283 results on '"Kohei Takizawa"'
Search Results
2. Biliary obstruction and pancreatitis after duodenal stent placement in the descending duodenum: a retrospective study
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Junichi Kaneko, Hirotoshi Ishiwatari, Koiku Asakura, Tatsunori Satoh, Junya Sato, Kazuma Ishikawa, Hiroyuki Matsubayashi, Yohei Yabuuchi, Yoshihiro Kishida, Masao Yoshida, Sayo Ito, Noboru Kawata, Kenichiro Imai, Kohei Takizawa, Kinichi Hotta, and Hiroyuki Ono
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Gastric outlet obstruction ,Self-expandable metallic stent ,Duodenal stent ,Biliary obstruction ,Pancreatitis ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Abstract Background Metallic stents placed in the descending duodenum can cause compression of the major duodenal papilla, resulting in biliary obstruction and pancreatitis. These are notable early adverse events of duodenal stent placement; however, they have been rarely examined. This study aimed to assess the incidence of and risk factors for biliary obstruction and/or pancreatitis after duodenal stent placement in the descending duodenum. Methods We retrospectively reviewed data of consecutive patients who underwent metallic stent placement in the descending duodenum for malignant gastric outlet obstruction at a tertiary referral cancer center between April 2014 and December 2019. Risk factors for biliary obstruction and/or pancreatitis were analyzed using a logistic regression model. Results Sixty-five patients were included. Biliary obstruction and/or pancreatitis occurred in 12 patients (18%): 8 with biliary obstruction, 2 with pancreatitis, and 2 with both biliary obstruction and pancreatitis. Multivariate analysis indicated that female sex (odds ratio: 9.2, 95% confidence interval: 1.4–58.6, P = 0.02), absence of biliary stents (odds ratio: 12.9, 95% confidence interval: 1.8–90.2, P = 0.01), and tumor invasion to the major duodenal papilla (odds ratio: 25.8, 95% confidence interval: 2.0–340.0, P = 0.01) were significant independent risk factors for biliary obstruction and/or pancreatitis. Conclusions The incidence of biliary obstruction and/or pancreatitis after duodenal stent placement in the descending duodenum was non-negligible. Female sex, absence of biliary stents, and tumor invasion to the major duodenal papilla were the primary risk factors. Risk stratification can allow endoscopists to better identify patients at significant risk and permit detailed informed consent.
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- 2022
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3. Current Treatment Strategy for Superficial Nonampullary Duodenal Epithelial Tumors
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Tetsuya Suwa, Kohei Takizawa, Noboru Kawata, Masao Yoshida, Yohei Yabuuchi, Yoichi Yamamoto, and Hiroyuki Ono
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cold snare polypectomy ,duodenal tumor ,endoscopic resection ,superficial nonampullary duodenal epithelial tumors ,underwater endoscopic mucosal resection ,Internal medicine ,RC31-1245 ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Endoscopic submucosal dissection (ESD) is the standard treatment method for esophageal, gastric, and colorectal cancers. However, it has not been standardized for duodenal lesions because of its high complication rates. Recently, minimally invasive and simple methods such as cold snare polypectomy and underwater endoscopic mucosal resection have been utilized more for superficial nonampullary duodenal epithelial tumors (SNADETs). Although the rate of complications associated with duodenal ESD has been gradually decreasing because of technical advancements, performing ESD for all SNADETs is unnecessary. As such, the appropriate treatment plan for SNADETs should be chosen according to the lesion type, patient condition, and endoscopist’s skill.
