
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Satoki Shichijo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Akira Maekawa
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takashi Kanesaka
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Sachiko Yamamoto
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Koji Higashino
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Kazuhide Higuchi
- Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan
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36
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Shichijo S, Takeuchi Y, Matsuno K, Uedo N, Kono M, Fukuda H, Shimamoto Y, Nakagawa K, Ohmori M, Iwatsubo T, Iwagami H, Inoue S, Matsuura N, Nakahira H, Maekawa A, Kanesaka T, Higashino K, Ishihara R. Pulley Traction-Assisted Colonic Endoscopic Submucosal Dissection: A Retrospective Case Series. Dig Dis 2019; 37:473-477. [PMID: 30943509 DOI: 10.1159/000499670] [Citation(s) in RCA: 5] [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] [Received: 01/30/2019] [Accepted: 03/18/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND STUDY AIMS We have reported the usefulness of traction-assisted colorectal endoscopic submucosal dissection (TAC-ESD) to overcome the technical difficulty of colorectal ESD. However, the direction of traction is toward the anal side only. We retrospectively evaluate the safety and efficacy of "pulley" TAC-ESD. PATIENTS AND METHODS We retrospectively analyzed patients diagnosed with colorectal polyps and treated by "pulley" TAC-ESD at Osaka International Cancer Institute from December 2017 to June 2018. RESULTS During the study period, 79 patients with 81 lesions were treated by ESD, and 54 of these patients were treated by traction-assisted ESD. Among them, 7 underwent "pulley" traction-assisted ESD (6 men, 1 woman; age, 48-69 years), resulting in en bloc resection with no complications. This afforded good visibility of the submucosal layer in 6 patients, but it was not effective in the remaining patient with the muscle-retracting sign. CONCLUSION The "pulley" method affords good visibility of the submucosal layer by changing the traction direction in cases that are difficult to manage by conventional traction-assisted ESD.
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Affiliation(s)
- Satoki Shichijo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan,
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Kenshi Matsuno
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Mitsuhiro Kono
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiromu Fukuda
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yusaku Shimamoto
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Kentaro Nakagawa
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Masayasu Ohmori
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Taro Iwatsubo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroyoshi Iwagami
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Shuntaro Inoue
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriko Matsuura
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroko Nakahira
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Akira Maekawa
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takashi Kanesaka
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Koji Higashino
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
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37
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Matsuno K, Ishihara R, Nakagawa K, Ohmori M, Iwagami H, Inoue S, Iwatsubo T, Nakahira H, Matsuura N, Shichijyo S, Maekawa A, Takashi K, Yamamoto S, Takeuchi Y, Higashino K, Uedo N, Matsunaga T. Endoscopic findings corresponding to multiple Lugol-voiding lesions in the esophageal background mucosa. J Gastroenterol Hepatol 2019; 34:390-396. [PMID: 30101499 DOI: 10.1111/jgh.14439] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 05/25/2018] [Revised: 07/20/2018] [Accepted: 07/26/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND AIM Multiple Lugol-voiding lesions (LVLs) on Lugol chromoendoscopy can predict the development of metachronous multiple cancers in the esophagus and the head and neck regions. However, Lugol chromoendoscopy sometimes causes adverse events such as chest pain and discomfort. We therefore investigated the endoscopic findings on narrow band imaging (NBI) or blue laser imaging (BLI) that correspond to the presence of multiple LVLs in patients with esophageal squamous cell carcinoma. METHODS First, we investigated the NBI/BLI findings corresponding to individual small LVLs (one-to-one correspondence). Second, we investigated the association between the grade of multiple LVLs and the five endoscopic findings, including multiple foci of dilated vessels (MDV), multiple small brownish areas without microvascular irregularity, and a nonuniform color tone. RESULTS One-to-one correspondence of endoscopic findings was analyzed in 106 small LVLs. The main findings matched with small LVLs were a focus of dilated vessels (44 lesions), a small brownish area (17 lesions), and a small brownish area with a focus of dilated vessels (19 lesions). The relationship between multiple LVLs and each finding assessed by NBI/BLI was assessed in 155 patients. Multivariate logistic regression indicated that the presence of MDV was the only finding independently associated with multiple LVLs (P < 0.01). CONCLUSIONS The presence of MDV in the noncancerous background esophageal mucosa was significantly associated with multiple LVLs. This pilot study demonstrates that MDV has the potential to be a new risk factor for the development of metachronous multiple esophageal squamous cell carcinoma.
