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Minoda Y, Ogino H, Sumida Y, Osoegawa T, Itaba S, Hashimoto N, Esaki M, Kitagawa Y, Yodoe K, Iboshi Y, Matsuguchi T, Tadokoro M, Chaen T, Kubo H, Kubokawa M, Harada N, Nishizima K, Fujii H, Hata Y, Tanaka Y, Ihara E, Ogawa Y. Is a small-caliber or large-caliber endoscope more suitable for colonic self-expandable metallic stent placement? A randomized controlled study. Therap Adv Gastroenterol 2022; 15:17562848211065331. [PMID: 35069801 PMCID: PMC8777335 DOI: 10.1177/17562848211065331] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 11/19/2021] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES The colonic self-expandable metallic stent (C-SEMS) with a 9-French (Fr) delivery system allows for a small-caliber endoscope (SCE) to be used to treat malignant colonic obstruction. Despite the lack of evidence, the SCE has become popular because it is considered easier to insert than the large-caliber endoscope (LCE). We aimed to determine whether the SCE is more suitable than the LCE for C-SEMS placement. METHODS Between July 2018 and November 2019, 50 consecutive patients who were scheduled to undergo C-SEMS for colon obstruction were recruited in this study. Patients were randomized to the SCE or LCE group. The SCE and LCE were used with 9-Fr and 10-Fr delivery systems, respectively. The primary outcome was the total procedure time. Secondary outcomes were the technical success rate, complication rate, clinical success rate, insertion time, guidewire-passage time, stent-deployment time, and colonic obstruction-scoring-system score. RESULTS Forty-five patients (SCE group, n = 22; LCE group, n = 23) were analyzed. The procedure time in the LCE group (median, 20.5 min) was significantly (p = 0.024) shorter than that in the SCE group (median, 25.1 min). The insertion time in the LCE group (median, 2.0 min) was significantly (p = 0.0049) shorter than that in the SCE group (median, 6.0 min). A sub-analysis of the procedure difficulties showed that the insertion time in the LCE group (median, 5.0 min) was significantly shorter than that in the SCE group (median, 8.5 min). CONCLUSION Both LCE and SCE can be used for C-SEMS; however, LCE is more suitable than SCE as it achieved a faster and equally efficacious C-SEMS placement as that of SCE. CLINICAL TRIAL REGISTRATION NUMBER University Hospital Medical Information Network Clinical Trials Registry (UMIN 32748).
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Affiliation(s)
| | | | - Yorinobu Sumida
- Department of Gastroenterology, Clinical
Research Institute, National Hospital Organization Kyushu Medical Center,
Fukuoka, Japan
| | - Takashi Osoegawa
- Department of Gastroenterology, Aso Iizuka
Hospital, Iizuka, Japan
| | - Soichi Itaba
- Department of Gastroenterology, Kyushu Rosai
Hospital, Kitakyushu, Japan
| | - Norikazu Hashimoto
- Department of Gastroenterology and Hepatology,
National Hospital Organization Fukuoka Higashi Medical Center, Koga,
Japan
| | - Mitsuru Esaki
- Department of Medicine and Bioregulatory
Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka,
Japan
| | - Yusuke Kitagawa
- Department of Internal Medicine, Saiseikai
Fukuoka General Hospital, Fukuoka, Japan
| | - Kentaro Yodoe
- Department of Gastroenterology, Aso Iizuka
Hospital, Iizuka, Japan
| | - Yoichiro Iboshi
- Department of Gastroenterology, Clinical
Research Institute, National Hospital Organization Kyushu Medical Center,
Fukuoka, Japan
| | | | - Mei Tadokoro
- Department of Gastroenterology and Hepatology,
National Hospital Organization Fukuoka Higashi Medical Center, Koga,
Japan
| | - Tomohito Chaen
- Department of Internal Medicine, Saiseikai
Fukuoka General Hospital, Fukuoka, Japan
| | - Hiroaki Kubo
- Department of Internal Medicine, Social
Insurance Nakabaru Hospital, Fukuoka, Japan
| | - Masaru Kubokawa
- Department of Gastroenterology, Aso Iizuka
Hospital, Iizuka, Japan
| | - Naohiko Harada
- Department of Gastroenterology, Clinical
Research Institute, National Hospital Organization Kyushu Medical Center,
Fukuoka, Japan
| | - Kenichi Nishizima
- Department of Gastroenterology, Kyushu Rosai
Hospital, Kitakyushu, Japan
| | - Hiroyuki Fujii
- Department of Gastroenterology and Hepatology,
National Hospital Organization Fukuoka Higashi Medical Center, Koga,
Japan
| | - Yoshitaka Hata
- Department of Medicine and Bioregulatory
Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka,
Japan
| | - Yoshimasa Tanaka
- Department of Medicine and Bioregulatory
Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka,
Japan
| | | | - Yoshihiro Ogawa
- Department of Medicine and Bioregulatory
Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka,
Japan
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Kumei S, Sakurai T, So S, Itaba S, Akiho H, Nakamura S, Kim H, Yamasaki M, Takatsu N, Maekawa R, Sakemi R, Watanabe T, Shibata M, Kume K, Yoshikawa I, Takaki Y, Harada M. Impact of the Concomitant Use of Immunomodulator and a Lower Week 8 Partial Mayo Score on the Persistence of Adalimumab in Refractory Ulcerative Colitis. Intern Med 2021; 60:3849-3856. [PMID: 34121007 PMCID: PMC8758447 DOI: 10.2169/internalmedicine.7279-21] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective Real-world data of adalimumab (ADA) in the treatment of ulcerative colitis (UC) are scarce. We aimed to study the ADA response rates and predictors of response in UC treatment. Methods This observational, prospective and multi-center study assessed the clinical outcome of refractory UC patients treated with ADA who previously had an inadequate response to either conventional therapies or other anti-TNF antibodies or tacrolimus. The primary endpoint was the proportion of UC patients achieving a clinical response and remission at 8 and 52 weeks. We also evaluated the parameters which were associated with a clinical response at 8 and 52 weeks. Results A total of 35 patients were enrolled from 11 centers. The clinical responses at 8 and 52 weeks were 60.0% and 51.4%, respectively. The clinical remission rates at 8 and 52 weeks were 45.7% and 48.6%, respectively. Positive predictors for week 52 response were combination of ADA with immunomodulator (IM) (OR: 27.229; 95% CI; 1.897-390.76; p=0.015) and a week 8 lower partial Mayo score (OR: 0.406; 95% CI; 0.204-0.809; p=0.010). A receiver operation characteristic curve analysis revealed the optimal week 8 partial Mayo score to be 2.5, therefore a partial Mayo score of ≤2 was a positive predictor for the continuation of ADA. No malignancy or death occurred during this study. Conclusion ADA was effective for inducing and maintaining both a clinical response and remission in patients with refractory UC. It remains possible that the concomitant use of IM and a week 8 partial Mayo score of ≤2 may predict the long-term response of ADA.
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Affiliation(s)
- Shinsuke Kumei
- Third Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Japan
| | | | - Suketo So
- Department of Gastroenterology, Tobata Kyoritsu Hospital, Japan
| | - Soichi Itaba
- Department of Gastroenterology, Kyushu Rosai Hospital, Japan
| | - Hirotada Akiho
- Department of Gastroenterology, Kitakyushu Municipal Medical Center, Japan
| | - Shigeo Nakamura
- Department of Gastroenterology, Steel Memorial Yawata Hospital, Japan
| | - Hyonji Kim
- Department of Gastroenterology, JCHO Fukuoka Yutaka Central Hospital, Japan
| | | | - Noritaka Takatsu
- Department of Gastroenterology, Tagawa Municipal Hospital, Japan
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Japan
| | - Ryuichiro Maekawa
- Department of Gastroenterology, Tagawa Social Insurance Hospital, Japan
| | - Ryosuke Sakemi
- Department of Gastroenterology, Tobata Kyoritsu Hospital, Japan
| | - Tatsuyuki Watanabe
- Third Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Japan
| | - Michihiko Shibata
- Third Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Japan
| | - Keiichiro Kume
- Third Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Japan
| | - Ichiro Yoshikawa
- Department of Endoscopy, University of Occupational and Environmental Health, School of Medicine, Japan
| | - Yasuhiro Takaki
- Department of Gastroenterology, Ashiya Central Hospital, Japan
| | - Masaru Harada
- Third Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Japan
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Takeda T, So S, Sakurai T, Nakamura S, Yoshikawa I, Yada S, Itaba S, Yamagata H, Akiho H, Takatsu N, Wada Y, Ohtsu K, Nagahama T, Yao K. Learning Effect of Diagnosing Depth of Invasion Using Non-Extension Sign in Early Gastric Cancer. Digestion 2020; 101:191-197. [PMID: 30889600 DOI: 10.1159/000498845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 02/11/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Determining the depth of invasion is important when considering therapeutic strategies for early gastric cancer (EGC). We determined the effects of learning the non-extension sign, that is, an index of T1b2 in EGC, on identifying its depth of invasion. METHODS Endoscopic images of 40 EGC cases (20 showing positive non-extension sign on endoscopy as T1b2 and 20 showing negative non-extension sign on endoscopy as T1a-T1b1) were randomly displayed on PowerPoint. Participants read endoscopy findings (pretest) and attended a 60-min lecture on how to read the non-extension sign. Then, they read the same images using the non-extension sign as the marker (posttest). The primary endpoint was a change in accuracy rate for determining the depth of invasion before and after attending the lecture, for nonexperts (< 80%). RESULTS Among 35 endoscopists, 12 were nonexperts; their test results were used for analyses. Accuracy rates for pretest and posttest among nonexperts were 75.2 and 82.5%, respectively, showing a significant increase in the accuracy rate after learning to read the non-extension sign (p = 0.003). CONCLUSION Nonexperts' diagnostic ability to determine the depth of invasion of EGC improved by learning to read the non-extension sign. Thus, the non-extension sign is considered a simple and useful diagnostic marker.
