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Trecca A, Borghini R, Medicina D, Del Sordo R, Mandelli G, Bella A, Galloro G, Fu KI, Villanacci V. Endoscopic features with associated histological and molecular alterations in serrated polyps with dysplasia: Retrospective analysis of a tertiary case series. Dig Liver Dis 2024; 56:687-694. [PMID: 37778895 DOI: 10.1016/j.dld.2023.09.007] [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: 07/05/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Serrated polyps are incompletely understood lesions and include serrated sessile lesion (SSL) without or with dysplasia and traditional serrated adenoma (TSA). AIMS We investigated prevalence and characteristics of serrated lesions, especially SSL with dysplasia (mixed polyps). METHODS This retrospective study analyzed data from consecutive patients referred for colonoscopy at a tertiary care center. Endoscopic and histopathological characteristics of identified lesions were studied. SSLs with dysplasia were molecularly analyzed for mutations and microsatellite instability. RESULTS Among 1147 patients, a total of 436 polyps were found, including 288 adenomas (66.1 %) and 114 serrated lesions (SLDR 26.2 %). PDR was 34.5 % and ADR was of 30.2 %. Serrated lesions included 75 hyperplastic polyps (17.2 %), 24 SSLs without dysplasia (5.5 %), 6 SSLs with dysplasia (mixed polyps) (1.4 %) and 9 TSA (2.1 %). The mixed polyps were evaluated molecularly: these analyses found no KRAS mutation, a single NRAS mutation in one lesion, the Val600Glu BRAF mutation in four lesions in both their serrated non-dysplastic and dysplastic areas, and microsatellite instability in four lesions, limited to the dysplastic areas. CONCLUSION Our single-center experience confirms the high prevalence of serrated lesions, a part of which are SSL with dysplasia. These lesions seem to carry specific molecular alterations.
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Affiliation(s)
| | - Raffaele Borghini
- Maternal and Child Health Department, Gastroenterology Unit, Sapienza University of Rome, Rome, Italy
| | - Daniela Medicina
- Institute of Pathology, ASST-Spedali Civili Brescia, Brescia, Italy
| | - Rachele Del Sordo
- Department of Medicine and Surgery, Section of Anatomic Pathology and Histology, Medical School, University of Perugia, Perugia, Italy
| | - Giulio Mandelli
- Institute of Pathology, ASST-Spedali Civili Brescia, Brescia, Italy
| | - Antonino Bella
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Giuseppe Galloro
- Department of Clinical Medicine and Surgery, Surgical Digestive Endoscopy Unit, University of Naples Federico II, Naples, Italy
| | - Kuang-I Fu
- Department of Endoscopy, Kanma Memorial Hospital, Tochigi, Japan
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2
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Takeda T, Ueyama H, Fu KI, Murata S, Nagahara A. Minute gastric adenocarcinoma of the fundic-gland type with submucosal invasion. Endoscopy 2022; 54:E468-E469. [PMID: 34571564 DOI: 10.1055/a-1625-5865] [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: 12/10/2022]
Affiliation(s)
- Tsutomu Takeda
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroya Ueyama
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Kuang-I Fu
- Department of Endoscopy, Kanma Memorial Hospital, Tokyo, Japan
| | | | - Akihito Nagahara
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
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3
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Yang XY, Fu KI, Chen YP, Chen ZW, Ding J. Diffuse xanthoma in early esophageal cancer: A case report. World J Clin Cases 2021; 9:5259-5265. [PMID: 34307576 PMCID: PMC8283587 DOI: 10.12998/wjcc.v9.i19.5259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/09/2021] [Accepted: 05/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gastrointestinal xanthomas are asymptomatic and infrequent non-neoplastic lesions that commonly occur in the stomach with Helicobacter pylori-associated gastritis and rarely in the esophagus. To date, there have been no reports of esophageal xanthoma combined with esophageal cancer. Herein, we present the first case in the literature of a diffuse xanthoma complicated with early esophageal cancer. Moreover, this combination makes the endoscopic diagnosis difficult if it is not in mind.
CASE SUMMARY A 68-year-old man visited our department with a 2-mo history of epigastric discomfort. He underwent surgery for gastric cancer 6 years ago. Esophagogastroduodenoscopy showed a semi-circumferential irregular yellowish-colored and granular lesion in the esophagus (30-35 cm from the incisors). Using magnifying endoscopy with narrow band imaging, aggregated minute and yellowish-colored spots with tortuous microvessels on the surface were observed, and background coloration was clearly seen in the lesion. As endoscopic biopsy suggested a histologically high-grade dysplasia; the lesion was completely resected en bloc by endoscopic submucosal dissection (ESD). The resected specimen was confirmed to be a squamous cell carcinoma in situ with extensive foamy cells in the superficial mucosal layer. Immunohistochemically, the observed foamy cells were strongly positive for CD68, which is characteristic of xanthoma. The clinical course was favorable, and no recurrence was observed 2 years and 7 mo after ESD.
CONCLUSION Diffuse xanthoma concurrent with early esophageal cancer is extremely rare. The characteristic endoscopic features may assist endoscopists in diagnosing similar lesions.
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Affiliation(s)
- Xiao-Yun Yang
- Department of Gastroenterology and Hepatology, The Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, Zhejiang Province, China
| | - Kuang-I Fu
- Department of Endoscopy, Kanma Memorial Hospital, Tokyo 325-0046, Japan
| | - Yan-Ping Chen
- Department of Gastroenterology and Hepatology, The Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, Zhejiang Province, China
| | - Zhen-Wei Chen
- Department of Pathology, The Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, Zhejiang Province, China
| | - Jing Ding
- Department of Gastroenterology and Hepatology, The Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, Zhejiang Province, China
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4
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Di L, Fu KI, Wu X, Liu X, Xie R, Zhu R, Tuo B. Endoscopic features and associated histology of an basaloid squamous cell carcinoma of the esophagus at the very early stage. BMC Cancer 2019; 19:513. [PMID: 31142308 PMCID: PMC6542137 DOI: 10.1186/s12885-019-5749-3] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 05/24/2019] [Indexed: 01/18/2023] Open
Abstract
Background Basaloid squamous cell carcinoma of the esophagus (BSCCE) is generally detected at advanced stage and the prognosis is poorer than advanced conventional esophageal squamous cell carcinoma. Therefore, early detection is a critical to improve patients’ survival. However, only a few cases of early BSCCE have been reported and the endoscopic features of early BSCCE are not well described. We herein report the endoscopic features and associated histology of an early BSCCE limited within the mucosal lamina propria (m2). To our knowledge, this is the earliest BSCCE reported to date. Case presentation A 62-year-old male patient was admitted to our hospital because of epigastric pain for 3 months. White light endoscopy revealed a flat lesion with mild sloping at the periphery. The lesion was covered with leukoplakia, and normal vascular network could not be seen in the lesion. Magnifying endoscopy with narrow-band imaging showed abnormal intra-papillary capillary loop categorized as type B1 according to the classification of the Japan Esophageal Society. Iodine staining revealed a less-stained lesion. The lesion was completely resected through endoscopic submucosal dissection. Histopathologically, tumor cells, which were limited within the mucosal lamina propria, formed solid nests and lobule structures, with ribbon-like arrangement of sparse cytoplasm and round to ovoid hyperchromatic nuclei. A final diagnosis of early BSCCE was established. Conclusions This is the earliest BSCCE reported to date. The prominent lesion with a gentle rising slope and less-staining or abnormal stain might be initial feature of early BSCCE.
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Affiliation(s)
- Lianjun Di
- Department of Gastroenterology, Affiliated Hospital, Zunyi Medical University, Zunyi, 563003, China
| | - Kuang-I Fu
- Department of Gastroenterology, Affiliated Hospital, Zunyi Medical University, Zunyi, 563003, China.,Department of Endoscopy, Kanma Memorial Hospital, Tokyo, Japan
| | - Xinglong Wu
- Department of pathology, Affiliated Hospital, Zunyi Medical University, Zunyi, China
| | - Xuemei Liu
- Department of Gastroenterology, Affiliated Hospital, Zunyi Medical University, Zunyi, 563003, China
| | - Rui Xie
- Department of Gastroenterology, Affiliated Hospital, Zunyi Medical University, Zunyi, 563003, China
| | - Rong Zhu
- Department of Gastroenterology, Affiliated Hospital, Zunyi Medical University, Zunyi, 563003, China
| | - Biguang Tuo
- Department of Gastroenterology, Affiliated Hospital, Zunyi Medical University, Zunyi, 563003, China.