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Affiliation(s)
- Kenshi Matsuno
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Kentaro Nakagawa
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Masayasu Ohmori
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroyoshi Iwagami
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Shuntaro Inoue
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Taro Iwatsubo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroko Nakahira
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriko Matsuura
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Satoki Shichijyo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Akira Maekawa
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Kanesaka Takashi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Sachiko Yamamoto
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Koji Higashino
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takashi Matsunaga
- Department of Medical Informatics, Osaka International Cancer Institute, Osaka, Japan
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38
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Iwatsubo T, Ishihara R, Morishima T, Maekawa A, Nakagawa K, Arao M, Ohmori M, Iwagami H, Matsuno K, Inoue S, Nakahira H, Matsuura N, Shichijo S, Kanesaka T, Yamamoto S, Takeuchi Y, Higashino K, Uedo N, Miyashiro I, Higuchi K, Fujii T. Impact of age at diagnosis of head and neck cancer on incidence of metachronous cancer. BMC Cancer 2019; 19:3. [PMID: 30606157 PMCID: PMC6318848 DOI: 10.1186/s12885-018-5231-7] [Citation(s) in RCA: 25] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 12/17/2018] [Indexed: 12/18/2022] Open
Abstract
Background Metachronous cancer in patients with head and neck cancer (HNC) is common and is associated with a poor prognosis. We aimed to evaluate the incidence of metachronous cancer at different sites according to age at diagnosis of index HNC. Methods We collected data on 2011 patients with oral cancer, oropharynx cancer, hypopharyngeal cancer, and laryngeal cancer as index cancers using the Osaka International Cancer Institute Cancer Registry database between 2005 and 2016. Among these, we analyzed 1953 patients after excluding 5 patients who were not followed-up and 53 patients with simultaneous multiple index cancers. We evaluated the cumulative incidence of metachronous cancer in the esophagus, lung, and other sites according to age at diagnosis of the index HNC using the Kaplan–Meier method. Multivariate logistic regression analysis was performed to identify factors that influenced the incidence of metachronous cancers following HNC. Results The cumulative incidence of metachronous esophageal cancer in young patients (< 65 years) was significantly higher than that in old patients (≥ 65 years) (12.1% vs 8.5% at 5 years, and 16.5% vs 11.2% at 10 years; p = 0.015). On the other hand, the cumulative incidence of the other cancers in young patients was significantly lower than that in old patients (7.8% vs 12.2% at 5 years, and 13.9% vs 15.3% at 10 years; p = 0.017). The cumulative incidence of lung cancer was not significance according to age at diagnosis of the index HNC. In the multivariate analysis, histological type (squamous cell carcinoma) and lesion location (hypopharynx and larynx) were independently associated with metachronous cancers. Moreover, age at diagnosis of the index HNC (< 65 years), histological type (squamous cell carcinoma) and lesion location (hypopharynx) were significant predictors of metachronous esophageal cancer incidence and lesion location (hypopharynx) was a significant predictor of metachronous lung cancer incidence. Conclusion Risk stratification of metachronous cancers with age and other predictors may help to properly manage patients with HNC. Trial registration The present study is a non-intervention trial.
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Affiliation(s)
- Taro Iwatsubo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan.,Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan.