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Affiliation(s)
- Teruyuki Takeda
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan, .,Department of Gastroenterology, Tobata Kyoritsu Hospital, Fukuoka, Japan,
| | - Suketo So
- Department of Gastroenterology, Tobata Kyoritsu Hospital, Fukuoka, Japan
| | - Toshihiro Sakurai
- Department of Gastroenterology, Ashiya Central Hospital, Fukuoka, Japan
| | - Shigeo Nakamura
- Department of Gastroenterology, Steel Memorial Yawata Hospital, Fukuoka, Japan
| | - Ichiro Yoshikawa
- Department of Endoscopy, Hospital of the University of Occupational and Environmental Health, Fukuoka, Japan
| | - Shinichiro Yada
- Department of Gastroenterology, Onga Hospital, Fukuoka, Japan
| | - Soichi Itaba
- Department of Gastroenterology, Kyushu Rosai Hospital, Fukuoka, Japan
| | - Hajime Yamagata
- Department of Gastroenterology, Kokura Medical Center, Fukuoka, Japan
| | - Hirotada Akiho
- Department of Gastroenterology, Kitakyushu Municipal Medical Center, Fukuoka, Japan
| | - Noritaka Takatsu
- Department of Gastroenterology, Tagawa Municipal Hospital, Fukuoka, Japan
| | - Yoko Wada
- Department of Gastroenterology, Wada Hospital, Oita, Japan
| | - Kensei Ohtsu
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.,Department of Gastroenterology, Tobata Kyoritsu Hospital, Fukuoka, Japan
| | - Takashi Nagahama
- Department of Endoscopy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Kenshi Yao
- Department of Endoscopy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
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Esaki M, Haraguchi K, Akahoshi K, Tomoeda N, Aso A, Itaba S, Ogino H, Kitagawa Y, Fujii H, Nakamura K, Kubokawa M, Harada N, Minoda Y, Suzuki S, Ihara E, Ogawa Y. Endoscopic mucosal resection vs endoscopic submucosal dissection for superficial non-ampullary duodenal tumors. World J Gastrointest Oncol 2020; 12:918-930. [PMID: 32879668 PMCID: PMC7443844 DOI: 10.4251/wjgo.v12.i8.918] [Citation(s) in RCA: 5] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 07/03/2020] [Accepted: 07/19/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The selection of endoscopic treatments for superficial non-ampullary duodenal epithelial tumors (SNADETs) is controversial.
AIM To compare the efficacy and safety of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) for SNADETs.
METHODS We retrospectively analyzed the data of patients with SNADETs from a database of endoscopic treatment for SNADETs, which included eight hospitals in Fukuoka, Japan, between April 2001 and October 2017. A total of 142 patients with SNADETs treated with EMR or ESD were analyzed. Propensity score matching was performed to adjust for the differences in the patient characteristics between the two groups. We analyzed the treatment outcomes, including the rates of en bloc/complete resection, procedure time, adverse event rate, hospital stay, and local or metastatic recurrence.
RESULTS Twenty-eight pairs of patients were created. The characteristics of patients between the two groups were similar after matching. The EMR group had a significantly shorter procedure time and hospital stay than those of the ESD group [median procedure time (interquartile range): 6 (3-10.75) min vs 87.5 (68.5-136.5) min, P < 0.001, hospital stay: 8 (6-10.75) d vs 11 (8.25-14.75) d, P = 0.006]. Other outcomes were not significantly different between the two groups (en bloc resection rate: 82.1% vs 92.9%, P = 0.42; complete resection rate: 71.4% vs 89.3%, P = 0.18; and adverse event rate: 3.6% vs 17.9%, P = 0.19, local recurrence rate: 3.6% vs 0%, P = 1; metastatic recurrence rate: 0% in both). Only one patient in the ESD group underwent emergency surgery owing to intraoperative perforation.
CONCLUSION EMR has significantly shorter procedure time and hospital stay than ESD, and provides acceptable curability and safety compared to ESD. Accordingly, EMR for SNADETs is associated with lower medical costs.
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Affiliation(s)
- Mitsuru Esaki
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 8128582, Japan
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo 1738610, Japan
| | - Kazuhiro Haraguchi
- Department of Gastroenterology, Hara-Sanshin Hospital, Fukuoka 8120033, Japan
| | - Kazuya Akahoshi
- Department of Gastroenterology, Aso Iizuka Hospital, Iizuka 8208502, Japan
| | - Naru Tomoeda
- Department of Gastroenterology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka 8108564, Japan
| | - Akira Aso
- Department of Gastroenterology, Kitakyushu Municipal Medical Center, Kitakyushu 8020077, Japan
| | - Soichi Itaba
- Department of Gastroenterology, Kyushu Rosai Hospital, Kitakyushu 8000296, Japan
| | - Haruei Ogino
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 8128582, Japan
| | - Yusuke Kitagawa
- Department of Internal Medicine, Saiseikai Fukuoka General Hospital, Fukuoka 8100001, Japan
| | - Hiroyuki Fujii
- Department of Gastroenterology and Hepatology, National Hospital Organization Fukuokahigashi Medical Center, Koga 81103195, Japan
| | - Kazuhiko Nakamura
- Department of Gastroenterology and Hepatology, National Hospital Organization Fukuokahigashi Medical Center, Koga 81103195, Japan
| | - Masaru Kubokawa
- Department of Gastroenterology, Aso Iizuka Hospital, Iizuka 8208502, Japan
| | - Naohiko Harada
- Department of Gastroenterology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka 8108564, Japan
| | - Yosuke Minoda
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 8128582, Japan
| | - Sho Suzuki
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo 1738610, Japan
| | - Eikichi Ihara
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 8128582, Japan
- Department of Gastroenterology and Metabolism, Graduate School of Medicine Sciences, Kyushu University, Fukuoka 8128582, Japan
| | - Yoshihiro Ogawa
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 8128582, Japan
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5
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Minoda Y, Chinen T, Osoegawa T, Itaba S, Haraguchi K, Akiho H, Aso A, Sumida Y, Komori K, Ogino H, Ihara E, Ogawa Y. Superiority of mucosal incision-assisted biopsy over ultrasound-guided fine needle aspiration biopsy in diagnosing small gastric subepithelial lesions: a propensity score matching analysis. BMC Gastroenterol 2020; 20:19. [PMID: 31964357 PMCID: PMC6975081 DOI: 10.1186/s12876-020-1170-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 07/22/2019] [Accepted: 01/13/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Gastric subepithelial lesions, including gastrointestinal stromal tumors, are often found during routine gastroscopy. While endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB) has been the gold standard for diagnosing gastric subepithelial lesions, alternative open biopsy procedures, such as mucosal incision-assisted biopsy (MIAB) has been reported useful. The aim of this study is to evaluate the efficacy of MIAB for the diagnosis of gastric SELs compared with EUS-FNAB. METHODS We retrospectively analyzed medical records of 177 consecutive patients with gastric SELs who underwent either MIAB or EUS-FNAB at five hospitals in Japan between January 2010 and January 2018. Diagnostic yield, procedural time, and adverse event rates for the two procedures were evaluated before and after propensity-score matching. RESULTS No major procedure-related adverse events were observed in either group. Both procedures yielded highly-accurate diagnoses once large enough samples were obtained; however, such successful sampling was more often accomplished by MIAB than by EUS-FNAB, especially for small SELs. As a result, MIAB provided better diagnostic yields for SELs smaller than 20-mm diameter. The diagnostic yields of both procedures were comparable for SELs larger than 20-mm diameter; however, MIAB required significantly longer procedural time (approximately 13 min) compared with EUS-FNAB. CONCLUSIONS Although MIAB required longer procedural time, it outperformed EUS-FNAB when diagnosing gastric SELs smaller than 20-mm diameter.