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- 2022
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4. Field Effect of Alcohol, Cigarette Smoking, and Their Cessation on the Development of Multiple Dysplastic Lesions and Squamous Cell Carcinoma: A Long-term Multicenter Cohort Study
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Manabu Muto, Chikatoshi Katada, Tetsuji Yokoyama, Tomonori Yano, Ichiro Oda, Yasumasa Ezoe, Satoshi Tanabe, Yuichi Shimizu, Hisashi Doyama, Tomoyuki Koike, Kohei Takizawa, Motohiro Hirao, Hiroyuki Okada, Takashi Ogata, Atsushi Katagiri, Takenori Yamanouchi, Yasumasa Matsuo, Hirofumi Kawakubo, Tai Omori, Nozomu Kobayashi, Tadakazu Shimoda, Atsushi Ochiai, Hideki Ishikawa, Kiichiro Baba, Yusuke Amanuna, Akira Yokoyama, Shinya Ohashi, Kazuhiro Kaneko, Shuko Morita, Makiko Funakoshi, Takahiro Horimatsu, Mari Takahashi, Haruhisa Suzuki, Satoshi Abiko, Kenichi Takemura, Hiroyoshi Nakanishi, Masahiro Saito, Nobuyuki Ara, Naomi Kakushima, Masaki Tanaka, Keisuke Hori, and Takashi Tsuda
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Field Cancerization ,Risk Reduction ,Esophageal Cancer ,Cessation of Alcohol Drinking ,Cessation of Cigarette Smoking ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background and Aims: Multiple developments of squamous dysplasia and squamous cell carcinoma (SCC) in the upper aerodigestive tract have been explained by field cancerization phenomenon and were associated with alcohol and cigarette use. Second primary SCC development after curative treatment impairs patients’ quality of life and survival; however, how these consumption and cessation affect field cancerization is still unknown. Methods: This is a multicenter cohort study including 331 patients with superficial esophageal SCC (ESCC) treated endoscopically and pooled data from 1022 healthy subjects for comparison. Physiological condition in the background esophageal mucosa was classified into 3 groups based on the number of Lugol-voiding lesions (LVLs) per endoscopic view: grade A, 0; grade B, 1–9; or grade C, ≥10 LVLs. Lifestyle surveys were conducted using a self-administered questionnaire. Patients were counseled on the need for alcohol and smoking cessation by physicians and were endoscopically surveyed every 6 months. Results: LVL grades were positively associated with alcohol drinking intensity, flushing reactions, smoking, and high-temperature food and were negatively associated with eating green and yellow vegetables and fruit. Second primary ESCC and head/neck SCC were significantly more prevalent in the grade C LVL (cumulative 5-y incidences 47.1%, 95% confidence interval [CI] = 38.0–57.2 and 13.3%, 95% CI = 8.1–21.5, respectively). Alcohol and smoking cessation significantly reduced the development of second primary ESCC (adjusted hazard ratios 0.47, 95% = CI 0.26–0.85 and 0.49, 95% CI = 0.26–0.91, respectively). Conclusion: Alcohol drinking, smoking, flushing reaction, and high-temperature food were closely associated with field cancerization, and cessation of alcohol and smoking significantly reduced the risk of development of second primary cancer. UMIN Clinical Trials Registry ID:UMIN000001676.