| | - Toshitaka Morishima
- Department of Cancer Strategy, Osaka International Cancer Institute, Osaka, Japan
| | - Akira Maekawa
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Kentaro Nakagawa
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Masamichi Arao
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Masayasu Ohmori
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Hiroyoshi Iwagami
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Kenshi Matsuno
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Shuntaro Inoue
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Hiroko Nakahira
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Noriko Matsuura
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Satoki Shichijo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Takashi Kanesaka
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Sachiko Yamamoto
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Koji Higashino
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Isao Miyashiro
- Department of Cancer Strategy, Osaka International Cancer Institute, Osaka, Japan
| | - Kazuhide Higuchi
- Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Takashi Fujii
- Department of Head and Neck Surgery, Osaka International Cancer Institute, Osaka, Japan
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39
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Iwagami H, Ishihara R, Nakagawa K, Ohmori M, Matsuno K, Inoue S, Arao M, Iwatsubo T, Nakahira H, Matsuura N, Shichijo S, Maekawa A, Takashi K, Yamamoto S, Takeuchi Y, Higashino K, Uedo N, Miyashiro I. Natural history of early gastric cancer: series of 21 cases. Endosc Int Open 2019; 7:E43-E48. [PMID: 30648138 PMCID: PMC6327720 DOI: 10.1055/a-0746-3329] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 02/26/2018] [Accepted: 08/22/2018] [Indexed: 01/07/2023] Open
Abstract
Background and study aims While knowledge of the natural history of early gastric cancer (EGC) may be useful in relevant clinical situations, few relevant reports are available. Therefore, we investigated the progression of EGC. We gathered data regarding 114 cases of EGC from 2005 to 2015 from a hospital cancer registry and analyzed 21 lesions that fulfilled five inclusion criteria. Deep progression was defined as submucosal invasion by a mucosal tumor and proper muscle invasion by a submucosal tumor. Lateral progression was defined as ≥ 20 % increase in size. During median follow-up of 23 months, one of 18 mucosal tumors showed deep progression and six showed lateral progression. Of three submucosal tumors, two showed deep progression and three showed lateral progression. Our study suggests that a certain proportion of mucosal cancers can lie dormant for several years. Further large-scale studies in a multicenter setting should overcome the limitations of this study.
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Affiliation(s)
- Hiroyoshi Iwagami
- Division of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Ryu Ishihara
- Division of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan,Corresponding author Ryu Ishihara, MD Division of Gastrointestinal OncologyOsaka International Cancer Institute3-1-69 OtemaeChuo-ku, Osaka, 541-8567Japan+81 6 6945 1902
| | - Kentaro Nakagawa
- Division of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Masayasu Ohmori
- Division of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Kenshi Matsuno
- Division of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Shuntaro Inoue
- Division of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Masamichi Arao
- Division of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Taro Iwatsubo
- Division of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroko Nakahira
- Division of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriko Matsuura
- Division of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Satoki Shichijo
- Division of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Akira Maekawa
- Division of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Kanesaka Takashi
- Division of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Sachiko Yamamoto
- Division of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yoji Takeuchi
- Division of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Koji Higashino
- Division of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriya Uedo
- Division of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Isao Miyashiro
- Division of Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
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40
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Kawamura T, Takeuchi Y, Asai S, Yokota I, Akamine E, Kato M, Akamatsu T, Tada K, Komeda Y, Iwatate M, Kawakami K, Nishikawa M, Watanabe D, Yamauchi A, Fukata N, Shimatani M, Ooi M, Fujita K, Sano Y, Kashida H, Hirose S, Iwagami H, Uedo N, Teramukai S, Tanaka K. A comparison of the resection rate for cold and hot snare polypectomy for 4-9 mm colorectal polyps: a multicentre randomised controlled trial (CRESCENT study). Gut 2018; 67:1950-1957. [PMID: 28970290 PMCID: PMC6176523 DOI: 10.1136/gutjnl-2017-314215] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [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: 03/26/2017] [Revised: 08/03/2017] [Accepted: 08/29/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To investigate the success rate of cold snare polypectomy (CSP) for complete resection of 4-9 mm colorectal adenomatous polyps compared with that of hot snare polypectomy (HSP). DESIGN A prospective, multicentre, randomised controlled, parallel, non-inferiority trial conducted in 12 Japanese endoscopy units. Endoscopically diagnosed sessile adenomatous polyps, 4-9 mm in size, were randomly assigned to the CSP or HSP group. After complete removal of the polyp using the allocated technique, biopsy specimens from the resection margin after polypectomy were obtained. The primary endpoint was the complete resection rate, defined as no evidence of adenomatous tissue in the biopsied specimens, among all pathologically confirmed adenomatous polyps. RESULTS A total of 796 eligible polyps were detected in 538 of 912 patients screened for eligibility between September 2015 and August 2016. The complete resection rate for CSP was 98.2% compared with 97.4% for HSP. The non-inferiority of CSP for complete resection compared with HSP was confirmed by the +0.8% (90% CI -1.0 to 2.7) complete resection rate (non-inferiority p<0.0001). Postoperative bleeding requiring endoscopic haemostasis occurred only in the HSP group (0.5%, 2 of 402 polyps). CONCLUSIONS The complete resection rate for CSP is not inferior to that for HSP. CSP can be one of the standard techniques for 4-9 mm colorectal polyps. (Study registration: UMIN000018328).