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5
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Di L, Fu KI, Xie R, Wu X, Tuo B. Atrophy or cancer? That is the question. Gastrointest Endosc 2018; 88:881-883.e1. [PMID: 30036507 DOI: 10.1016/j.gie.2018.07.014] [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: 05/28/2018] [Accepted: 07/16/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Lianjun Di
- Department of Gastroenterology, Affiliated Hospital, Zunyi Medical College, Zunyi, China
| | - Kuang-I Fu
- Department of Gastroenterology, Affiliated Hospital, Zunyi Medical College, Zunyi, China; Department of Endoscopy, Kanma Memorial Hospital, Tokyo, Japan
| | - Rui Xie
- Department of Gastroenterology, Affiliated Hospital, Zunyi Medical College, Zunyi, China
| | - Xinglong Wu
- Department of Pathology, Affiliated Hospital, Zunyi Medical College, Zunyi, China
| | - Biguang Tuo
- Department of Gastroenterology, Affiliated Hospital, Zunyi Medical College, Zunyi, China
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6
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Xie R, Fu KI, Chen SM, Tuo BG, Wu HC. Neurofibromatosis type 1-associated multiple rectal neuroendocrine tumors: A case report and review of the literature. World J Gastroenterol 2018; 24:3806-3812. [PMID: 30197486 PMCID: PMC6127664 DOI: 10.3748/wjg.v24.i33.3806] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/12/2018] [Accepted: 07/21/2018] [Indexed: 02/06/2023] Open
Abstract
Neurofibromatosis type 1 (NF-1) is commonly associated with benign or malignant tumors in both the central and peripheral nervous systems. However, rare cases of NF-1-associated multiple rectal neuroendocrine tumors have been reported. This report describes a case of a 39 year old female with NF-1 and intermittent hematochezia as a primary symptom. Physical examination showed multiple subcutaneous nodules and café au lait spots with obvious scoliosis of the back. Imaging examinations and colonoscopy found malformation of the left external iliac vein and multiple gray-yellow nodules with varying sizes and shapes in the rectal submucosal layer. Histological and immunohistochemical results suggested multiple rectal neuroendocrine tumors, a rare disease with few appreciable symptoms and a particularly poor prognosis. The patient with NF-1 presented here had not only multiple rectal neuroendocrine neoplasms but also vascular malformations, scoliosis and other multiple system lesions. This case therefore contributes to improving clinical understanding, diagnosis and treatment of related complications for patients with NF-1 who present with associated medical conditions.
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Affiliation(s)
- Rui Xie
- Department of Gastroenterology, Affiliated Hospital to Zunyi Medical College, Zunyi 563003, Guizhou Province, China
| | - Kuang-I Fu
- Department of Gastroenterology, Affiliated Hospital to Zunyi Medical College, Zunyi 563003, Guizhou Province, China
- Department of Endoscopy, Kanma Memorial Hospital, Tokyo 3250046, Japan
| | - Shao-Min Chen
- Department of Gastroenterology, Affiliated Hospital to Zunyi Medical College, Zunyi 563003, Guizhou Province, China
| | - Bi-Guang Tuo
- Department of Gastroenterology, Affiliated Hospital to Zunyi Medical College, Zunyi 563003, Guizhou Province, China
| | - Hui-Chao Wu
- Department of Gastroenterology, Affiliated Hospital to Zunyi Medical College, Zunyi 563003, Guizhou Province, China
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7
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Iwatate M, Sano Y, Tanaka S, Kudo SE, Saito S, Matsuda T, Wada Y, Fujii T, Ikematsu H, Uraoka T, Kobayashi N, Nakamura H, Hotta K, Horimatsu T, Sakamoto N, Fu KI, Tsuruta O, Kawano H, Kashida H, Takeuchi Y, Machida H, Kusaka T, Yoshida N, Hirata I, Terai T, Yamano HO, Nakajima T, Sakamoto T, Yamaguchi Y, Tamai N, Nakano N, Hayashi N, Oka S, Ishikawa H, Murakami Y, Yoshida S, Saito Y. Validation study for development of the Japan NBI Expert Team classification of colorectal lesions. Dig Endosc 2018; 30:642-651. [PMID: 29603399 DOI: 10.1111/den.13065] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [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: 02/14/2018] [Accepted: 03/26/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM The Japan narrow-band imaging (NBI) Expert Team (JNET) was organized to unify four previous magnifying NBI classifications (the Sano, Hiroshima, Showa, and Jikei classifications). The JNET working group created criteria (referred to as the NBI scale) for evaluation of vessel pattern (VP) and surface pattern (SP). We conducted a multicenter validation study of the NBI scale to develop the JNET classification of colorectal lesions. METHODS Twenty-five expert JNET colonoscopists read 100 still NBI images with and without magnification on the web to evaluate the NBI findings and necessity of the each criterion for the final diagnosis. RESULTS Surface pattern in magnifying NBI images was necessary for diagnosis of polyps in more than 60% of cases, whereas VP was required in around 90%. Univariate/multivariate analysis of candidate findings in the NBI scale identified three for type 2B (variable caliber of vessels, irregular distribution of vessels, and irregular or obscure surface pattern), and three for type 3 (loose vessel area, interruption of thick vessel, and amorphous areas of surface pattern). Evaluation of the diagnostic performance for these three findings in combination showed that the sensitivity for types 2B and 3 was highest (44.9% and 54.7%, respectively), and that the specificity for type 3 was acceptable (97.4%) when any one of the three findings was evident. We found that the macroscopic type (polypoid or non-polypoid) had a minor influence on the key diagnostic performance for types 2B and 3. CONCLUSION Based on the present data, we reached a consensus for developing the JNET classification.
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Affiliation(s)
- Mineo Iwatate
- Gasrtrointestinal Center and Institute of Minimally-Invasive Endoscopic Care (iMEC), Sano Hospital, Kobe, Japan
| | - Yasushi Sano
- Gasrtrointestinal Center and Institute of Minimally-Invasive Endoscopic Care (iMEC), Sano Hospital, Kobe, Japan
| | - Shinji Tanaka
- Department of Endoscopy, Hiroshima University, Hiroshima, Japan
| | - Shin-Ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Shoichi Saito
- Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
| | | | | | | | - Hiroaki Ikematsu
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan
| | - Toshio Uraoka
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Nozomu Kobayashi
- Department of Gastroenterology, Tochigi Cancer Center, Utsunomiya, Japan
| | | | - Kinichi Hotta
- Division of Endoscopy, Shizuoka Cancer Center, Suntogun, Japan
| | | | - Naoto Sakamoto
- Department of Gastroenterology, Juntendo University, Tokyo, Japan
| | - Kuang-I Fu
- Department of Gastroenterology, Kanma Memorial Hospital, Nasushiobara, Japan
| | - Osamu Tsuruta
- Division of Gastroenterology, Kurume University, Kurume, Japan
| | - Hiroshi Kawano
- Department of Gastroenterology, St. Mary's Hospital, Kurume, Japan
| | - Hiroshi Kashida
- Department of Gastroenterology and Hepatology, Kindai University, Osaka-Sayama, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hirohisa Machida
- Internal Medicine, Machida Gastrointestinal Hospital, Osaka, Japan
| | - Toshihiro Kusaka
- Department of Gastroenterology and Hepatology, Kyoto Katsura Hospital, Kyoto, Japan
| | - Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto, Japan
| | - Ichiro Hirata
- Department of Gastroenterology, Osaka Central Hospital, Osaka, Japan
| | | | - Hiro-O Yamano
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Takeshi Nakajima
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Taku Sakamoto
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | | | - Naoto Tamai
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Naoko Nakano
- Department of Gastroenterology, Fujita Health University, Toyoake, Japan
| | - Nana Hayashi
- Department of Endoscopy, Hiroshima University, Hiroshima, Japan
| | - Shiro Oka
- Department of Endoscopy, Hiroshima University, Hiroshima, Japan
| | - Hideki Ishikawa
- Department of Molecular-Targeting Cancer Prevention, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | - Shigeaki Yoshida
- CEO, Aomori Prefectural Central Hospital Administration, Aomori, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
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Affiliation(s)
- Luli Hu
- Department of Gastroenterology, Affiliated Hospital, Zunyi Medical College, Zunyi, China
| | - Kuang-I Fu
- Department of Gastroenterology, Affiliated Hospital, Zunyi Medical College, Zunyi, China
| | - Biguang Tuo
- Department of Gastroenterology, Affiliated Hospital, Zunyi Medical College, Zunyi, China
| | - Lianjun Di
- Department of Gastroenterology, Affiliated Hospital, Zunyi Medical College, Zunyi, China
| | - Xuemei Liu
- Department of Gastroenterology, Affiliated Hospital, Zunyi Medical College, Zunyi, China
| | - Kui Zhao
- Department of Gastroenterology, Affiliated Hospital, Zunyi Medical College, Zunyi, China
| | - Huichao Wu
- Department of Gastroenterology, Affiliated Hospital, Zunyi Medical College, Zunyi, China
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9
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Yu GQ, Huang XM, Li HY, Tang W, Hu DM, Lü MH, Fu KI. Use of an abdominal obstetric binder in colonoscopy: A randomized, prospective trial. J Gastroenterol Hepatol 2018; 33:1365-1369. [PMID: 29292858 DOI: 10.1111/jgh.14077] [Citation(s) in RCA: 5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 11/25/2017] [Accepted: 12/19/2017] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIMS Various methods have been reported as aids to cecal intubation. This study aimed to prospectively investigate whether an abdominal obstetric binder (AOB) used during pregnancy and attached to the patients' abdomen during colonoscopy could facilitate effective colonoscopic insertion. METHODS This was a prospective study of 451 consecutive outpatient colonoscopies performed by a single experienced endoscopist. The recruited patients were randomly separated into two groups that received colonoscopy either with (Group A) or without an AOB attached (Group B). The cecal intubation time, cecal intubation length of the colonoscope, use of manual pressure, position change of each patient, and the number of patients with abdominal distension were collected for comparison. RESULTS A total of 451 patients (224 in Group A and 227 in Group B) were ultimately included in this study. In Group A, cecal intubation time and cecal intubation length of colonoscope (CIL) were significantly reduced (P < 0.001). The patients had significantly fewer position changes and manual pressure in Group A (P < 0.001). Significantly less abdominal distension was reported by patients in Group A (P < 0.001). CONCLUSIONS During colonoscopy, the application of an AOB provided a significantly faster and more effective colonoscope insertion.