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Affiliation(s)
- Yosuke Minoda
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Takatoshi Chinen
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Takashi Osoegawa
- Department of Gastroenterology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Soichi Itaba
- Department of Gastroenterology, Kyushu Rosai Hospital, Fukuoka, Japan
| | | | - Hirotada Akiho
- Department of Gastroenterology, Kitakyushu Municipal Medical Center, Fukuoka, Japan
| | - Akira Aso
- Department of Gastroenterology, Kitakyushu Municipal Medical Center, Fukuoka, Japan
| | - Yorinobu Sumida
- Department of Gastroenterology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Keishi Komori
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Haruei Ogino
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Eikichi Ihara
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Yoshihiro Ogawa
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Osoegawa T, Minoda Y, Ihara E, Komori K, Aso A, Goto A, Itaba S, Ogino H, Nakamura K, Harada N, Makihara K, Tsuruta S, Yamamoto H, Ogawa Y. Mucosal incision-assisted biopsy versus endoscopic ultrasound-guided fine-needle aspiration with a rapid on-site evaluation for gastric subepithelial lesions: A randomized cross-over study. Dig Endosc 2019; 31:413-421. [PMID: 30723945 DOI: 10.1111/den.13367] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 10/06/2018] [Accepted: 01/31/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES This study aimed to compare the diagnostic yield of mucosal incision-assisted biopsy (MIAB) and endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) with a rapid on-site evaluation (ROSE) for gastric subepithelial lesions (SEL) suspected of being gastrointestinal stromal tumors (GIST) with an intraluminal growth pattern. METHODS This was a prospective randomized, cross-over multicenter study. The primary outcome was the diagnostic yield of EUS-FNA and MIAB. The secondary outcomes were the technical success rate, complication rate, procedure time and biopsy frequency. RESULTS A total of 47 patients were randomized to the MIAB group (n = 23) and EUS-FNA group (n = 24). There was no significant difference in the diagnostic yield of MIAB and EUS-FNA (91.3% vs 70.8%, P = 0.0746). The complication rates of MIAB and EUS-FNA did not differ to a statistically significant extent. The mean procedure time in the MIAB group was significantly longer than that in the EUS-FNA group (34 vs 26 min, P = 0.0011). CONCLUSIONS The diagnostic yield of MIAB was satisfactorily as high as EUS-FNA with ROSE for gastric SEL with an intraluminal growth pattern.
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Affiliation(s)
- Takashi Osoegawa
- Department of Medicine and Bioregulatory Science, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yosuke Minoda
- Department of Medicine and Bioregulatory Science, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Eikichi Ihara
- Department of Medicine and Bioregulatory Science, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keishi Komori
- Department of Medicine and Bioregulatory Science, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akira Aso
- Department of Medicine and Bioregulatory Science, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ayako Goto
- Department of Medicine and Bioregulatory Science, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Soichi Itaba
- Department of Gastroenterology, Kyushu Rosai Hospital, Fukuoka, Japan
| | - Haruei Ogino
- Department of Medicine and Bioregulatory Science, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazuhiko Nakamura
- Department of Medicine and Bioregulatory Science, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Naohiko Harada
- Department of Gastroenterology, Kyushu Medical Center, Fukuoka, Japan
| | - Kosuke Makihara
- Department of Anatomic Pathology, Kyushu Rosai Hospital, Fukuoka, Japan
| | - Shinichi Tsuruta
- Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hidetaka Yamamoto
- Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshihiro Ogawa
- Department of Medicine and Bioregulatory Science, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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7
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Nakamura K, Osada M, Goto A, Iwasa T, Takahashi S, Takizawa N, Akahoshi K, Ochiai T, Nakamura N, Akiho H, Itaba S, Harada N, Iju M, Tanaka M, Kubo H, Somada S, Ihara E, Oda Y, Ito T, Takayanagi R. Short- and long-term outcomes of endoscopic resection of rectal neuroendocrine tumours: analyses according to the WHO 2010 classification. Scand J Gastroenterol 2016; 51:448-55. [PMID: 26540372 DOI: 10.3109/00365521.2015.1107752] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Although the World Health Organisation (WHO) defined a novel classification of gastroenteropancreatic neuroendocrine tumours (NETs) in 2010, indications for endoscopic resection of rectal NETs in the guidelines were based on evidence accumulated for carcinoid tumours defined by a previous classification. This study was designed to clarify indications for endoscopic resection of rectal NETs corresponding to the new WHO classifications. MATERIAL AND METHODS One hundred-seventy rectal NETs resected endoscopically from April 2001 to March 2012 were histologically re-classified according to the WHO 2010 criteria. The clinicopathological features of these lesions were analysed, and the short- and long-term outcomes of endoscopic resection were evaluated. RESULTS Of the 170 rectal NETs, 166 were histopathologically diagnosed as NET G1 and four as NET G2. Thirty-eight tumours (22.4%) were positive for lymphovascular invasion, a percentage higher than expected. Although the curative resection rate was low (65.3%), en bloc (98.8%) and complete (85.9%) resection rates were high. Modified endoscopic mucosal resection (88.0%) and endoscopic submucosal dissection (92.2%) resulted in significantly higher complete resection rates than conventional endoscopic mucosal resection (36.4%). No patient experienced tumour recurrence, despite the low curative resection rate. CONCLUSION Despite the low curative resection rate, prognosis after endoscopic resection of rectal NETs was excellent. Prospective large-scale, long-term studies are required to determine whether NET G2 and tumours >1 cm should be included in the indication for endoscopic resection and whether tumours with lymphovascular invasion can be followed up without additional surgery.
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Affiliation(s)
- Kazuhiko Nakamura
- a Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences , Kyushu University , Higashi-Ku , Fukuoka , Japan
| | - Mikako Osada
- b Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences , Kyushu University , Higashi-Ku , Fukuoka , Japan
| | - Ayako Goto
- a Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences , Kyushu University , Higashi-Ku , Fukuoka , Japan
| | - Tsutomu Iwasa
- a Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences , Kyushu University , Higashi-Ku , Fukuoka , Japan
| | - Shunsuke Takahashi
- b Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences , Kyushu University , Higashi-Ku , Fukuoka , Japan
| | - Nobuyoshi Takizawa
- b Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences , Kyushu University , Higashi-Ku , Fukuoka , Japan
| | - Kazuya Akahoshi
- c Department of Gastroenterology , Aso Iizuka Hospital , Iizuka , Japan
| | - Toshiaki Ochiai
- d Department of Internal Medicine , Saiseikai Fukuoka General Hospital , Fukuoka , Japan
| | - Norimoto Nakamura
- e Department of Gastroenterology , Harasanshin Hospital , Hakata-Ku , Fukuoka , Japan
| | - Hirotada Akiho
- f Department of Gastroenterology , Kitakyushu Municipal Medical Center , Kokurakita-Ku , Kitakyushu , Japan
| | - Soichi Itaba
- g Department of Gastroenterology , Kyushu Rosai Hospital , Kitakyushu, Fukuoka , Japan
| | - Naohiko Harada
- h Department of Gastroenterology , National Hospital Organization Kyushu Medical Center , Chuo-Ku , Fukuoka , Japan
| | - Moritomo Iju
- i Department of Gastroenterology , Fukuoka City Hospital , Hakata-Ku , Fukuoka , Japan
| | - Munehiro Tanaka
- j Department of Gastroenterology and Hepatology , National Hospital Organization Fukuoka Higashi Medical Center , Koga , Japan
| | - Hiroaki Kubo
- k Department of Internal Medicine , Social Insurance Nakabaru Hospital , Shime-Machi , Kasuya-Gun , Japan
| | - Shinichi Somada
- l Department of Gastroenterology , National Hospital Organization Beppu Medical Center , Beppu , Oita Japan
| | - Eikichi Ihara
- a Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences , Kyushu University , Higashi-Ku , Fukuoka , Japan
| | - Yoshinao Oda
- b Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences , Kyushu University , Higashi-Ku , Fukuoka , Japan
| | - Tetsuhide Ito
- a Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences , Kyushu University , Higashi-Ku , Fukuoka , Japan
| | - Ryoichi Takayanagi
- a Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences , Kyushu University , Higashi-Ku , Fukuoka , Japan
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8
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Minoda Y, Itaba S, Kaku T, Makihara K, Matsuoka J, Murao H, Hamada T, Nakamura K. [Synchronous gastrointestinal stromal tumors of the rectum and duodenum: a case report]. Nihon Shokakibyo Gakkai Zasshi 2016; 112:1991-7. [PMID: 26537326 DOI: 10.11405/nisshoshi.112.1991] [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] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
An 85-year-old woman with anemia underwent colonoscopy, which revealed a 25-mm submucosal tumor with ulceration in the lower rectum. Histological examination of a biopsy showed that the lesion was a gastrointestinal stromal tumor (GIST). Subsequent esophagogastroduodenoscopy revealed a submucosal tumor in the duodenum, and examination of a biopsy obtained by endoscopic ultrasound-guided fine-needle aspiration also confirmed that this lesion was a GIST. The rectal lesion was surgically resected to control bleeding and was confirmed as a GIST histologically. Simultaneous development of GISTs in the rectum and duodenum is extremely rare.