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Affiliation(s)
- Takuji Kawamura
- Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Satoshi Asai
- Department of Gastroenterology, Tane General Hospital, Osaka, Japan
| | - Isao Yokota
- Department of Biostatistics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Eisuke Akamine
- Department of Gastroenterology, Tane General Hospital, Osaka, Japan
| | - Minoru Kato
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takuji Akamatsu
- Department of Gastroenterology and Hepatology, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
| | - Kazuhiro Tada
- Department of Gastroenterology, Bellland General Hospital, Osaka, Japan
| | - Yoriaki Komeda
- Department of Gastroenterology and Hepatology, Kindai University, Osaka, Japan
| | - Mineo Iwatate
- Gastrointestinal Center, Sano Hospital, Hyogo, Japan
| | - Ken Kawakami
- Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Michiko Nishikawa
- Department of Gastroenterology, Yodogawa Christian Hospital, Osaka, Japan
| | - Daisuke Watanabe
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Atsushi Yamauchi
- Division of Gastroenterology and Hepatology, Kitano Hospital, Osaka, Japan
| | - Norimasa Fukata
- The Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Masaaki Shimatani
- The Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Makoto Ooi
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Koichi Fujita
- Department of Gastroenterology, Yodogawa Christian Hospital, Osaka, Japan
| | - Yasushi Sano
- Gastrointestinal Center, Sano Hospital, Hyogo, Japan
| | - Hiroshi Kashida
- Department of Gastroenterology and Hepatology, Kindai University, Osaka, Japan
| | - Satoru Hirose
- Department of Gastroenterology, Bellland General Hospital, Osaka, Japan
| | - Hiroyoshi Iwagami
- Department of Gastroenterology and Hepatology, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Satoshi Teramukai
- Department of Biostatistics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kiyohito Tanaka
- Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, Japan,Department of Medical Information, Kyoto Second Red Cross Hospital, Kyoto, Japan
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41
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Iwatsubo T, Takeuchi Y, Yamasaki Y, Nakagawa K, Arao M, Ohmori M, Iwagami H, Matsuno K, Inoue S, Nakahira H, Matsuura N, Shichijo S, Maekawa A, Kanesaka T, Yamamoto S, Higashino K, Uedo N, Ishihara R. Differences in Clinical Course of Intraprocedural and Delayed Perforation Caused by Endoscopic Submucosal Dissection for Colorectal Neoplasms: A Retrospective Study. Dig Dis 2018; 37:53-62. [PMID: 30227392 DOI: 10.1159/000492868] [Citation(s) in RCA: 11] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 08/13/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although the use of endoscopic submucosal dissection (ESD) as a minimally invasive treatment for large superficial colorectal neoplasms is increasing, colorectal ESD remains technically challenging. As perforation in the colorectum is generally considered to be associated with a higher risk of complications, the aim of this study was to investigate the characteristics of perforation caused by colorectal ESD. METHODS This retrospective study included 635 lesions treated with colorectal ESD, between February 2011 and December 2015, in a tertiary cancer center. We evaluated and compared the clinical course and short-term outcomes of the intraprocedural perforation group with those of the delayed perforation and no perforation groups. RESULTS Perforation occurred in 45 (7.1%) of the 635 cases. Thirty-six cases were intraprocedural perforation (5.7%), all of which were successfully closed with endoclips during the procedure. Nine cases of delayed perforation occurred (1.4%). No emergency surgery was performed in the intraprocedural perforation group; however, 5 of 9 cases underwent emergency surgery in the delayed perforation group (56%, p < 0.0001). There were statistically significant differences between the intraprocedural and delayed perforation groups with regard to the hospitalization period, fasting period, abdominal pain scale, peak white blood cell (WBC) count, and peak C-reactive protein (CRP), and between the intraprocedural and no perforation groups with regard to the location of the lesion, hospitalization period, fasting period, abdominal pain scale, peak WBC, peak CRP, and en bloc resection rate. CONCLUSIONS While intraprocedural perforation due to colorectal ESD can be managed conservatively, delayed perforation can lead to serious adverse events.