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Affiliation(s)
- Guang Qiu Yu
- Department of Gastroenterology, The Second Affiliated Hospital of Suzhou University, Jiangsu Province, Suzhou, China
| | - Xiao Mei Huang
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Sichuan Province, Luzhou, China
| | - Hai Yan Li
- Department of Gastroenterology, The Second Affiliated Hospital of Suzhou University, Jiangsu Province, Suzhou, China
| | - Wen Tang
- Department of Gastroenterology, The Second Affiliated Hospital of Suzhou University, Jiangsu Province, Suzhou, China
| | - Duan Min Hu
- Department of Gastroenterology, The Second Affiliated Hospital of Suzhou University, Jiangsu Province, Suzhou, China
| | - Mu Han Lü
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Sichuan Province, Luzhou, China
| | - Kuang-I Fu
- Department of Endoscopy, Kanma Memorial Hospital, Nasushiobara, Japan
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10
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Liu CX, Shen YY, Shi N, Hu YB, Jia XF, Zhou CJ, Fu KI. Correlation of endoscopic images and histological findings of a high grade dysplasia developed in a gastric xanthoma. Int J Clin Exp Pathol 2018; 11:1018-1022. [PMID: 31938196 PMCID: PMC6957991] [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] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 01/27/2018] [Indexed: 06/10/2023]
Abstract
Gastric neoplasia developed in a xanthoma is very rare. We herein report a high grade dysplasia (HGD) arising in a gastric xanthoma removed by endoscopic submucosal dissection (ESD). A 57-year-old man was referred to our hospital for removal of rectal polyps. During surveillance esophago-gastro-duodenoendoscopy before polypectomy, an irregularly shaped gastric xanthoma with unusual color was found in the stomach. Although, magnifying narrow band imaging showed no typical neoplastic vessel or surface pattern on the surface and endoscopic biopsies revealed no tumor, diagnostic ESD was performed because of its irregular shape and unusual color for a commonly seen xanthoma. Histologically, a high grade dysplasia, 6 mm×6 mm in size, was detected within a gastric xanthoma. This is the first report of correlation of endoscopic images and histological findings of a HGD in a gastric xanthoma.
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Affiliation(s)
- Cheng-Xia Liu
- Department of Digestive Medicine, Binzhou Medical University HospitalBinzhou, Shandong, China
| | - Yuan-Yuan Shen
- Department of Digestive Medicine, Binzhou Medical University HospitalBinzhou, Shandong, China
| | - Ning Shi
- Department of Digestive Medicine, Binzhou Medical University HospitalBinzhou, Shandong, China
| | - Ying-Bin Hu
- Department of Digestive Medicine, Binzhou Medical University HospitalBinzhou, Shandong, China
| | - Xing-Fang Jia
- Department of Digestive Medicine, Binzhou Medical University HospitalBinzhou, Shandong, China
| | - Cheng-Jun Zhou
- Department of Pathology, The Second Affiliated Hospital, Shandong UniversityJinan, Shandong, China
| | - Kuang-I Fu
- Department of Gastroenterology, Kanma Memorial Hospital2-5 Nasushiobara City, Tochigi, Japan
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11
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Jin P, Fu KI, Yu Y, He YQ, Wei Z, Wang X, Cai Q, Sheng JQ. Traction using a clip-with-line is a preferred method for trainees in performing esophageal endoscopic submucosal dissection: an animal model study. Therap Adv Gastroenterol 2017; 10:343-351. [PMID: 28491139 PMCID: PMC5405881 DOI: 10.1177/1756283x16687926] [Citation(s) in RCA: 6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The optimal operative process of esophageal endoscopic submucosal dissection (ESD), especially for the beginners, is not established. In this study, the clip-with-line method, the tunneling method and the conventional method for esophageal ESD were compared in a training course on live pigs. METHODS 15 trainee endoscopists were randomized into three groups, the clip-with-line method group, the tunneling method group, and the conventional method group. Each trainee performed four esophageal ESDs on live pigs with one of the specified methods, assisted by a senior endoscopist. The procedural time and speed, the en bloc resection rates, adverse events, and self-completion rates were recorded, and learning curves were drawn. RESULTS The procedural time in the clip-with-line group was significantly shorter than those in the tunneling and the conventional method group (47.4 ± 9.0 min versus 67.0 ± 15.1 min and 67.0 ± 11.8 min, p = 0.000). The clip-with-line method had the lowest rates of perforation and muscle layer injury among the three methods. The en bloc resection rates and self-completion rates were similar among the three groups. Learning curves analysis showed the clip-with-line method was the easiest one for the trainees to master. CONCLUSIONS The clip-with-line method shortened procedural time for trainees, and was associated with lower rates of adverse events. This method is preferred for endoscopists in their learning periods for esophageal ESD.