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Affiliation(s)
- Yosuke Minoda
- Department of Gastroenterology, Kyushu Rosai Hospital
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9
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Matsuoka J, Itaba S, Makihara Y, Murao H, Umeno N, Minoda Y, Kaku T, Kuniyoshi M, Hamada T, Nakamura K. [Three cases of pedunculated gastric hamartomatous inverted polyps resected endoscopically]. Nihon Shokakibyo Gakkai Zasshi 2016; 112:1030-6. [PMID: 26050726 DOI: 10.11405/nisshoshi.112.1030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
We report three cases of pedunculated gastric hamartomatous inverted polyps (HIPs) that were successfully treated by endoscopic polypectomy. The first case involved an 87-year-old woman with mild anemia. Esophagogastroduodenoscopy (EGD) revealed a pedunculated, reddish polyp located at the greater curvature of the upper stomach. The second case involved a 34-year-old woman in whom a pedunculated polyp was found at the gastric fundus during routine EGD. The third patient was a 59-year-old woman with epigastric discomfort. EGD revealed a pedunculated polyp in the gastric fundus. Polypectomy was successfully performed in all three cases. Histological examination revealed that the tumors comprised submucosal proliferation of cystically dilated gastric glands and hyperplastic glands;thus, we diagnosed gastric HIPs, which are rare and typically difficult to diagnose. Gastric HIPs should be considered in the differential diagnosis of elevated gastric lesions.
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10
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Affiliation(s)
- Soichi Itaba
- Department of Gastroenterology, Kyushu Rosai Hospital, Fukuoka, Japan
| | - Toyoma Kaku
- Department of Gastroenterology, Kyushu Rosai Hospital, Fukuoka, Japan
| | - Yosuke Minoda
- Department of Gastroenterology, Kyushu Rosai Hospital, Fukuoka, Japan
| | - Hiroyuki Murao
- Department of Gastroenterology, Kyushu Rosai Hospital, Fukuoka, Japan
| | - Kazuhiko Nakamura
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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11
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Aso A, Ihara E, Osoegawa T, Nakamura K, Itaba S, Igarashi H, Ito T, Aishima S, Oda Y, Tanaka M, Takayanagi R. Key endoscopic ultrasound features of pancreatic ductal adenocarcinoma smaller than 20 mm. Scand J Gastroenterol 2014; 49:332-8. [PMID: 24417737 DOI: 10.3109/00365521.2013.878745] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [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: 02/04/2023]
Abstract
BACKGROUND AND STUDY AIMS. Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis compared with other solid pancreatic tumors. Diagnosis of PDAC in the earliest possible stage is important to improve the prognosis. Although endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has been the gold-standard modality for diagnosing pancreatic lesions, its diagnostic yield is not satisfactory for pancreatic tumors smaller than 20 mm. The purpose of this study was to determine the EUS findings that are useful for differentiating PDAC from other solid pancreatic tumors when the lesions are smaller than 20 mm. PATIENTS AND METHODS. We performed a retrospective review of 126 patients with pancreatic tumors smaller than 20 mm who had undergone EUS. According to the final pathological diagnoses, they were categorized into either the PDAC or non-PDAC group. We, then, compared the EUS findings between the two groups. RESULTS. Among the 126 patients, we diagnosed PDAC in 75 patients and non-PDAC in the remaining patients, including neuroendocrine tumor in 43 patients, intraductal papillary mucinous carcinoma in 3 patients, solid pseudopapillary neoplasm in 2 patients, and inflammatory pseudotumor in 3 patients. Of all EUS findings, three factors were significantly indicative of PDAC: an irregular tumor edge, main pancreatic duct dilation, and tumor location in the pancreatic head. The predicted probability for PDAC was 80%, 92.6%, and 74.1%, respectively. CONCLUSIONS. EUS could be a useful modality for differentiating PDAC from other solid pancreatic tumors, when the diagnostic yield of EUS-FNA is unsatisfactory, even for lesions smaller than 20 mm.
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Affiliation(s)
- Akira Aso
- Department of Medicine and Bioregulatory Science, Kyushu University, Graduate School of Medical Sciences , Fukuoka , Japan
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12
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Itaba S, Nakamura K, Aso A, Tokunaga S, Akiho H, Ihara E, Iboshi Y, Iwasa T, Akahoshi K, Ito T, Takayanagi R. Prospective, randomized, double-blind, placebo-controlled trial of ulinastatin for prevention of hyperenzymemia after double balloon endoscopy via the antegrade approach. Dig Endosc 2013; 25:421-7. [PMID: 23368820 DOI: 10.1111/den.12014] [Citation(s) in RCA: 9] [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: 05/07/2012] [Accepted: 10/30/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND Double balloon endoscopy (DBE) allows the entire small intestine to be viewed using a combination of antegrade and retrograde approaches. Acute pancreatitis is a serious complication of antegrade DBE with no effective prophylactic treatment currently available. Ulinastatin has been shown to be effective for the prevention of pancreatitis following endoscopic retrograde cholangiopancreatography. We therefore assessed the efficacy of ulinastatin for hyperenzymemia after antegrade DBE. PATIENTS AND METHODS Forty-four patients were enrolled in this prospective, randomized, double-blind, placebo-controlled trial. Patients in the ulinastatin group received 150 000 U ulinastatin by i.v. drip infusion for 2 h from the start of the procedure. Serum concentrations of pancreatic amylase and lipase were measured before and 3 and 18 h after antegrade DBE. RESULTS The study was terminated after interim analysis. Of the 44 patients, 23 were randomized to ulinastatin and 21 to placebo.The groups were similar with regard to sex ratio, age, type of endoscope, insertion time, total procedure time, number of endoscope pull-back procedures, and baseline pancreaticamylase and lipase concentrations. Post-DBE hyperenzymemia was observed in 35.0% and 47.8% of patients in the placebo and ulinastatin groups, respectively. The higher frequency of hyperenzymemia in the ulinastatin group was unexpected, but the difference was not statistically significant. One patient in the placebo group (5.0%) and none in the ulinastatin group experienced acute pancreatitis, but the difference was not statistically significant. CONCLUSION The results of this trial suggest that ulinastatin does not prevent hyperenzymemia following antegrade DBE.
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Affiliation(s)
- Soichi Itaba
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University Hospital, Kyushu University, Fukuoka, Japan
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13
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Tanaka Y, Akahoshi K, Motomura Y, Osoegawa T, Yukaya T, Ihara E, Iwao R, Komori K, Nakama N, Itaba S, Kubokawa M, Hisano T, Nakamura K. Pretherapeutic evaluation of buried bumper syndrome by endoscopic ultrasonography. Endoscopy 2012; 44 Suppl 2 UCTN:E162. [PMID: 22622722 DOI: 10.1055/s-0031-1291715] [Citation(s) in RCA: 3] [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)
- Y Tanaka
- Department of Gastroenterology, Aso Iizuka Hospital, Iizuka, Japan
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14
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Tokunaga N, Itaba S, Nakamura K, Yamada M, Okamoto R, Aso A, Igarashi H, Akiho H, Ito T, Takayanagi R, Goto A. [A case of lymph node metastasis from esophageal small-cell-type endocrine cell carcinoma diagnosed by endoscopic ultrasound-guided fine-needle aspiration]. Nihon Shokakibyo Gakkai Zasshi 2012; 109:1360-1366. [PMID: 22863959] [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: 06/01/2023]
Abstract
A 70-year-old man presented with a 0-IIc lesion in the lower esophagus. He underwent esophageal endoscopic submucosal dissection (ESD). The pathological diagnosis was squamous cell carcinoma with small cell carcinoma. The patient received chemoradiotherapy after ESD, but this was interrupted because of myelosuppression. Follow-up endoscopic ultrasonography (EUS) at 5 months after the ESD revealed paracardial lymph node swelling (17mm). He underwent EUS-guided fine-needle aspiration (FNA), and lymph node metastasis of small-cell-type endocrine cell carcinoma was diagnosed. He received VP-16 chemotherapy but died 22 months after the ESD.