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Affiliation(s)
- Taro Iwatsubo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka,
| | - Yasushi Yamasaki
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan.,Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Kentaro Nakagawa
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Masamichi Arao
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Masayasu Ohmori
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroyoshi Iwagami
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Kenshi Matsuno
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Shuntaro Inoue
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroko Nakahira
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriko Matsuura
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Satoki Shichijo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Akira Maekawa
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takashi Kanesaka
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Sachiko Yamamoto
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Koji Higashino
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
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42
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Kanesaka T, Uedo N, Yao K, Ezoe Y, Doyama H, Oda I, Kaneko K, Kawahara Y, Yokoi C, Sugiura Y, Ishikawa H, Takeuchi Y, Arao M, Iwatsubo T, Iwagami H, Matsuno K, Muto M, Saito Y, Tomita Y. Multiple convex demarcation line for prediction of benign depressed gastric lesions in magnifying narrow-band imaging. Endosc Int Open 2018; 6:E145-E155. [PMID: 29399611 PMCID: PMC5794433 DOI: 10.1055/s-0043-121267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 03/11/2017] [Accepted: 09/08/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND STUDY AIMS With magnifying narrow-band imaging (M-NBI) of the gastric mucosa, a characteristic demarcation line (DL) is occasionally found in non-cancerous depressed lesions. This DL forms multiple convex shapes along the edge of the epithelia of surrounding mucosa. We have termed this novel finding a multiple convex DL (MCDL). In this study, we clarified the prevalence of an MCDL in depressed gastric lesions detected in patients at high risk for gastric cancer and determined the diagnostic yield necessary to distinguish between cancer and non-cancer. PATIENTS AND METHODS This was a post hoc analysis of a multicenter prospective trial. In total, 362 small (≤ 10 mm) depressed lesions were detected in 1353 patients. Presence or absence of a DL in target lesions was evaluated on M-NBI images. The proportion of MCDLs among lesions with a DL was evaluated. RESULTS Images of 347 lesions (39 cancerous and 308 non-cancerous) were evaluable. A DL was present in 252/347 lesions (73 %). When the cutoff value for the proportion of MCDLs needed to distinguish non-cancer from cancer was set at two-thirds, an MCDL was observed in 86/252 lesions (34 %). In 86 lesions with an MCDL, 83 (97 %) were non-cancerous. The sensitivity, specificity, positive predictive value, and negative predictive value of an MCDL for non-cancerous lesions were 38 %, 91 %, 97 %, and 19 %, respectively. CONCLUSIONS Presence of an MCDL had high specificity and positive predictive value for non-cancerous lesions. Evaluating the shape of the DL is useful for differentiation between cancer and non-cancerous lesions.
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Affiliation(s)
- Takashi Kanesaka
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Kenshi Yao
- Department of Endoscopy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Yasumasa Ezoe
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hisashi Doyama
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan
| | - Ichiro Oda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Kazuhiro Kaneko
- Department of Gastroenterology, Endoscopy Division, National Cancer Center Hospital East, Chiba, Japan
| | | | - Chizu Yokoi
- Endoscopy Division, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yasushi Sugiura
- Division of Gastroenterology and Hepatology, Kitano Hospital, Osaka, Japan
| | - Hideki Ishikawa
- Department of Molecular Targeting Cancer Prevention, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Masamichi Arao
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Taro Iwatsubo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroyoshi Iwagami
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Kenji Matsuno
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Manabu Muto
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yasuhiko Tomita
- Department of Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
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43
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Yokoyama S, Uyama S, Iwagami H, Yamashita Y. Successful combination of endoscopic pyloromyotomy and balloon dilatation for hypertrophic pyloric stenosis in an older child: A novel procedure. Surg Case Rep 2016; 2:145. [PMID: 27915443 PMCID: PMC5136377 DOI: 10.1186/s40792-016-0274-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 12/01/2016] [Indexed: 01/30/2023] Open
Abstract
Background Hypertrophic pyloric stenosis (HPS) is a rare cause of gastric outlet obstruction beyond infancy. Ramstedt pyloromyotomy remains the gold standard treatment for HPS. This type of HPS can be managed successfully with pyloromyotomy under laparoscopic or open procedures. Endoscopic pyloric balloon dilation (EPBD) has not been recommended in the treatment of HPS, and there are only a small number of reported cases who had had successful endoscopic pyloromyotomy (EP) for HPS only in infants. Case presentation The patient was suspected of having HPS when the patient was 1 year old after infancy. However, his parents thought that the vomiting and poor sucking were caused by Down syndrome-associated muscular hypotonia. Since then, no additional tests have been performed at their request. At 6 years of age, he was readmitted to our department because of persistent vomiting and failure to thrive, and HPS was diagnosed again. However, it was unknown whether the HPS had been persisting since infancy or was acquired. The first EPBD was slightly effective but did not remain effective for a long time. When the second EPBD was performed in combination with EP, the amount and frequency of vomiting were reduced dramatically. Conclusions The combination of EP and EPBD procedure may represent a safe, effective, and minimally invasive option for selected HPS patients in whom laparotomy would pose a significant risk or who do not respond to conventional medical treatment. To our knowledge, this is the first report to describe combination treatment with EP and EPBD in an older child with HPS.