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Affiliation(s)
- Peng Jin
- Department of Gastroenterology, PLA Army General Hospital, Beijing 100700, China
| | - Kuang-I Fu
- Department of Gastroenterology, PLA Army General Hospital, Beijing 100700, China
| | - Yang Yu
- Department of Gastroenterology, PLA Army General Hospital, Beijing 100700, China
| | - Yu-Qi He
- Department of Gastroenterology, PLA Army General Hospital, Beijing 100700, China
| | - Zhi Wei
- Department of Gastroenterology, Jinan Military General Hospital, Jinan, China
| | - Xin Wang
- Department of Gastroenterology, PLA Army General Hospital, Beijing 100700, China
| | - Qiang Cai
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA, USA
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12
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He YQ, Li AQ, Sheng JQ, Yu DL, Fu KI. Complete mucosal repair after endoscopic submucosal enucleation of a gastric submucosal tumor assisted by the clip-with-line method. Endoscopy 2017; 49:E3-E4. [PMID: 28068683 DOI: 10.1055/s-0042-119037] [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: 12/10/2022]
Affiliation(s)
- Yu-Qi He
- Department of Gastroenterology, PLA Army General Hospital, Beijing, China
| | - Ai-Qin Li
- Department of Gastroenterology, PLA Army General Hospital, Beijing, China
| | - Jian-Qiu Sheng
- Department of Gastroenterology, PLA Army General Hospital, Beijing, China
| | - Dong-Liang Yu
- Department of Gastroenterology, PLA Army General Hospital, Beijing, China
| | - Kuang-I Fu
- Department of Gastroenterology, PLA Army General Hospital, Beijing, China
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Lü MH, Fu KI, Wang ZQ, Liu Y, Xia HF, Deng MM. Traction with snare during endoscopic submucosal dissection of a gastrointestinal stromal tumor in the gastric fundus. Endoscopy 2017; 48 Suppl 1:E183-5. [PMID: 27213972 DOI: 10.1055/s-0042-105644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Mu Han Lü
- Department of Gastroenterology, Affiliated Hospital of Luzhou Medical College, Luzhou, China
| | - Kuang-I Fu
- Department of Gastroenterology, Affiliated Hospital of Luzhou Medical College, Luzhou, China
| | - Zhong Qiong Wang
- Department of Gastroenterology, Affiliated Hospital of Luzhou Medical College, Luzhou, China
| | - Yong Liu
- Department of Pathology, Affiliated Hospital of Luzhou Medical College, Luzhou, China
| | - Hong Fen Xia
- Endoscopy Center, Affiliated Hospital of Luzhou Medical College, Luzhou, China
| | - Ming-Ming Deng
- Department of Gastroenterology, Affiliated Hospital of Luzhou Medical College, Luzhou, China
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14
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Tsou YK, Liu CY, Fu KI, Lin CH, Lee MS, Su MY, Ohata K, Chiu CT. Endoscopic Submucosal Dissection of Superficial Esophageal Neoplasms Is Feasible and Not Riskier for Patients with Liver Cirrhosis. Dig Dis Sci 2016; 61:3565-3571. [PMID: 27770376 PMCID: PMC5104793 DOI: 10.1007/s10620-016-4342-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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] [Received: 07/08/2016] [Accepted: 10/05/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Esophageal endoscopic submucosal dissection (ESD) has rarely been reported for the treatment of cirrhotic patients. AIM To report the results of ESD treatment of superficial esophageal neoplasms (SENs) for cirrhotic patients. METHODS Forty patients with 50 consecutive SENs undergoing 46 sessions of ESD were retrospectively reviewed. The cirrhotic group included eight patients (11 SENs) with liver cirrhosis consisting of six patients classified as Child-Pugh class A liver cirrhosis and two patients classified as class B liver cirrhosis. Four patients (6 SENs) had coexisting esophageal varices. Parameters were compared between the cirrhotic patients and the non-cirrhotic controls (32 patients, 39 SENs). RESULTS Platelet counts of the cirrhotic group were significantly lower, while international normalized ratio was significantly higher. When the cirrhotic group and non-cirrhotic group were compared, the mean tumor length (4 vs. 3.7 cm, p = 0.56) and median procedure time (15.1 vs. 11.5 min/cm2, p = 0.30) were similar. The en bloc resection rates were 81.8 and 89.7 % (p = 0.60). Within the cirrhotic group, both lesions without en bloc resection were patients with esophageal varices. The rates of submucosal disease for the cirrhotic group and non-cirrhotic groups were 54.5 and 25.6 % (p = 0.064), respectively, while the R0 resection rates were 77.8 and 94.3 % (p = 0.16), respectively. The two lesions without R0 resection in cirrhotic group had positive vertical but not horizontal margins due to submucosal invasion. Intraprocedural bleeding occurred more frequently in cirrhotic patients than non-cirrhotic patients (18.2 vs. 0 %, p = 0.045). None of the patients suffered from esophageal perforation, postoperative bleeding, or death that was related to the ESD. CONCLUSION Esophageal ESD seems to be safely and can be effectively performed on cirrhotic patients, particularly those without severe liver dysfunction.
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Affiliation(s)
- Yung-Kuan Tsou
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chia-Yuan Liu
- Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital and Department of Medicine, Mackay Medical College, New Taipei, Taiwan
| | - Kuang-I Fu
- Department of Gastroenterology, Kanma Memorial Hospital, Nasushiobara, Japan
| | - Cheng-Hui Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Mu-Shien Lee
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ming-Yao Su
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ken Ohata
- Department of Gastroenterology, NTT Medical Center Tokyo, 5-9-22 Higashi-gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan.
| | - Cheng-Tang Chiu
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
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15
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Sano Y, Tanaka S, Kudo SE, Saito S, Matsuda T, Wada Y, Fujii T, Ikematsu H, Uraoka T, Kobayashi N, Nakamura H, Hotta K, Horimatsu T, Sakamoto N, Fu KI, Tsuruta O, Kawano H, Kashida H, Takeuchi Y, Machida H, Kusaka T, Yoshida N, Hirata I, Terai T, Yamano HO, Kaneko K, Nakajima T, Sakamoto T, Yamaguchi Y, Tamai N, Nakano N, Hayashi N, Oka S, Iwatate M, Ishikawa H, Murakami Y, Yoshida S, Saito Y. Narrow-band imaging (NBI) magnifying endoscopic classification of colorectal tumors proposed by the Japan NBI Expert Team. Dig Endosc 2016; 28:526-33. [PMID: 26927367 DOI: 10.1111/den.12644] [Citation(s) in RCA: 316] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 02/17/2016] [Accepted: 02/25/2016] [Indexed: 12/11/2022]
Abstract
Many clinical studies on narrow-band imaging (NBI) magnifying endoscopy classifications advocated so far in Japan (Sano, Hiroshima, Showa, and Jikei classifications) have reported the usefulness of NBI magnifying endoscopy for qualitative and quantitative diagnosis of colorectal lesions. However, discussions at professional meetings have raised issues such as: (i) the presence of multiple terms for the same or similar findings; (ii) the necessity of including surface patterns in magnifying endoscopic classifications; and (iii) differences in the NBI findings in elevated and superficial lesions. To resolve these problems, the Japan NBI Expert Team (JNET) was constituted with the aim of establishing a universal NBI magnifying endoscopic classification for colorectal tumors (JNET classification) in 2011. Consensus was reached on this classification using the modified Delphi method, and this classification was proposed in June 2014. The JNET classification consists of four categories of vessel and surface pattern (i.e. Types 1, 2A, 2B, and 3). Types 1, 2A, 2B, and 3 are correlated with the histopathological findings of hyperplastic polyp/sessile serrated polyp (SSP), low-grade intramucosal neoplasia, high-grade intramucosal neoplasia/shallow submucosal invasive cancer, and deep submucosal invasive cancer, respectively.
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Affiliation(s)
| | | | - Shin-Ei Kudo
- Showa University, Northern Yokohama Hospital, Yokohama, Japan
| | - Shoichi Saito
- The Jikei University School of Medicine, Tokyo, Japan
| | | | | | | | | | - Toshio Uraoka
- National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | | | | | | | | | | | - Kuang-I Fu
- The First Hospital of China Medical University, Shenyang, China
| | | | | | | | - Yoji Takeuchi
- Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | | | | | | | | | | | | | | | | | | | | | - Naoto Tamai
- The Jikei University School of Medicine, Tokyo, Japan
| | | | | | - Shiro Oka
- Hiroshima University, Hiroshima, Japan
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16
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Jin P, Yu Y, Fu KI, Yu DL, Li AQ, Sheng JQ. A new traction method with use of the snare as a "second hand" during endoscopic submucosal dissection. Endoscopy 2016; 47 Suppl 1 UCTN:E286-7. [PMID: 26099096 DOI: 10.1055/s-0034-1392028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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)
- Peng Jin
- Department of Gastroenterology, Beijing Military General Hospital, Beijing, China
| | - Yang Yu
- Department of Gastroenterology, Beijing Military General Hospital, Beijing, China
| | - Kuang-I Fu
- Department of Gastroenterology, Beijing Military General Hospital, Beijing, China
| | - Dong-liang Yu
- Department of Gastroenterology, Beijing Military General Hospital, Beijing, China
| | - Ai-qin Li
- Department of Gastroenterology, Beijing Military General Hospital, Beijing, China
| | - Jian-qiu Sheng
- Department of Gastroenterology, Beijing Military General Hospital, Beijing, China
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17
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He YQ, Li AQ, Wang X, Fu KI, Sheng JQ. Endoscopic submucosal dissection of high grade intraepithelial neoplasia of the head and neck in a patient after surgical resection of esophageal cancer. Endoscopy 2016; 47 Suppl 1 UCTN:E49-50. [PMID: 25926205 DOI: 10.1055/s-0034-1365429] [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: 12/10/2022]
Affiliation(s)
- Yu-qi He
- Department of Gastroenterology, Beijing Military General Hospital, Beijing 100700, China
| | - Ai-qin Li
- Department of Gastroenterology, Beijing Military General Hospital, Beijing 100700, China
| | - Xin Wang
- Department of Gastroenterology, Beijing Military General Hospital, Beijing 100700, China
| | - Kuang-I Fu
- Department of Gastroenterology, Beijing Military General Hospital, Beijing 100700, China
| | - Jian-qiu Sheng
- Department of Gastroenterology, Beijing Military General Hospital, Beijing 100700, China
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18
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Jin P, Sheng JQ, Yu DL, Fu KI. Treating scar tissues during endoscopic submucosal dissection for gastrointestinal neoplasms. Endoscopy 2015; 46 Suppl 1 UCTN:E420. [PMID: 25314172 DOI: 10.1055/s-0034-1377439] [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: 12/10/2022]
Affiliation(s)
- Peng Jin
- Department of Gastroenterology, Beijing Military General Hospital, Beijing, China
| | - Jian-qiu Sheng
- Department of Gastroenterology, Beijing Military General Hospital, Beijing, China
| | - Dong-liang Yu
- Department of Gastroenterology, Beijing Military General Hospital, Beijing, China
| | - Kuang-I Fu
- Department of Gastroenterology, Beijing Military General Hospital, Beijing, China
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19
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Jin P, Sheng J, Li A, Fu KI. Submucosal tunnel dissection through the pyloric ring for removal of a sessile duodenal adenoma adjacent to a scar. Endoscopy 2014; 45 Suppl 2 UCTN:E303-4. [PMID: 24008478 DOI: 10.1055/s-0033-1344557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 12/13/2022]
Affiliation(s)
- P Jin
- Department of Gastroenterology, Beijing Military General Hospital, Beijing 100700, China
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20
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Hatogai K, Oono Y, Fu KI, Odagaki T, Ikematsu H, Kojima T, Yano T, Kaneko K. Unexpected endoscopic full-thickness resection of a duodenal neuroendocrine tumor. World J Gastroenterol 2013; 19:4267-4270. [PMID: 23864794 PMCID: PMC3710433 DOI: 10.3748/wjg.v19.i26.4267] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 04/03/2013] [Accepted: 04/11/2013] [Indexed: 02/06/2023] Open
Abstract
A 57-year-old man underwent endoscopy for investigation of a duodenal polyp. Endoscopy revealed a hemispheric submucosal tumor, about 5 mm in diameter, in the anterior wall of the duodenal bulb. Endoscopic biopsy disclosed a neuroendocrine tumor histologically, therefore endoscopic mucosal resection was conducted. The tumor was effectively and evenly elevated after injection of a mixture of 0.2% hyaluronic acid and glycerol at a ratio of 1:1 into the submucosal layer. A small amount of indigo-carmine dye was also added for coloration of injection fluid. The lesion was completely resected en bloc with a snare after submucosal fluid injection. Immediately, muscle-fiber-like tissues were identified in the marginal area of the resected defect above the blue-colored layer, which suggested perforation. The defect was completely closed with a total of 9 endoclips, and no symptoms associated with peritonitis appeared thereafter. Histologically, the horizontal and vertical margins of the resected specimen were free of tumor and muscularis propria was also seen in the resected specimen. Generally, endoscopic mucosal resection is considered to be theoretically successful if the mucosal defect is colored blue. The blue layer in this case, however, had been created by unplanned injection into the subserosal rather than the submucosal layer.