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Affiliation(s)
- Noriko Tokunaga
- Department of Medicine and Bioregulatory Science, Kyushu University, Japan
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15
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Tanaka Y, Motomura Y, Akahoshi K, Iwao R, Komori K, Nakama N, Osoegawa T, Itaba S, Kubokawa M, Hisano T, Ihara E, Nakamura K, Takayanagi R. Predictive factors for colonic diverticular rebleeding: a retrospective analysis of the clinical and colonoscopic features of 111 patients. Gut Liver 2012; 6:334-8. [PMID: 22844561 PMCID: PMC3404170 DOI: 10.5009/gnl.2012.6.3.334] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 12/10/2011] [Indexed: 12/14/2022] Open
Abstract
Background/Aims Colonic diverticular bleeding can stop spontaneously or be stopped by endoscopic hemostasis. We analyzed the clinical and colonoscopic features of patients with colonic diverticular bleeding to establish the predictive factors for rebleeding. Methods A total of 111 patients (median age, 72 years) with colonic diverticular bleeding in Aso Iizuka Hospital between April 2007 and July 2010 were enrolled. Age, sex, body mass index (BMI), comorbidity, medication, location of bleeding, colonoscopic findings and hemostatic methods were analyzed retrospectively from the hospital records. Results The most common sites of bleeding were the ascending (39.6%) and sigmoid (29.7%) colon. Overt rebleeding occurred in 30 patients (27.0%). Spontaneous hemostasis was seen in 81 patients (73.0%), and endoscopic hemostatic treatment was performed in 30 patients. The BMI in the patients with colonic diverticular rebleeding was significantly higher than in patients without rebleeding. Colonoscopic findings of actively bleeding or nonbleeding visible vessels in the responsible diverticula were more frequent in the group with rebleeding. Conclusions A higher BMI and colonoscopic findings of actively bleeding or nonbleeding visible vessels can be used as predictive factors for colonic diverticular rebleeding. Patients with such findings should be carefully followed up after hemostasis of the initial colonic diverticular bleeding.
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Affiliation(s)
- Yoshimasa Tanaka
- Department of Gastroenterology, Aso Iizuka Hospital, Iizuka, Japan
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16
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Komori K, Akahoshi K, Tanaka Y, Motomura Y, Kubokawa M, Itaba S, Hisano T, Osoegawa T, Nakama N, Iwao R, Oya M, Nakamura K. Endoscopic submucosal dissection for esophageal granular cell tumor using the clutch cutter. World J Gastrointest Endosc 2012; 4:17-21. [PMID: 22267979 PMCID: PMC3262174 DOI: 10.4253/wjge.v4.i1.17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 09/01/2011] [Accepted: 01/12/2012] [Indexed: 02/05/2023] Open
Abstract
Endoscopic submucosal dissection (ESD) with a knife is a technically demanding procedure associated with a high complication rate. The shortcomings of this method are the deficiencies of fixing the knife to the target lesion, and of compressing it. These shortcomings can lead to major complications such as perforation and bleeding. To reduce the risk of complications related to ESD, we developed a new grasping type scissors forceps (Clutch Cutter®, Fujifilm, Japan) which can grasp and incise the targeted tissue using an electrosurgical current. Esophagogastroduodenoscopy on a 59-year-old Japanese man revealed a 16mm esophageal submucosal nodule with central depression. Endoscopic ultrasonography demonstrated a hypoechoic solid tumor limited to the submucosa without lymph node involvement. The histologic diagnosis of the specimen obtained by biopsy was granular cell tumor. It was safely and accurately resected without unexpected incision by ESD using the CC. No delayed hemorrhage or perforation occurred. Histological examination confirmed that the granular cell tumor was completely excised with negative resection margin.We report herein a case of esophageal granular cell tumor successfully treated by an ESD technique using the CC.
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Affiliation(s)
- Keishi Komori
- Keishi Komori, Kazuya Akahoshi, Yoshimasa Tanaka, Yasuaki Motomura, Masaru Kubokawa, Soichi Itaba, Terumasa Hisano, Takashi Osoegawa, Naotaka Nakama, Risa Iwao, Department of Gastroenterology, Aso Iizuka Hospital, 3-83, Yoshio-machi, Iizuka, Fukuoka 820-8505, Japan
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17
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Itaba S, Akahoshi K, Motomura Y, Iwao R, Tanaka Y, Komori K, Osoegawa T, Kubokawa M, Hisano T, Matono H, Oya M, Nakamura K. [A case of rectal implantation cyst diagnosed by EUS and EUS-guided FNA]. Nihon Shokakibyo Gakkai Zasshi 2011; 108:2030-2035. [PMID: 22139491] [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: 05/31/2023]
Abstract
A 73-year-old woman was referred to our hospital complaining of bloody stool. She had undergone high anterior resection with the double stapling technique for a sigmoid colon cancer 2 years prior to this admission. Colonoscopy revealed a soft submucosal tumor, 4cm in size, on the anal side of the previous anastomosis in the rectum. EUS revealed a cystic lesion located in the third and fourth layers of the rectal wall. EUS-FNA was performed, and the content of the cystic lesion was transparent mucinous liquid. Histologically, the specimen revealed PAS and Alcian blue-positive mucinous material and a small number of inflammatory cells such as foamy macrophages. Therefore, this cystic lesion was diagnosed as a rectal implantation cyst.
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Affiliation(s)
- Soichi Itaba
- Department of Gastroenterology, Aso Iizuka Hospital.
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18
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Shimizu S, Itaba S, Yada S, Takahata S, Nakashima N, Okamura K, Rerknimitr R, Akaraviputh T, Lu X, Tanaka M. Significance of telemedicine for video image transmission of endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography procedures. J Hepatobiliary Pancreat Sci 2011; 18:366-74. [PMID: 21127912 DOI: 10.1007/s00534-010-0351-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND With the rapid and marked progress in gastrointestinal endoscopy, the education of doctors in many new diagnostic and therapeutic procedures is of increasing importance. Telecommunications (telemedicine) is very useful and cost-effective for doctors' continuing exposure to advanced skills, including those needed for hepato-pancreato-biliary diseases. Nevertheless, telemedicine in endoscopy has not yet gained much popularity. We have successfully established a new system which solves the problems of conventional ones, namely poor streaming images and the need for special expensive teleconferencing equipment. METHODS The digital video transport system, free software that transforms digital video signals directly into Internet Protocol without any analog conversion, was installed on a personal computer using a network with as much as 30 Mbps per channel, thereby providing more than 200 times greater information volume than the conventional system. Kyushu University Hospital in Japan was linked internationally to worldwide academic networks, using security software to protect patients' privacy. RESULTS Of the 188 telecommunications link-ups involving 108 institutions in 23 countries performed between February 2003 and August 2009, 55 events were endoscopy-related, 19 were live demonstrations, and 36 were gastrointestinal teleconferences with interactive discussions. The frame rate of the transmitted pictures was 30/s, thus preserving smooth high-quality streaming. CONCLUSIONS This paper documents the first time that an advanced tele-endoscopy system has been established over such a wide area using academic high-volume networks, funded by the various governments, and which is now available all over the world. The benefits of a network dedicated to research and education have barely been recognized in the medical community. We believe our cutting-edge system will be a milestone in endoscopy and will improve the quality of gastrointestinal education, especially with respect to endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasonography (EUS) procedures.
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Affiliation(s)
- Shuji Shimizu
- Department of Endoscopic Diagnostics and Therapeutics, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
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19
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Itaba S, Sumida Y, Aso A, Iboshi Y, Iwasa T, Ogino H, Igarashi H, Akiho H, Nakamura K, Ito T, Takayanagi R. Endoscopic ultrasound-guided transmural drainage of inflammatory peripancreatic fluid collections with a wire-guided triple-lumen needle knife. Dig Endosc 2011; 23:269. [PMID: 21699574 DOI: 10.1111/j.1443-1661.2010.01089.x] [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: 02/08/2023]
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20
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Fujita H, Ohuchida K, Mizumoto K, Itaba S, Ito T, Nakata K, Yu J, Kayashima T, Hayashi A, Souzaki R, Tajiri T, Onimaru M, Manabe T, Ohtsuka T, Tanaka M. High EGFR mRNA expression is a prognostic factor for reduced survival in pancreatic cancer after gemcitabine-based adjuvant chemotherapy. Int J Oncol 2011; 38:629-41. [PMID: 21243324 DOI: 10.3892/ijo.2011.908] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Accepted: 12/20/2010] [Indexed: 01/12/2023] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) still presents a major therapeutic challenge and a phase III clinical trial has revealed that the combination of gemcitabine and a human epidermal growth factor receptor type I (HER1/EGFR) targeting agent presented a significant benefit compared to treatment with gemcitabine alone. The aim of this study was to investigate EGFR mRNA expression in resected PDAC tissues and its correlation with patient prognosis. We obtained formalin-fixed paraffin-embedded (FFPE) tissue samples from 88 patients with PDAC who underwent pancreatectomy, and measured EGFR mRNA levels by quantitative real-time reverse transcription-polymerase chain reaction. The high-level EGFR group had significantly shorter disease-free-survival (p=0.029) and overall-survival (p=0.014) as shown by univariate analyses, although these did not reach statistical significance, as shown by multivariate analyses. However, we found that high EGFR expression was an independent prognostic factor in patients receiving gemcitabine-based adjuvant chemotherapy (p=0.023). Furthermore, we measured EGFR mRNA levels in 20 endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) cytological specimens. Altered EGFR levels were distinguishable in microdissected neoplastic cells from EUS-FNA cytological specimens compared to those in whole cell pellets. In conclusion, quantitative analysis of EGFR mRNA expression using FFPE tissue samples and microdissected neoplastic cells from EUS-FNA cytological specimens could be useful in predicting prognosis and sensitivity to gemcitabine in PDAC patients.