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- 2022
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5. Present Status of Endoscopic Submucosal Dissection for Non-Ampullary Duodenal Epithelial Tumors
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Naomi Kakushima, Masao Yoshida, Yohei Yabuuchi, Noboru Kawata, Kohei Takizawa, Yoshihiro Kishida, Sayo Ito, Kenichiro Imai, Kinichi Hotta, Hirotoshi Ishiwatari, Hiroyuki Matsubayashi, and Hiroyuki Ono
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endoscopic mucosal resection ,endoscopic submucosal dissection ,laparoscopic endoscopic cooperative surgery ,nonampullary duodenal epithelial tumors ,Internal medicine ,RC31-1245 ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Prediction of histology by endoscopic examination is important in the clinical management of non-ampullary duodenal epithelial tumors (NADETs), including adenoma and adenocarcinoma. The use of a simple scoring system based on the findings of white-light endoscopy or magnified endoscopy with narrow-band imaging is useful to differentiate between Vienna category 3 (C3) and C4/5 lesions. Less invasive endoscopic resection procedures, such as cold snare polypectomy, are quick to perform and convenient for small (
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- 2020
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6. A novel, simple, and dedicated device for endoscopic mucosal defect closure
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Yohei Nose, Kohei Takizawa, Kazuo Shiotsuki, Tsuyoshi Yamaguchi, Masaomi Agatsuma, Shun Nitta, Kotaro Yamashita, Takuro Saito, Koji Tanaka, Kazuyoshi Yamamoto, Tomoki Makino, Tsuyoshi Takahashi, Yukinori Kurokawa, Hidetoshi Eguchi, Yuichiro Doki, and Kiyokazu Nakajima
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device development ,endoscopic submucosal dissection ,mucosal defect closure ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Abstract Objectives Endoscopic submucosal dissection (ESD) has become popular, but complications such as postoperative bleeding remain an issue. Although some methods of closing a mucosal defect with a snare and clips have been reported to be effective and safe, the snare is not a dedicated device, and the procedure is difficult and time‐consuming. We aimed to find an alternative method for defect closure after ESD by developing a dedicated device. Methods We have improved five prototypes. The load on the stopper when starting to tighten and loosen a loop and the maximum load on the stopper and the movement distance of the thread when sliding the stopper were measured five times for each prototype. With the 5th prototype, we finalized the design and named it FLEXLOOP. Additionally, the material and shape of the outer tube were improved. Then, the usability of FLEXLOOP was evaluated in pigs. The operation time for closing mucosal defects with the snare or FLEXLOOP was measured five times. Results We made FLEXLOOP, which had a lower load when sliding and a higher load when loosening than the snare. The improvement of the outer tube significantly reduced the load on the sheath when sliding it. We confirmed the feasibility of mucosal defect closure with FLEXLOOP in pigs. The median operation time was 563 s (range 340–679 s) with the snare and 355 s (range 303–455 s) with FLEXLOOP (p = 0.047). Conclusions FLEXLOOP can be a promising option for defect closure after ESD.
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- 2022
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7. Comparison of the Diagnostic Yield of the Standard 22-Gauge Needle and the New 20-Gauge Forward-Bevel Core Biopsy Needle for Endoscopic Ultrasound-Guided Tissue Acquisition from Pancreatic Lesions
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Shinya Fujie, Hirotoshi Ishiwatari, Keiko Sasaki, Junya Sato, Hiroyuki Matsubayashi, Masao Yoshida, Sayo Ito, Noboru Kawata, Kenichiro Imai, Naomi Kakushima, Kohei Takizawa, Kinichi Hotta, and Hiroyuki Ono
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core biopsy needle ,diagnostic yield ,endoscopic ultrasound-guided fine needle aspiration ,biopsy ,fine-needle ,pancreas ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background/Aims To compare the diagnostic yield of 20-gauge forward-bevel core biopsy needle (CBN) and 22-gauge needle for endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) of solid pancreatic masses. Methods : The use of 20-gauge CBN was prospectively evaluated for 50 patients who underwent EUS-FNA from June 2016 to December 2016. Data were compared with those obtained by a retrospective study of 50 consecutive patients who underwent EUS-FNA using standard 22-gauge needles between December 2016 and April 2017. At least two punctures were performed for each patient; the sample from the first pass was used for cytology with or without histology and that from the second pass was used for histology. Sample quantity was evaluated using the sample obtained from the second pass. Results : There was no significant difference in the diagnostic accuracy rate between the first and second passes (20-gauge CBN: 96% [48/50]; standard 22-gauge needle: 88% [44/50]). Samples >10× power fields in length were obtained from 90% (43/48) and 60% (30/50) of patients using the 20-gauge CBN and standard 22-gauge needle, respectively (p=0.01). Technical failure occurred for two patients with the 20-gauge CBN. Conclusion : s Diagnostic accuracy of the 20-gauge CBN was comparable to that of the 22-gauge needle. However, two passes with the 20-gauge CBN yielded a correct diagnosis for 100% of patients when technically feasible. Moreover, the 20-gauge CBN yielded core tissue for 90% patients, which was a performance superior to that of the 22-gauge needle.