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21
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Konuma H, Fu KI, Konuma I, Ueyama H, Takahashi T, Ogura K, Miyazaki A, Watanabe S. Endoscopic full-thickness resection of a lateral spreading rectal tumor after unplanned injection of dilute hyaluronic acid into the subserosal layer (with video). Tech Coloproctol 2012; 16:247-50. [PMID: 22350267 DOI: 10.1007/s10151-012-0811-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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] [Received: 10/21/2011] [Accepted: 02/05/2012] [Indexed: 12/12/2022]
Abstract
A 74-year-old woman underwent colonoscopy for investigation of a liver tumor. A lateral spreading tumor of the non-granular type (LST-NG), 25 mm in diameter, was detected at the rectosigmoid junction. As magnifying image-enhanced colonoscopy suggested a tubulovillous adenoma, endoscopic mucosal resection (EMR) was chosen for removal of the LST-NG. The lesion was effectively and evenly lifted after injection of 0.4% hyaluronic acid diluted with glycerol in the ratio of 1:1. A small amount of indigo-carmine dye was also added for coloration of the plane of resection. The lesion was completely removed en bloc. Although a blue-colored layer was identified in the resection defect, a small amount of a whitish layer was detected above the blue layer. The muscle layer was clearly located on the underside of the resected polyp. A total of 14 endoclips were used to close the defect completely. The patient was successfully treated conservatively without surgery. Histology of the resected specimen showed that it contained a tubulovillous adenoma with the submucosal layer and both layers of the muscularis propria. The surgical margin was free of neoplastic change horizontally and vertically. To the best of our knowledge, this is the first case report of full-thickness resection associated with EMR after unplanned injection of dilute hyaluronic acid into the subserosal layer rather than the intended submucosal layer. We describe how to promptly recognize this complication during colonoscopy, in order to achieve immediate closure of the defect, with the identification of a "mirror target sign" on the colonic wall.
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Affiliation(s)
- H Konuma
- Department of Gastroenterology, Juntendo University Nerima Hospital, 3-1-10 Nerimatakanodai, Nerima, Tokyo, 177-8521, Japan
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Sashiyama H, Fu KI, Hamahata Y, Tsutsumi O, Hoshino T, Tsujinaka Y. Closure of a rectal perforation by clipping the margins to presacral tissue. Endoscopy 2011; 43 Suppl 2 UCTN:E81-2. [PMID: 21425020 DOI: 10.1055/s-0030-1255784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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)
- H Sashiyama
- Department of Coloproctology, Tokatsu Tsujinaka Hospital, Abiko, Chiba, Japan.
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Morimoto T, Fu KI, Konuma H, Izumi Y, Asano A, Kokubu S, Miyazaki A, Watanabe S. Endoscopic hemostasis with hemoclips for active gastric variceal bleeding. Endoscopy 2011; 42 Suppl 2:E333-4. [PMID: 21170835 DOI: 10.1055/s-0030-1255942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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)
- T Morimoto
- Department of Gastroenterology, Juntendo University Nerima Hospital, Tokyo, Japan
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Sashiyama H, Fu KI, Hoshino T, Tsujinaka Y. Education and imaging: Gastrointestinal: gastric anisakiasis presenting as a submucosal tumour diagnosed by endoscopic submucosal dissection. J Gastroenterol Hepatol 2010; 25:1806. [PMID: 21069912 DOI: 10.1111/j.1440-1746.2010.06519.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 12/09/2022]
Affiliation(s)
- H Sashiyama
- Department of Coloproctology, Tokatsu-Tsujinaka Hospital, Abiko, Chiba, Japan
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Morimoto T, Fu KI, Konuma H, Izumi Y, Matsuyama S, Ogura K, Miyazaki A, Watanabe S. Peeling a giant ileal lipoma with endoscopic unroofing and submucosal dissection. World J Gastroenterol 2010; 16:1676-9. [PMID: 20355250 PMCID: PMC2848380 DOI: 10.3748/wjg.v16.i13.1676] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Lipoma is relatively common in the colon but is less often in the small intestine. Most lipomas are incidentally detected at endoscopy and are usually small and asymptomatic. However, some of them can present with obstruction and/or intussusceptions. Surgical resection is commonly recommended to remove such significant lipomas with a limited pedicle and larger than 2 cm in size, as endoscopic resection may result in unfavorable complications such as intestinal perforations. We report a case of 62-year-old man presenting with hematochezia. Colonoscopy showed a submucosal tumor, about 50 mm in size, in the terminal ileum. A clinical diagnosis of lipoma was established based on the findings of colonoscopy and abdominal computed tomography (CT). As the patient complained of hematochezia and mild iron deficiency anemia associated with repeated tumor prolapse, we decided to remove his lipoma. Consequently, the lesion was completely removed en bloc. Although abdominal CT immediately after removal of the lesion showed a small amount of free air, conservative treatment was successfully carried out for the perforation. Histologically, the removed lesion was a lipoma.
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Ikematsu H, Matsuda T, Emura F, Saito Y, Uraoka T, Fu KI, Kaneko K, Ochiai A, Fujimori T, Sano Y. Efficacy of capillary pattern type IIIA/IIIB by magnifying narrow band imaging for estimating depth of invasion of early colorectal neoplasms. BMC Gastroenterol 2010; 10:33. [PMID: 20346170 PMCID: PMC2868042 DOI: 10.1186/1471-230x-10-33] [Citation(s) in RCA: 156] [Impact Index Per Article: 11.1] [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: 08/03/2009] [Accepted: 03/27/2010] [Indexed: 12/12/2022] Open
Abstract
Background Capillary patterns (CP) observed by magnifying Narrow Band Imaging (NBI) are useful for differentiating non-adenomatous from adenomatous colorectal polyps. However, there are few studies concerning the effectiveness of magnifying NBI for determining the depth of invasion in early colorectal neoplasms. We aimed to determine whether CP type IIIA/IIIB identified by magnifying NBI is effective for estimating the depth of invasion in early colorectal neoplasms. Methods A series of 127 consecutive patients with 130 colorectal lesions were evaluated from October 2005 to October 2007 at the National Cancer Center Hospital East, Chiba, Japan. Lesions were classified as CP type IIIA or type IIIB according to the NBI CP classification. Lesions were histopathologically evaluated. Inter and intraobserver variabilities were assessed by three colonoscopists experienced in NBI. Results There were 15 adenomas, 66 intramucosal cancers (pM) and 49 submucosal cancers (pSM): 16 pSM superficial (pSM1) and 33 pSM deep cancers (pSM2-3). Among lesions diagnosed as CP IIIA 86 out of 91 (94.5%) were adenomas, pM-ca, or pSM1; among lesions diagnosed as CP IIIB 28 out of 39 (72%) were pSM2-3. Sensitivity, specificity and diagnostic accuracy of the CP type III for differentiating pM-ca or pSM1 (<1000 μm) from pSM2-3 (≥1000 μm) were 84.8%, 88.7 % and 87.7%, respectively. Interobserver variability: κ = 0.68, 0.67, 0.72. Intraobserver agreement: κ = 0.79, 0.76, 0.75 Conclusion Identification of CP type IIIA/IIIB by magnifying NBI is useful for estimating the depth of invasion of early colorectal neoplasms.