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Affiliation(s)
- Hayato Fujita
- Department of Surgery and Oncology, Kyushu University, Fukuoka, Japan
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21
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Iwasa T, Nakamura K, Ogino H, Itaba S, Akiho H, Okamoto R, Iboshi Y, Aso A, Murao H, Kanayama K, Ito T, Takayanagi R. Multiple ulcers in the small and large intestines occurred during tocilizumab therapy for rheumatoid arthritis. Endoscopy 2011; 43:70-2. [PMID: 21108178 DOI: 10.1055/s-0030-1255931] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [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: 01/22/2023]
Abstract
Tocilizumab is a monoclonal antibody against human interleukin-6 receptor which blocks the binding of interleukin-6 to its receptor. Tocilizumab is effective for the treatment of inflammatory disorders including rheumatoid arthritis. We report a case of multiple ulcers in the small and large intestines, which occurred during tocilizumab therapy. A 57-year-old woman started to use tocilizumab for rheumatoid arthritis. Three months later, she complained of hematochezia. Double-balloon endoscopy revealed multiple small aphthoid ulcers in the small and large intestines. One month after the woman had recovered, she was given tocilizumab again. The woman had hematochezia and abdominal pain again 2 weeks later. Colonoscopy revealed multiple round, discrete punched-out ulcers in the terminal ileum, and vast deep ulcers from the cecum to the descending colon. Bioptic histopathology and cultivation showed non-specific findings. Six weeks after discontinuation of tocilizumab, ulcers in the small and large intestine dramatically improved, leaving ulcer scars. This disease course and the results of examination made us strongly suspect that tocilizumab induced multiple ulcers in the small and large intestines. Interleukin-6 is a pleiotropic cytokine and involved in intestinal mucosal wound healing as well as in inflammatory processes. It is possible that tocilizumab inhibited tissue repair of the intestine and caused intestinal ulcers.
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Affiliation(s)
- T Iwasa
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Japan
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22
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Itaba S, Iboshi Y, Nakamura K, Ogino H, Sumida Y, Aso A, Yoshinaga S, Akiho H, Igarashi H, Kato M, Kotoh K, Ito T, Takayanagi R. Low-frequency of bacteremia after endoscopic submucosal dissection of the stomach. Dig Endosc 2011; 23:69-72. [PMID: 21198920 DOI: 10.1111/j.1443-1661.2010.01066.x] [Citation(s) in RCA: 30] [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] [Indexed: 12/14/2022]
Abstract
BACKGROUND Mainstream therapy for early gastric cancer in Japan has now shifted from endoscopic mucosal resection (EMR) to endoscopic submucosal dissection (ESD). Although bacteremia is reported as being infrequent and transient in gastric EMR, there are no reports of it being investigated in gastric ESD. This study aimed to determine the frequency of bacteremia in gastric ESD. PATIENTS AND METHODS A prospective study, in 46 consecutive patients who underwent gastric ESD, investigated the frequency of bacteremia before and after the procedure. RESULTS The median time for the total ESD procedure was 105min (range 30-400). The median volume of the submucosal injection was 80ml (range 20-260). The mean size of the resected specimen was 40±9.7mm. Blood cultures obtained before ESD were positive in 4.4% (2/45) of cases. Bacillus subtilis and Bacillus spp. were the isolated microorganisms. Blood cultures obtained 10min after ESD were positive in 4.3% (2/46) of cases; with the same microorganisms being isolated. Blood cultures obtained 3h after ESD were all negative. No signs of sepsis were seen in the two patients with a positive blood culture 10min after ESD. CONCLUSIONS The frequency of bacteremia after gastric ESD was low and transient. ESD for gastric lesions is thought to have a low risk of infectious complications; therefore, prophylactic administration of antibiotics may not be warranted.
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Affiliation(s)
- Soichi Itaba
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Asou A, Itaba S, Kubo H, Sumida Y, Akiho H, Nakamura K, Goto A, Ito T, Takayanagi R. [A case of postoperative recurrent gastric cancer resembling esophageal achalasia diagnosed by endoscopic ultrasound-guided fine-needle aspiration]. Nihon Shokakibyo Gakkai Zasshi 2010; 107:1791-1797. [PMID: 21071896] [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: 05/30/2023]
Abstract
A 74 year-old man underwent subtotal gastrectomy for advanced gastric cancer in 2000. The histological type of the cancer was signet-ring cell carcinoma, and the clinical stage was stage II (T2, N1, M0). In June 2008 the patient was referred to our hospital complaining of dysphagia. Esophageal endoscopy revealed a circular stenosis with covered with normal mucosa between the lower esophagus and the esophago-gastric junction. Histologically, samples obtained by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) revealed signet-ring cell carcinoma. Our experience suggests that EUS-FNA was useful for the histological diagnosis of recurrence of gastric cancer.
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Affiliation(s)
- Akira Asou
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University
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24
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Kubo H, Nakamura K, Itaba S, Yoshinaga S, Kinukawa N, Sadamoto Y, Ito T, Yonemasu H, Takayanagi R. Differential diagnosis of cystic tumors of the pancreas by endoscopic ultrasonography. Endoscopy 2009; 41:684-9. [PMID: 19670136 DOI: 10.1055/s-0029-1214952] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND STUDY AIMS Generally, cystic tumors are divided into two categories: neoplastic cystic tumors and non-neoplastic cystic (NNC) tumors. Neoplastic cystic tumors include mucinous cystic neoplasm (MCN), intraductal papillary-mucinous neoplasm (IPMN), and serous cystic neoplasm (SCN). MCNs and IPMNs have the potential to progress to a malignant state, whereas SCNs are known for their almost benign behavior. Thus, in order to make management decisions, it is important to distinguish between potentially malignant (MCN and IPMN), and benign (SCN and NNC) tumors. The aim of this study was to retrospectively investigate the value of endoscopic ultrasonography (EUS) for the differential diagnosis of cystic tumors of the pancreas. PATIENTS AND METHODS A total of 76 patients with cystic tumors of the pancreas were preoperatively examined by EUS. Eight cases were MCNs, 45 were IPMNs, 13 were SCNs, and 10 were NNC tumors. The EUS findings relevant to distinguishing between potentially malignant and benign were analyzed statistically. RESULTS All patients with MCNs were female and all these tumors were located in the pancreatic body/tail. IPMN, however, occurred predominantly in men, and in the pancreatic head. Eight of 11 monolocular cystic tumors were NNC in nature. Eleven of 13 SCNs included microcystic areas within the tumors. All MCNs were round in appearance, whereas 93 % of IPMNs were not round in appearance. Mural nodules were present in 25 % of MCN and 38 % of IPMN cases. In univariate analysis, age, tumor size, locularity, the number of cystic formation, cystic component, and appearance were significant variables. In multivariate analysis, locularity and cystic component were important for differential diagnosis of potentially malignant cystic tumors. CONCLUSIONS The characteristics of cystic tumors of the pancreas revealed by EUS are useful for their differential diagnosis.
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Affiliation(s)
- H Kubo
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan.
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25
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Itaba S, Iboshi Y, Nakamura K, Kanayama K, Akiho H, Goto A, Yao T, Takayanagi R. Education and imaging. Gastrointestinal: Solitary Peutz-Jeghers-type hamartoma of the colon. J Gastroenterol Hepatol 2009; 24:498. [PMID: 19335790 DOI: 10.1111/j.1440-1746.2009.05836.x] [Citation(s) in RCA: 5] [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: 12/09/2022]
Affiliation(s)
- S Itaba
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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26
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Higuchi N, Sumida Y, Nakamura K, Itaba S, Yoshinaga S, Mizutani T, Honda K, Taki K, Murao H, Ogino H, Kanayama K, Akiho H, Goto A, Segawa Y, Yao T, Takayanagi R. Impact of double-balloon endoscopy on the diagnosis of jejunoileal involvement in primary intestinal follicular lymphomas: a case series. Endoscopy 2009; 41:175-8. [PMID: 19214900 DOI: 10.1055/s-0028-1119467] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In recent years, primary gastrointestinal follicular lymphoma has been increasingly detected in the duodenum on esophagogastroduodenoscopy (EGD). Primary gastrointestinal follicular lymphomas are frequently distributed to multiple sites in the gastrointestinal tract. Therefore, investigation into the spread of follicular lymphomas in the small bowel is important in order to determine the most appropriate treatment strategy. The performance of double-balloon endoscopy (DBE) in the diagnosis of jejunoileal follicular lymphoma lesions has not been fully evaluated. We aimed to investigate the value of DBE in addition to computed tomography (CT) and (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG-PET) in the diagnosis of jejunoileal follicular lymphoma. DBE with biopsy was performed in seven patients with primary duodenal follicular lymphoma diagnosed by EGD, in order to investigate jejunoileal involvement. Jejunoileal follicular lymphoma lesions were detected by DBE in six out of the seven patients (three in the jejunum and three in the jejunum and ileum), whereas CT and (18)F-FDG-PET failed to detect the existence of these lesions. Endoscopic findings of the jejunoileal lesions revealed multiple white nodules and white villi, which were similar to those of duodenal lesions. DBE was more useful for the diagnosis of jejunoileal involvement in primary intestinal follicular lymphoma than CT and (18)F-FDG-PET. The use of DBE will become important for determining the most appropriate treatment for gastrointestinal follicular lymphoma.