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- 2019
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8. Metabolic Profiling of Human Gastric Cancer Cells Treated With Salazosulfapyridine
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Kohei Takizawa MD, Koji Muramatsu PA, Kouji Maruyama PhD, Kenichi Urakami MD, PhD, Takashi Sugino MD, PhD, Masatoshi Kusuhara MD, PhD, Ken Yamaguchi MD, PhD, Hiroyuki Ono MD, PhD, and Yuko Kitagawa MD, PhD
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Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Purpose: The adhesion molecule cluster of differentiation 44v9 interacts with and stabilizes the cystine/glutamate exchanger protein, which functions as a transporter of cystine. Stabilized cystine/glutamate exchanger increases extracellular cystine uptake and enhances glutathione production. Augmented levels of reduced glutathione mitigate reactive oxygen species and protect cancer cells from apoptosis. Salazosulfapyridine blocks cystine/glutamate exchanger activity and mitigates the supply of cystine to increase intracellular ROS production, thereby increasing cell susceptibility to apoptosis. This enhances the effect of anticancer drugs such as cisplatin. Currently, salazosulfapyridine is being developed as a promising anticancer agent. In the present study, we elucidated the molecular mechanism associated with salazosulfapyridine by investigating the salazosulfapyridine-induced changes in glutathione metabolism in cultured gastric cancer cell lines. Methods: The effect of salazosulfapyridine treatment on glutathione metabolism was investigated in 4 gastric cancer (AGS, MKN1, MKN45, and MKN74) and 2 colorectal cancer (HCT15 and HCT116) cell lines using metabolomic analyses. In addition, the effect of inhibition of the reduced form of nicotinamide adenine dinucleotide phosphate by 2-deoxyglucose on glutathione metabolism was evaluated. Results: Under hypoxia, enhanced glycolysis resulted in lactate accumulation with an associated reduction in nicotinamide adenine dinucleotide phosphate. Salazosulfapyridine treatment decreased the cysteine content and inhibited the formation of glutathione. Combined treatment with salazosulfapyridine and 2-deoxyglucose significantly inhibited cell proliferation. 2-Deoxyglucose, an inhibitor of glycolysis, depleted nicotinamide adenine dinucleotide phosphate required for the formation of glutathione. Conclusions: Our results indicate that in cancer cells having a predominant glycolytic pathway, metabolomic analyses under hypoxic conditions enable the profiling of global metabolism. In addition, inhibiting the supply of nicotinamide adenine dinucleotide phosphate by blocking glycolysis is a potential treatment strategy for cancer, in addition to cystine blockade by salazosulfapyridine.