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Affiliation(s)
- Hiroaki Ikematsu
- National Cancer Center East Hospital, Department of GI Oncology & Endoscopy, Chiba, Japan
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Kikuchi T, Fu KI, Saito Y, Uraoka T, Fukuzawa M, Fukunaga S, Sakamoto T, Nakajima T, Matsuda T. Transcutaneous monitoring of partial pressure of carbon dioxide during endoscopic submucosal dissection of early colorectal neoplasia with carbon dioxide insufflation: a prospective study. Surg Endosc 2010. [PMID: 20177925 DOI: 10.1007/s00464-010-0938-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND The authors have reported that carbon dioxide (CO(2)) insufflation is safe and effective for lengthy endoscopic submucosal dissection (ESD) with the patient under conscious sedation. However, CO(2) monitoring has not been assessed to clarify whether partial pressure of carbon dioxide (PCO(2)) increases during this type of long procedure. This study aimed to monitor CO(2) before, during, and after ESD to investigate whether CO(2) insufflation is safe for patients receiving a lengthy ESD of early colorectal neoplasia under conscious sedation. METHODS This study prospectively enrolled 35 consecutive patients who underwent ESD at the National Cancer Center Hospital. Transcutaneous PCO(2) (PtcCO(2)) was measured with a noninvasive sensor before, during, and after ESD for patients under conscious sedation using midazolam. RESULTS The mean size of removed lesions was 44 ± 22 mm (range, 15-100 mm). The operation time was 90 ± 100 min (range, 15-600 mm). The dose of midazolam was 5.7 ± 4.0 mg (range, 2-19 mg). The mean PtcCO(2) was 41 ± 5 mmHg (range, 33-53 mmHg) before ESD and 44 ± 6 mmHg (range, 32-54 mmHg) afterward. The mean peak PtcCO(2) during ESD was 55 ± 7 mmHg (range, 39-78 mmHg), which was significantly higher than before or after ESD (p < 0.0001). However, no complication associated with CO(2) insufflation such as CO(2) narcosis, gas embolism, or arrhythmia needing treatment was seen in any of the cases. CONCLUSIONS This study suggests that CO(2) insufflation is safe for patients receiving a lengthy colorectal ESD under conscious sedation.
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Affiliation(s)
- Tsuyoshi Kikuchi
- Endoscopy Division, National Cancer Center Hospital, Chuo-ku, Tokyo, 104-0045, Japan
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Bando H, Ikematsu H, Fu KI, Oono Y, Kojima T, Minashi K, Yano T, Matsuda T, Saito Y, Kaneko K, Ohtsu A. A laterally-spreading tumor in a colonic interposition treated by endoscopic submucosal dissection. World J Gastroenterol 2010; 16:392-4. [PMID: 20082488 PMCID: PMC2807963 DOI: 10.3748/wjg.v16.i3.392] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Herein we describe an early colonic carcinoma which developed in a colonic interposition 14 years after surgery for esophageal cancer, which was successfully treated by endoscopic submucosal dissection (ESD). An 80-year-old man underwent colonic interposition between the upper esophagus and stomach after surgery for an early esophageal squamous cell carcinoma in 1994. He received a surveillance endoscopy, and a laterally-spreading tumor of granular type, approximately 20 mm in size, was identified in the colonic interposition. An endoscopic biopsy revealed moderately differentiated adenocarcinoma histologically, however, we diagnosed the lesion as an intramucosal carcinoma based on the endoscopic findings. The lesion was safely and completely removed en bloc by ESD using a bipolar knife. Histologically, the lesion was an intramucosal moderately differentiated adenocarcinoma in a tubular adenoma.
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Matsuda T, Saito Y, Fujii T, Uraoka T, Nakajima T, Kobayashi N, Emura F, Ono A, Shimoda T, Ikematsu H, Fu KI, Sano Y, Fujimori T. Size does not determine the grade of malignancy of early invasive colorectal cancer. World J Gastroenterol 2009; 15:2708-13. [PMID: 19522020 PMCID: PMC2695885 DOI: 10.3748/wjg.15.2708] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To clarify the clinicopathological characteristics of small and large early invasive colorectal cancers (EI-CRCs), and to determine whether malignancy grade depends on size.
METHODS: A total of 583 consecutive EI-CRCs treated by endoscopic mucosal resection or surgery at the National Cancer Center Hospital between 1980 and 2004 were enrolled in this study. Lesions were classified into two groups based on size: small (≤ 10 mm) and large (> 10 mm). Clinicopathological features, incidence of lymph node metastasis (LNM) and risk factors for LNM, such as depth of invasion, lymphovascular invasion (LVI) and poorly differentiated adenocarcinoma (PDA) were analyzed in all resected specimens.
RESULTS: There were 120 (21%) small and 463 (79%) large lesions. Histopathological analysis of the small lesion group revealed submucosal deep cancer (sm: ≥ 1000 &mgr;m) in 90 (75%) cases, LVI in 26 (22%) cases, and PDA in 12 (10%) cases. Similarly, the large lesion group exhibited submucosal deep cancer in 380 (82%) cases, LVI in 125 (27%) cases, and PDA in 79 (17%) cases. The rate of LNM was 11.2% and 12.1% in the small and large lesion groups, respectively.
CONCLUSION: Small EI-CRC demonstrated the same aggressiveness and malignant potential as large cancer.
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Matsuda T, Fujii T, Saito Y, Nakajima T, Uraoka T, Kobayashi N, Ikehara H, Ikematsu H, Fu KI, Emura F, Ono A, Sano Y, Shimoda T, Fujimori T. Efficacy of the invasive/non-invasive pattern by magnifying chromoendoscopy to estimate the depth of invasion of early colorectal neoplasms. Am J Gastroenterol 2008; 103:2700-6. [PMID: 18853968 DOI: 10.1111/j.1572-0241.2008.02190.x] [Citation(s) in RCA: 245] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE During colonoscopy, estimation of the depth of invasion in early colorectal lesions is crucial for an adequate therapeutic management and for such task, magnifying chromoendoscopy (MCE) has been proposed as the best in vivo method. However, validation in large-scale studies is lacking. The aim of this prospective study was to clarify the effectiveness of MCE in the diagnosis of the depth of invasion of early colorectal neoplasms in a large series. METHODS A total of 4,215 neoplastic lesions were evaluated using MCE from October 1998 to September 2005 at the National Cancer Center Hospital, Tokyo, Japan. Lesions were prospectively classified according to the clinical classification of the pit pattern: invasive pattern or non-invasive pattern. All lesions were histopathologically evaluated. RESULTS There were 3,371 adenomas, 612 intramucosal cancers (m-ca), 232 submucosal cancers (sm-ca): 52 sm superficial (sm1) and 180 sm deep cancers (sm 2-3). Among lesions diagnosed as invasive pattern, 154 out of 178 (86.5%) were sm2-3, while among lesions diagnosed as non-invasive pattern, 4,011 out of 4,037 (99.4%) were adenomas, m-ca, or sm1. Sensitivity, specificity and diagnostic accuracy of the invasive pattern to differentiate m-ca or sm1 (< 1000 microm) from sm2-3 (> or = 1000 microm) were 85.6%, 99.4%, and 98.8%, respectively. CONCLUSION The determination of invasive or non-invasive pattern by MCE is a highly effective in vivo method to predict the depth of invasion of colorectal neoplasms.
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Affiliation(s)
- Takahisa Matsuda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
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Matsuda T, Saito Y, Fu KI, Uraoka T, Kobayashi N, Nakajima T, Ikehara H, Mashimo Y, Shimoda T, Murakami Y, Parra-Blanco A, Fujimori T, Saito D. Does autofluorescence imaging videoendoscopy system improve the colonoscopic polyp detection rate?--a pilot study. Am J Gastroenterol 2008; 103:1926-32. [PMID: 18647285 DOI: 10.1111/j.1572-0241.2008.01931.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [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: 12/11/2022]
Abstract
OBJECTIVES Colonoscopy is considered the gold standard for the detection of colorectal polyps; however, polyps can be missed with conventional white light (WL) colonoscopy. The aim of this pilot study was to evaluate whether a newly developed autofluorescence imaging (AFI) system can detect more colorectal polyps than WL. METHODS A modified back-to-back colonoscopy using AFI and WL was conducted for 167 patients in the right-sided colon including cecum, ascending and transverse colon by a single experienced colonoscopist. The patient was randomized to undergo the first colonoscopy with either AFI or WL (group A: AFI-WL, group B: WL-AFI). The time needed for both insertion and examination for withdrawal and all lesions detected in the right-sided colon were recorded. RESULTS Eighty-three patients were randomized to group A and 84 to group B. The total number of polyps detected by AFI and WL colonoscopy was 100 and 73, respectively. The miss rate for all polyps with AFI (30%) was significantly less than that with WL (49%) (P= 0.01). CONCLUSIONS AFI detects more polyps in the right-sided colon compared to WL colonoscopy.