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Affiliation(s)
- N Higuchi
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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27
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Tokunaga N, Itaba S, Yoshinaga S, Murao H, Akiho H, Nakamura K, Nagai E, Goto A, Segawa Y, Takayanagi R. [A case of early recurrence with multiple liver metastases after curative operation of gastric cancer successfully treated by S-1/CDDP combination chemotherapy]. Gan To Kagaku Ryoho 2008; 35:1927-1929. [PMID: 19011345] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
A 68-year-old man underwent esophagogastroduodenoscopy (EGD) in February 2005. A type 2 advanced gastric cancer was observed on the gastric antrum. Abdominal US and CT revealed no distant metastasis. Curative distal gastrectomy with D2 lymph node dissection was therefore performed the next month. Postoperative staging was stage I B. In June 2005, he had symptoms of right hypochondralgia, general fatigue and appetite loss. An abdominal CT the next month revealed multiple liver metastases and so S-1/CDDP combination chemotherapy was initiated. After two courses of chemotherapy, marked decreases in size of the liver metastasis were recognized. However, we had to change the chemotherapy regimen because of adverse effect from the chemotherapy regime after the initial 2 courses. The patient died from tumor progression in May 2006.
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Affiliation(s)
- Noriko Tokunaga
- Dept. of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University
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28
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Affiliation(s)
- S Itaba
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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29
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Itaba S, Honda K, Nakamura K, Yoshinaga S, Higuchi N, Akiho H, Gibo J, Arita Y, Ito T, Tanaka M, Segawa Y, Iwasa T, Takayanagi R. [Case of Zollinger-Ellison syndrome diagnosed three years after ulcer perforation in the third portion of the duodenum]. Nihon Shokakibyo Gakkai Zasshi 2008; 105:705-710. [PMID: 18460860] [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: 05/26/2023]
Abstract
A 61-year-old woman was referred to our hospital for a double balloon endoscopy (DBE) examination of small intestine. She had undergone laparotomy for a perforated ulcer of the 3rd portion in the duodenum 3 years prior to this admission. Esophagogastroduodenoscopy at the previous hospital revealed multiple ulcers in the 2nd and 3rd portions in the duodenum. DBE revealed multiple ulcer scars in the proximal jejunum. Zollinger-Ellison syndrome was suspected from the distribution of the ulcers and scars. Serum gastrin was high and a selective arterial calcium injection test showed a step up of gastrin level only in the gastroduodenal artery area. We diagnosed a gastrinoma located on the ventral side of the 2nd portion of the duodenum from imaging studies. The tumor was extirpated and histologically found to be a neuroendocrine tumor in a lymph node. Serum gastrin level decreased to the normal range a day after surgery.
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Affiliation(s)
- Soichi Itaba
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University
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30
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Affiliation(s)
- S Itaba
- Department of Gastroenterology, Beppu Medical Center, Beppu, Oita, Japan
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31
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Itaba S, Sumida Y, Nakamura K, Murao H, Goto A, Kumashiro Y, Yao T, Takayanagi R. EN BLOC REMOVAL OF A GASTRIC CARCINOID TUMOR USING ENDOSCOPIC SUBMUCOSAL DISSECTION TECHNIQUES. Dig Endosc 2007. [DOI: 10.1111/j.1443-1661.2007.00757.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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32
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Itaba S, Higuchi N, Nakamura K, Sumida Y, Kashiwabara Y, Arita Y, Ito T, Migita Y, Takayanagi R. Education and Imaging. Hepatobiliary and pancreatic: spontaneous cystogastric fistula. J Gastroenterol Hepatol 2007; 22:1348. [PMID: 17688674 DOI: 10.1111/j.1440-1746.2007.05088.x] [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: 12/09/2022]
Affiliation(s)
- S Itaba
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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33
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Matsumoto M, Yoshimura R, Akiho H, Higuchi N, Kobayashi K, Matsui N, Taki K, Murao H, Ogino H, Kanayama K, Sumida Y, Mizutani T, Honda K, Yoshinaga S, Itaba S, Muta H, Harada N, Nakamura K, Takayanagi R. Gastric emptying in diabetic patients by the (13)C-octanoic acid breath test: role of insulin in gastric motility. J Gastroenterol 2007; 42:469-74. [PMID: 17671762 DOI: 10.1007/s00535-007-2031-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [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: 08/31/2006] [Accepted: 02/25/2007] [Indexed: 02/04/2023]
Abstract
BACKGROUND Impairment of gastric emptying is well recognized in patients with diabetes mellitus (DM), especially long-standing insulin-dependent diabetes mellitus (IDDM). The aim of this study was to evaluate the cause of delayed gastric emptying in DM patients. METHODS In 16 controls, 16 non-insulin-dependent diabetes mellitus (NIDDM) patients and 23 IDDM patients, gastric emptying was studied using the (13)C octanoic acid breath test. Breath samples were taken before a test meal labeled with 100 mg of (13)C octanoic acid, and at 15-min intervals over a 300-min period postprandially. RESULTS In all DM patients, the gastric emptying coefficient was lower than that in the controls (P < 0.05), and lag time and half-emptying time were significantly longer (P < 0.05). Both NIDDM and IDDM patients showed delayed (13)CO(2) excretion compared with the controls, but IDDM patients showed more delayed gastric emptying than NIDDM patients (P < 0.05). There were no significant differences in sex, HbA1c level, or the rate of neuropathy between the two groups. CONCLUSIONS IDDM patients showed delayed gastric emptying compared with NIDDM patients, and the (13)C octanoic acid breath test is useful for evaluating DM patients with delayed gastric emptying.
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Affiliation(s)
- Masahiro Matsumoto
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Fukuoka, Japan
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34
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Itaba S, Iwasa T, Sadamoto Y, Nasu T, Misawa T, Inoue K, Shimokawa H, Nakamura K, Takayanagi R. Pneumocystis pneumonia during combined therapy of infliximab, corticosteroid, and azathioprine in a patient with Crohn's disease. Dig Dis Sci 2007; 52:1438-41. [PMID: 17404870 DOI: 10.1007/s10620-006-9575-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [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: 04/04/2006] [Accepted: 08/16/2006] [Indexed: 01/06/2023]
Affiliation(s)
- Soichi Itaba
- Department of Gastroenterology, Kitakyushu Municipal Medical Center, Kitakyushu, Fukuoka, Japan
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35
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Iwasa T, Sadamoto Y, Itaba S, Nasu T, Ihara Y, Misawa T, Nakamura K. [A case of mesenteric desmoid tumor]. Nihon Shokakibyo Gakkai Zasshi 2007; 104:804-8. [PMID: 17548947] [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: 05/15/2023]
Abstract
A 53-year-old man was admitted hospital because of frequent vomiting and poor digestion. Abdominal computed tomography showed a tumor, about 5 cm in diameter at the duodeno-jejunal junction. A barium contrast duodeno-small bowel series revealed stenosis in the therd portion, where push enteroscopy could not pass with normal mucosa. The preoperative diagnosis was submucosal or mesenteric tumor. Open surgery was performed. The tumor derived from the mesenterium and involved the anal side of the small intestine. The tumor was removed with partial excision of the upper jejunum. The diagnosis of mesenteric desmoid tumor was confirmed, histologically.