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Affiliation(s)
- Satoshi Yokoyama
- Department of Pediatric surgery, Japanese Red Cross Society, Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama, 640-8558, Japan.
| | - Shiro Uyama
- Department of Pediatric surgery, Japanese Red Cross Society, Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama, 640-8558, Japan
| | - Hiroyoshi Iwagami
- Department of Gastroenterology and Hepatology, Japanese Red Cross Society, Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama, 640-8558, Japan
| | - Yukitaka Yamashita
- Department of Gastroenterology and Hepatology, Japanese Red Cross Society, Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama, 640-8558, Japan
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44
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Matsumoto H, Minaga K, Yamashita Y, Iwagami H, Hatamaru K, Nakatani Y, Akamatsu T, Seta T, Urai S, Uenoyama Y. [A case of transcatheter arterial embolization for reduction of a hemorrhagic rectal gastrointestinal stromal tumor]. Nihon Shokakibyo Gakkai Zasshi 2015; 112:1046-1053. [PMID: 26050728 DOI: 10.11405/nisshoshi.112.1046] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A 91-year-old woman was referred to our hospital with a primary complaint of hematochezia. A rectal submucosal tumor and an acute hemorrhagic rectal ulcer were noted on colonoscopy. After hemostasis was achieved with APC, the patient was diagnosed with a GIST by EUS-FNA. We performed TAE of the middle and inferior rectal artery to secure hemostasis, because these arteries were also observed to be bleeding during hospitalization. A CT scan and colonoscopy revealed that the rectal GIST had reduced and that the acute rectal ulcer had been successfully treated. We report a case in which TAE was used to achieve tumor reduction of a hemorrhagic rectal GIST.
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Affiliation(s)
- Hisakazu Matsumoto
- Department of Gastroenterology, Japan Red Cross Hospital Wakayama Medical Center
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45
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Abstract
In order to improve the antibacterial activity of ampicillin, new penicillin derivatives having a 1-aryltriazole-4-carboxamide group or a 5-arylisoxazole-3-carboxamide group at the alpha-position of benzylpenicillin or p-hydroxybenzylpenicillin were synthesized. Some compounds in these series were found to possess high activity against Pseudomonas and other Gram-negative bacteria. In addition, structure-activity relationships, especially the effect of the hydrophobic character of the compounds on activity, were investigated.
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46
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Yasuda N, Iwagami H, Nakanishi E, Nakamiya T, Sasaki Y, Murata T. Synthesis and antibacterial activity of 6- and 7-[2-(5-carboxyimidazole-4-carboxamido)phenylacetamido]-penicillins and cephalosporins. J Antibiot (Tokyo) 1983; 36:242-9. [PMID: 6339459 DOI: 10.7164/antibiotics.36.242] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The synthesis and antibacterial activity of a series of beta-lactam antibiotics having a 5-carboxyimidazole-4-carbonyl group attached through an amide linkage to ampicillin, cephaloglycin or their analogs are described. Some compounds of this series were found to possess high activity against Pseudomonas and other Gram-negative bacteria.
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