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Affiliation(s)
- Takahisa Matsuda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
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Kobayashi N, Saito Y, Matsuda T, Fu KI. False-positive nonlifting sign. Gastrointest Endosc 2008; 68:408; author reply 408-9. [PMID: 18656611 DOI: 10.1016/j.gie.2008.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Accepted: 01/12/2008] [Indexed: 02/08/2023]
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Fu KI, Kato S, Sano Y, Onuma EK, Saito Y, Matsuda T, Koba I, Yoshida S, Fujii T. Staging of early colorectal cancers: magnifying colonoscopy versus endoscopic ultrasonography for estimation of depth of invasion. Dig Dis Sci 2008; 53:1886-92. [PMID: 18080834 DOI: 10.1007/s10620-007-0104-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2007] [Accepted: 10/27/2007] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Preoperative estimation of depth of invasion in early colorectal cancers (CRCs) is essential for patient management. This study was conducted to compare the diagnostic accuracies of magnifying colonoscopy and endoscopic ultrasonography (EUS) for estimating the depth of invasion of early CRCs. SUBJECTS AND METHODS A total of 438 early CRCs were removed endoscopically or surgically from July 1993 through March 1999 at our hospital. Before removal, 102 lesions were evaluated with both magnifying colonoscopy and EUS and were included in this analysis. The diagnostic accuracy of each method, referring to the histology of the resected specimens, was evaluated. RESULTS The overall diagnostic accuracies were 87% (89/102) for magnifying colonoscopy and 75% (76/102) for EUS (P = 0.0985). Subgroup analysis was also done for polypoid and non-polypoid lesions. For polypoid lesions, the overall diagnostic accuracies of magnifying colonoscopy and EUS were 88% (60/68) and 72% (49/68), (P = 0.0785), and for non-polypoid lesions, they were 85% (29/34) and 79% (27/34), (P = 0.7169). CONCLUSION Although, there is a substantial difference in the overall diagnostic accuracies, it is not statistically significant. Therefore, we conclude that magnifying colonoscopy is at least as accurate as EUS for preoperative staging of early CRCs.
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Affiliation(s)
- Kuang-I Fu
- Department of Radiology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotuga, Tochigi 321-0293, Japan.
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Fu KI, Fukui H, Tominaga K, Kaji Y, Hiraishi H, Fujimori T. Gastric ulcer penetrating into the heart. Endoscopy 2008; 38 Suppl 2:E14. [PMID: 17123210 DOI: 10.1055/s-2006-944631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Kuang-I Fu
- Department of Surgical and Molecular Pathology, Dokkyo University School of Medicine, Tochigi, Japan
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Sano Y, Fu KI, Saito Y, Doi T, Hanafusa M, Fujii S, Fujimori T, Ohtsu A. A newly developed bipolar-current needle-knife for endoscopic submucosal dissection of large colorectal tumors. Endoscopy 2008; 38 Suppl 2:E95. [PMID: 17366431 DOI: 10.1055/s-2006-944622] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Y Sano
- Division of Digestive Endoscopy and Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba, Japan
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36
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Hurlstone DP, Fu KI, Brown SR, Thomson M, Atkinson R, Tiffin N, Cross SS. EMR using dextrose solution versus sodium hyaluronate for colorectal Paris type I and 0-II lesions: a randomized endoscopist-blinded study. Endoscopy 2008; 40:110-4. [PMID: 18253905 DOI: 10.1055/s-2007-966987] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [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: 12/10/2022]
Abstract
BACKGROUND AND AIMS Loss of mucosal 'lift' prior to submucosal dissection or endoscopic mucosal resection (EMR) increases the risk of complications. We conducted a randomized controlled trial comparing dextrose solution with sodium hyaluronic acid (SHA) for the EN BLOC resection of Paris type I/0-II and lateral spreading lesions of the colorectum. PATIENTS AND METHODS Patients with Paris type I/0-II or lateral spreading tumor lesions of < 30 mm were randomized in a 1 : 1 ratio to undergo EMR using either dextrose solution or SHA. The primary study outcome was complete resection. Secondary outcomes were endoscopic complications (i. e. perforation or bleeding) and polyp recurrence rates. RESULTS A total of 174 patients were randomized. R0 resection was achieved in 59 of the 82 lesions (72 %) in the dextrose group and 56 of the 81 lesions (69 %) in the SHA group ( P > 0.1), with no significant difference in median lesion diameter ( P > 0.1). The median number of post resection surveillance colonoscopies was 3 (range 2 - 7) in the dextrose group and 4 (range 2 - 6) in the SHA group ( P = NS). The median post index EMR resection follow-up period was 20 months (range 4 - 26) in the DS group and 18 months (range 3 - 22) in the SHA group ( P = NS). Recurrence rates were 1/82 (1.21 %) in the dextrose group and 1/81 (1.23 %) in the SHA group ( P = NS). CONCLUSIONS EMR using dextrose solution is as effective as SHA in terms of resection completion, recurrence rates, and complications.
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Affiliation(s)
- D P Hurlstone
- Gastroenterology and Liver Unit at Royal Hallamshire Hospital Sheffield, UK.
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Fujii T, Ono A, Fu KI. A novel endoscopic suturing technique using a specially designed so-called "8-ring" in combination with resolution clips (with videos). Gastrointest Endosc 2007; 66:1215-20. [PMID: 17945221 DOI: 10.1016/j.gie.2007.05.054] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2006] [Accepted: 05/31/2007] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although EMR has been proven to be a safe procedure, the risk of hemorrhage and perforation increases with the size of the resected lesion. To overcome such complications, we previously reported a technique using an endoloop and metal clips to close large mucosal defects after EMR. This procedure, however, requires a 2-channel colonoscope, which is not always available. OBJECTIVES Our purpose was to demonstrate the feasibility of mucosal defect closure by using a conventional single-channel colonoscope, a specially designed figure-of-8-shaped stainless steel ring (8-ring) and resolution clips. DESIGN Pilot study. SETTING Private outpatient clinic. PATIENTS A total of 10 patients with 10 lesions underwent this procedure for closure after EMR. INTERVENTION After EMR, a Resolution clip (Boston Scientific, Natick, Mass) was placed through 1 hole of the 8-ring and then attached to normal mucosa near 1 side of the resection site. Another resolution clip was inserted through the remaining hole of the device and clipped in the normal mucosa on the other side, thus providing complete closure. To strengthen the closure, conventional endoclips were also placed. MAIN OUTCOME MEASUREMENTS Technical feasibility of endoscopic closure of the mucosal defect after EMR and complications associated with endoscopic procedures. RESULTS Mean size of resected lesion was 16.3 mm. All the defects were successfully closed without any complication such as delayed bleeding or perforation. LIMITATIONS Further study is needed to examine the maximum size of defects that can be closed with this method. CONCLUSIONS Defects after EMR can be treated successfully with this simple technique.
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Saito Y, Uraoka T, Matsuda T, Emura F, Ikehara H, Mashimo Y, Kikuchi T, Fu KI, Sano Y, Saito D. Endoscopic treatment of large superficial colorectal tumors: a case series of 200 endoscopic submucosal dissections (with video). Gastrointest Endosc 2007; 66:966-73. [PMID: 17524403 DOI: 10.1016/j.gie.2007.02.053] [Citation(s) in RCA: 295] [Impact Index Per Article: 17.4] [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] [Received: 07/10/2006] [Accepted: 02/27/2007] [Indexed: 02/08/2023]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) is accepted as a minimally invasive treatment for early gastric cancer; however, it is not widely used in the colorectum because of its technical difficulty. OBJECTIVE To determine the feasibility of using ESD for treating large superficial colorectal tumors and to evaluate the clinical outcome. DESIGN AND SETTING Case series conducted at the National Cancer Center Hospital in Tokyo. PATIENTS A total of 198 consecutive patients were treated for 200 lesions. INTERVENTIONS Procedures were performed, before July 2004, by using a monopolar needle knife or an insulation-tipped knife (IT knife). After July 2004, the procedures were performed by using a bipolar needle knife or an IT knife. After injection of glycerol and sodium hyaluronate acid into the submucosal (sm) layer, a circumferential incision was made and sm dissection was performed endoscopically. MAIN OUTCOME MEASUREMENTS The en bloc resection rate was 84% and the curative resection rate was 83%. RESULTS Among the 200 ESDs, 51 involved tubular adenomas, 99 intramucosal cancers, 22 minute sm cancers, and 28 sm deep cancers. The median operation time was 90 minutes, and the mean size of resected specimens was 38 mm (range, 20-150 mm). Perforations occurred in 10 cases (5%) and postoperative bleeding in 4 cases (2%), but only 1 perforation case needed emergency surgery, because endoscopic clipping was ineffective. LIMITATIONS No long-term outcome data yet. CONCLUSIONS ESD is a feasible technique for treating large superficial colorectal tumors, because it provides a higher en bloc resection rate and is less invasive than surgical resection.