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Affiliation(s)
- Tsutomu Iwasa
- Department of Gastroenterology, Kitakyushu Municipal Medical Center
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36
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Honda K, Mizutani T, Higuchi N, Kanayama K, Sumida Y, Yoshinaga S, Itaba S, Akiho H, Yoshimura R, Nakamura K, Ueki T, Miyasaka Y, Takayanagi R. A Meckel's diverticulum with an ileal ulcer detected with double-balloon enteroscopy. Endoscopy 2007; 39 Suppl 1:E160. [PMID: 17570100 DOI: 10.1055/s-2006-925379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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 Honda
- Dept. of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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37
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Itaba S, Yoshinaga S, Nakamura K, Mizutani T, Honda K, Takayanagi R, Yamada K. Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of peripancreatic tuberculous lymphadenitis. J Gastroenterol 2007; 42:83-6. [PMID: 17322998 DOI: 10.1007/s00535-006-1913-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [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: 07/11/2006] [Accepted: 09/12/2006] [Indexed: 02/04/2023]
Abstract
The percentage of patients with atypical extrapulmonary forms of tuberculosis has been increasing. Among extrapulmonary tuberculosis cases, tuberculosis of the pancreas and peripancreatic lymph nodes is a rare clinical entity. Here, we present a case of peripancreatic tuberculous lymphadenitis diagnosed by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) both cytologically and microbiologically. A 23-year-old man had a 1-week history of epigastralgia and low-grade fever. Subsequently, he was found to have an abnormality on abdominal ultrasound. A computed tomography scan of the abdomen showed a solitary mass consisting of multiple cystic components with rim enhancement in the peripancreatic portion contiguous to the gall bladder. Endoscopic ultrasound-guided fine-needle aspiration was performed to confirm the diagnosis. The cytological examination revealed epithelioid cells with caseous necrosis, indicating tuberculosis. The aspirated fluid was positive by polymerase chain reaction (PCR) analysis and culture for Mycobacterium tuberculosis. Antituberculosis therapy with isoniazid, rifampicin, ethambutol, and pyrazinamide was started based on the PCR and cytology results, and a good response to the treatment was noted. Endoscopic ultrasound-guided fine-needle aspiration cytology with PCR analysis is very useful for the diagnosis of peripancreatic tuberculosis.
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Affiliation(s)
- Soichi Itaba
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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38
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Honda K, Itaba S, Mizutani T, Sumida Y, Kanayama K, Higuchi N, Yoshinaga S, Akiho H, Kawabe K, Arita Y, Ito T, Nakamura K, Takayanagi R. An increase in the serum amylase level in patients after peroral double-balloon enteroscopy: an association with the development of pancreatitis. Endoscopy 2006; 38:1040-3. [PMID: 17058172 DOI: 10.1055/s-2006-944831] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [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 STUDY AIMS Double-balloon enteroscopy (DBE) is a novel technique that allows the enteroscope to be inserted deep into the small intestine. The procedure has been thought to be safe, but cases of acute pancreatitis after peroral DBE have recently been observed. The aim of this study was to confirm the occurrence of hyperamylasemia after peroral DBE. PATIENTS AND METHODS Peroral DBE was carried out in 13 patients from July 2005 to February 2006. Blood samples were taken before and 3 h after the procedure, and serum pancreatic amylase levels were measured. The patients were also evaluated for pancreatic-type abdominal pain after the procedure. Hyperamylasemia after peroral DBE was defined as an elevation of the serum pancreatic amylase level to more than the upper normal limit and twice the level before the procedure. Pancreatitis was diagnosed on the basis of both pancreatic-type abdominal pain and hyperamylasemia. RESULTS Hyperamylasemia after peroral DBE occurred in six patients (46.2 %). One of the six patients with hyperamylasemia had pancreatic-type abdominal pain after the procedure and developed acute pancreatitis. The average procedure time was 105 min (range 65 - 155 min) in the patients with hyperamylasemia, and did not significantly differ from that in the group without hyperamylasemia (99 min). CONCLUSIONS Hyperamylasemia after peroral DBE occurs frequently and may be associated with development of pancreatitis.
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Affiliation(s)
- K Honda
- Dept. of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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39
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Itaba S, Iwasa T, Sadamoto Y, Nasu T, Misawa T, Nakamura K. An unusual duodenal polyp: pedunculated Brunner's glands hyperplasia. Gastrointest Endosc 2006; 63:1070-1; discussion 1071. [PMID: 16733132 DOI: 10.1016/j.gie.2005.11.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 08/30/2005] [Accepted: 11/11/2005] [Indexed: 02/08/2023]
Affiliation(s)
- Soichi Itaba
- Department of Gastroenterology, Kitakyushu Municipal Medical Center, Kitakyushu City, Japan
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40
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Honda K, Mizutani T, Nakamura K, Higuchi N, Kanayama K, Sumida Y, Yoshinaga S, Itaba S, Akiho H, Kawabe K, Arita Y, Ito T. Acute pancreatitis associated with peroral double-balloon enteroscopy: A case report. World J Gastroenterol 2006; 12:1802-4. [PMID: 16586559 PMCID: PMC4124365 DOI: 10.3748/wjg.v12.i11.1802] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [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] [Indexed: 02/06/2023] Open
Abstract
A 58-year-old Japanese man had tarry stool and severe anemia. Neither upper nor lower gastrointestinal (GI) endoscopy showed any localized lesions. Thus, the source of his GI bleeding was suspected to be in the small intestine, and he underwent peroral double-balloon enteroscopy (DBE) using EN-450T5 (Fujinon-Toshiba ES System Co., Tokyo, Japan). There were no lesions considered to be the source of GI bleeding. After the procedure, the patient began to experience abdominal pain. Laboratory tests revealed hyperamylasemia and abdominal computed tomography revealed an inflammation of the pancreas and the peripancreas. He was thus diagnosed to have acute pancreatitis. Conservative treatments resulted in both clinical and laboratory amelioration. He had no history of alcohol ingestion, gallstone disease or pancreatitis. Magnetic resonance cholangiopancreatography demonstrated no structural alterations and no stones in the pancreatobiliary ductal system. As his abdominal pain started after the procedure, his acute pancreatitis was thus thought to have been related to the peroral DBE. This is the first reported case of acute pancreatitis probably associated with peroral DBE.
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Affiliation(s)
- Kuniomi Honda
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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41
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Itaba S, Chijiiwa Y, Matsuzaka H, Motomura Y, Nawata H. Presence of C-type natriuretic peptide (CNP) in guinea pig caecum: role and mechanisms of CNP in circular smooth muscle relaxation. Neurogastroenterol Motil 2004; 16:375-82. [PMID: 15198660 DOI: 10.1111/j.1365-2982.2004.00506.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [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: 12/12/2022]
Abstract
The distribution and role of C-type natriuretic peptide (CNP) in the gastrointestinal tract are still unclear. This study was designed to investigate the distribution of CNP in guinea pig caecum and the inhibitory mechanisms of CNP in caecal circular smooth muscle cells. CNP immunoreactivity was recognized in smooth muscle cells, myenteric and submucosal neurons of the caecum by immunohistochemistry. CNP mRNA expression was demonstrated in both freshly dispersed and cultured smooth muscle cells by reverse-transcription polymerase chain reaction. CNP inhibited 1 nmol L(-1) cholecystokinin octapeptide (CCK-8)-induced smooth muscle cell contraction in a dose-dependent manner, with an IC(50) value of 0.24 nmol L(-1), and significantly stimulated the production of intracellular cyclic guanosine monophosphate. Furthermore, inhibitors of both soluble and particulate guanylate cyclase (GC) partially but significantly inhibited CNP-induced relaxation. This is the first report demonstrating that CNP localizes in gastrointestinal smooth muscle cells and the enteric nervous system. These results suggest that CNP acts locally through neural and autocrine pathways to modulate colonic motility via both particulate and soluble GC systems. These two pathways appear to be through natriuretic peptide receptor (NPR)-B, which has particulate GC domain, and NPR-C, which activates soluble GC, judging from previous findings that NPR-A is not expressed in these cells.
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Affiliation(s)
- S Itaba
- Department of Molecular Genetics, Division of Molecular and Clinical Genetics, Medical Institute of Bioregulation, Kyushu University, Beppu 874-0838, Japan.
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42
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Sadamoto Y, Koujima M, Itaba S, Miyagi Y, Imamura M, Motosato K, Sato T, Inoue Y, Siomichi S, Amagase Y. [A case of advanced hepatocellular carcinoma with lung and bone metastases effectively treated by orally administered UFT]. Gan To Kagaku Ryoho 2000; 27:471-3. [PMID: 10740643] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
A 52-year-old male underwent hepatic subsegmentectomy for hepatocellular carcinoma (HCC). Five months later, a recurrent tumor was found in the liver and transcatheter arterial embolization (TAE) was performed. However, recurrent tumors were growing rapidly with multiple lung and bone metastases. The titer of serum AFP was elevated to 896,095 ng/ml and the titer of serum PIVKA-II was elevated to 1294.5 AU/ml. The patient was treated by oral administration of UFT (600 mg/day). Two weeks later, his general condition was improved, and several months later, the liver tumor, multiple lung metastases and multiple bone metastases had almost disappeared. The titers of serum AFP and PIVKA-II were reduced to the normal range. He has maintained a good state of health for about four years now. This case suggests the clinical usefulness of UFT for advanced HCC.
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Affiliation(s)
- Y Sadamoto
- Dept. of Internal Medicine, Kokura National Hospital
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Itaba S, Akahoshi K, Araki Y, Nakamura K, Chijiiwa Y, Ohata Y, Shimura H, Nawata H. Preoperative colonoscopic diagnosis of minute appendicular adenoma: report of a case. Endoscopy 1998; 30:S64. [PMID: 9693915 DOI: 10.1055/s-2007-1001331] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 02/08/2023]
Affiliation(s)
- S Itaba
- Third Dept. of Internal Medicine, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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