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Affiliation(s)
- Yutaka Saito
- Division of Endoscopy, National Cancer Center Hospital, Tokyo, Japan
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39
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Parra-Blanco A, Fu KI, Nicolás-Pérez D, Gimeno-García AZ, Carrillo M, Quintero E. Is acetic acid really effective as a mucolytic agent for magnifying colonoscopy diagnosis? Endoscopy 2007; 39:920-1; author reply 923. [PMID: 17968810 DOI: 10.1055/s-2007-966846] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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40
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Taku K, Sano Y, Fu KI, Saito Y, Matsuda T, Uraoka T, Yoshino T, Yamaguchi Y, Fujita M, Hattori S, Ishikawa T, Saito D, Fujii T, Kaneko E, Yoshida S. Iatrogenic perforation associated with therapeutic colonoscopy: a multicenter study in Japan. J Gastroenterol Hepatol 2007; 22:1409-14. [PMID: 17593224 DOI: 10.1111/j.1440-1746.2007.05022.x] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.9] [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: 02/06/2023]
Abstract
BACKGROUND AND AIM Colonic perforation is the serious accidental complication. The aim of this study is to analyze the clinical presentation and management of recent iatrogenic perforations during therapeutic colonoscopy. METHODS Consecutive patients referred to four academic cancer centers in Japan were retrospectively reviewed using each center's endoscopy database of medical records. Data was obtained by means of an extensive data collection sheet. Since we evaluated the data including iatrogenic perforation during newly developed therapeutic procedure such as endoscopic submucosal dissection (ESD) or hemoclips, the collection of patient data was set from the period of the beginning of ESD technique in each hospital in this study. RESULTS The overall rate of occurrence of perforation was 0.15% (23/15, 160). Perforation rate for EMR (0.58%) showed a significantly higher rate (P < 0.0001) than that for hot biopsy and polypectomy. The rate for ESD (14%) showed a markedly higher rate (P < 0.0001) than that for other standard procedures. Of those perforations, endoscopic clipping was performed in 56.5% of the patients, and conservative treatment was successful in 100% of the patients with successful closure. Both CT scan findings and serology results (WBC, CRP) after perforation were poor predictors for need for surgery as opposed to conservative management. CONCLUSIONS Further improvements in EMR with special knife techniques are required to simply and safely remove large colorectal neoplasms, because perforation rate for ESD shows a markedly higher. Conservative management may be possible in patients who have undergone complete endoscopic clipping.
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Affiliation(s)
- Keisei Taku
- Division of Endoscopy and Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba, Japan
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41
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Kobayashi N, Saito Y, Sano Y, Uragami N, Michita T, Nasu J, Matsuda T, Fu KI, Fujii T, Fujimori T, Ishikawa T, Saito D. Determining the treatment strategy for colorectal neoplastic lesions: endoscopic assessment or the non-lifting sign for diagnosing invasion depth? Endoscopy 2007; 39:701-5. [PMID: 17661244 DOI: 10.1055/s-2007-966587] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.4] [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: 01/02/2023]
Abstract
BACKGROUND AND STUDY AIMS Assessment of the invasion depth of colorectal neoplasia is important in deciding between endoscopic and surgical resection treatment methods. Prior to attempting endoscopic resection, the lesion is lifted by submucosal injection, and a positive "non-lifting sign" is usually considered to indicate deeper submucosal infiltration. The purpose of this prospective multicenter study was to assess the predictive value of the non-lifting sign for differentiating between adenoma and early cancer (up to discrete submucosal infiltration [sm1]) and cancer with deeper infiltration (sm2). PATIENTS AND METHODS During an 11-month period, a total of 271 colorectal neoplastic lesions in 239 patients were included in the study. Apart from the location, size, and macroscopic type of the lesion, the presence or absence of the non-lifting sign was recorded and compared with the endoscopic assessment of invasion depth. RESULTS The non-lifting sign had a sensitivity of 61.5 %, a specificity of 98.4 %, a positive predictive value of 80.0 %, a negative predictive value of 96.0 %, and an accuracy of 94.8 %. Endoscopic diagnosis of deeper infiltration had a sensitivity of 84.6 %, a specificity of 98.8 %, a positive predictive value of 88.0 %, a negative predictive value of 98.4 %, and an accuracy of 97.4 %. Statistically significant differences were found in terms of sensitivity and accuracy. CONCLUSION Because of its lower sensitivity and accuracy, the non-lifting sign will not replace endoscopic assessment. If a lesion does not lift, this can make resection technically difficult, but does not reliably predict deeper cancerous invasion.
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Affiliation(s)
- N Kobayashi
- Division of Endoscopy, National Cancer Center Hospital, Tokyo, Japan.
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Horimatsu T, Fu KI, Sano Y, Yano T, Saito Y, Matsuda T, Fujimori T, Yoshida S. Acute appendicitis as a rare complication after endoscopic mucosal resection. Dig Dis Sci 2007; 52:1741-4. [PMID: 17429724 DOI: 10.1007/s10620-006-9467-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2006] [Accepted: 05/24/2006] [Indexed: 12/13/2022]
Affiliation(s)
- Takahiro Horimatsu
- Division of Gastrointestinal Oncology and Digestive Endoscopy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
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44
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Nakamura H, Fu KI, Hurlstone DP, Kaji Y, Fujimori T. Submucosal xanthachromia after endoscopic mucosal resection: laparotomy or conservative therapy? Gut 2007; 56:448-9. [PMID: 17339259 PMCID: PMC1856797 DOI: 10.1136/gut.2006.114256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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45
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Nakamura H, Fu KI, Matsumoto J, Kaji Y, Fujimori T. Polypectomy as a diagnostic tool for ileocecal lymphoma. Endoscopy 2007; 39 Suppl 1:E43. [PMID: 17285497 DOI: 10.1055/s-2006-945067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- H Nakamura
- Department of Gastroenterology , Chofu Surgical Clinic, Tokyo, Japan
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46
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Fu KI, Ishikawa T, Fujii H, Hirabayashi K, Igarashi S, Kaji Y. An ileal metastasis from a parotid gland cancer that mimicked a flat adenoma. Endoscopy 2007; 39 Suppl 1:E28. [PMID: 17285507 DOI: 10.1055/s-2006-944988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- K I Fu
- Department of Radiology, Dokkyo University School of Medicine, Mibu, Shimotuga, Tochigi, Japan.
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Ikematsu H, Fu KI, Saito Y, Matsuda T, Shimoda T, Fujii T. Ectopic gastric mucosa in the rectum mimicking an early depressed cancer treated by endoscopic mucosal resection. Endoscopy 2007; 39 Suppl 1:E171-2. [PMID: 17614073 DOI: 10.1055/s-2007-966581] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- H Ikematsu
- National Cancer Center Hospital East (NCCHE), Department of Gastrointestinal Oncology & Endoscopy, Chiba, Japan.
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48
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Fu KI, Kaji Y, Fujimori T. Magnifying colonoscopy or "ultrahigh" magnifying colonoscopy: that is the question. Gastrointest Endosc 2006; 64:1036; author reply 1036-7. [PMID: 17140931 DOI: 10.1016/j.gie.2006.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2006] [Accepted: 07/05/2006] [Indexed: 02/08/2023]
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49
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Fu KI, Kaji Y, Fukui H, Fujimori T. Adenoma or carcinoma: an important but difficult distinction. Gastroenterology 2006; 131:1361; author reply 1361-2. [PMID: 17030215 DOI: 10.1053/j.gastro.2006.08.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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50
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Fu KI, Mashimo Y, Matsuda T, Saito Y. Is endoscopic ultrasonography necessary for depth evaluation of rectal carcinoid tumors <or=10 mm? Dis Colon Rectum 2006; 49:1238-9; author reply 1239-40. [PMID: 16752204 DOI: 10.1007/s10350-006-0589-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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