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- 2020
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9. Steroid Therapy and Steroid Response in Autoimmune Pancreatitis
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Hiroyuki Matsubayashi, Hirotoshi Ishiwatari, Kenichiro Imai, Yoshihiro Kishida, Sayo Ito, Kinichi Hotta, Yohei Yabuuchi, Masao Yoshida, Naomi Kakushima, Kohei Takizawa, Noboru Kawata, and Hiroyuki Ono
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autoimmune pancreatitis ,igg4 ,corticosteroid ,treatment ,Biology (General) ,QH301-705.5 ,Chemistry ,QD1-999 - Abstract
Autoimmune pancreatitis (AIP), a unique subtype of pancreatitis, is often accompanied by systemic inflammatory disorders. AIP is classified into two distinct subtypes on the basis of the histological subtype: immunoglobulin G4 (IgG4)-related lymphoplasmacytic sclerosing pancreatitis (type 1) and idiopathic duct-centric pancreatitis (type 2). Type 1 AIP is often accompanied by systemic lesions, biliary strictures, hepatic inflammatory pseudotumors, interstitial pneumonia and nephritis, dacryoadenitis, and sialadenitis. Type 2 AIP is associated with inflammatory bowel diseases in approximately 30% of cases. Standard therapy for AIP is oral corticosteroid administration. Steroid treatment is generally indicated for symptomatic cases and is exceptionally applied for cases with diagnostic difficulty (diagnostic steroid trial) after a negative workup for malignancy. More than 90% of patients respond to steroid treatment within 1 month, and most within 2 weeks. The steroid response can be confirmed on clinical images (computed tomography, ultrasonography, endoscopic ultrasonography, magnetic resonance imaging, and 18F-fluorodeoxyglucose-positron emission tomography). Hence, the steroid response is included as an optional diagnostic item of AIP. Steroid treatment results in normalization of serological markers, including IgG4. Short- and long-term corticosteroid treatment may induce adverse events, including chronic glycometabolism, obesity, an immunocompromised status against infection, cataracts, glaucoma, osteoporosis, and myopathy. AIP is common in old age and is often associated with diabetes mellitus (33−78%). Thus, there is an argument for corticosteroid therapy in diabetes patients with no symptoms. With low-dose steroid treatment or treatment withdrawal, there is a high incidence of AIP recurrence (24−52%). Therefore, there is a need for long-term steroid maintenance therapy and/or steroid-sparing agents (immunomodulators and rituximab). Corticosteroids play a critical role in the diagnosis and treatment of AIP.
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- 2019
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10. A simple endoscopic scoring system to differentiate between duodenal adenoma and carcinoma
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Naomi Kakushima, Masao Yoshida, Tomohiro Iwai, Noboru Kawata, Masaki Tanaka, Kohei Takizawa, Sayo Ito, Kenichiro Imai, Kinichi Hotta, Hirotoshi Ishiwatari, Hiroyuki Matsubayashi, Hiroyuki Ono, and Keiko Sasaki
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background and study aims Diagnosis of nonampullary duodenal low grade adenoma (Vienna classification category 3, VCL 3) and high grade adenoma/carcinoma (VCL 4 or higher) is important for clinical management decisions. However, there are no criteria based on which endoscopic diagnosis can differentiate between VCL3 and VCL4 or higher. This study aimed to establish simple diagnostic criteria to differentiate between VCL3 and VCL4 or higher. Patients and methods This retrospective study included patients with superficial nonampullary duodenal epithelial tumors (NADETs) who underwent tumor resection between June 2004 and November 2016 at a single cancer center hospital. Using patient demographics and endoscopic findings from 2004 to 2013, variables related to the final histology of VCL4 or higher were analyzed, and a predictive model was developed. Validation analysis was performed on patients treated between 2014 and 2016. Results A total of 150 lesions in 134 patients were included. Lesion diameter, reddish color, depression, heterogeneous or no nodularity, and mixed or depressed macroscopic types were significantly predictive of VCL4 or higher. A predictive score model was developed and a score of 3 points was defined as an appropriate cutoff for predicting VCL4 or higher. In the validation analysis, the accuracy rate of VCL4 or higher diagnosis was 86 % when the score was ≥ 3 points. Scores between patients with VCL3 and VCL4 or higher were significantly different (P = 0.0004). Conclusions A simple and useful endoscopic scoring system was developed to preoperatively differentiate between VCL3 and VCL4 or higher among superficial NADETs.
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- 2017
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11. Use of a novel shorter minimum caliber needle for creating endoscopic tattoos for preoperative localization: a comparative ex vivo study
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Kenichiro Imai, Kinichi Hotta, Sayo Ito, Yuichiro Yamaguchi, Takeshi Kawakami, Takuya Wada, Kimihiro Igarashi, Yoshihiro Kishida, Yusuke Kinugasa, Noboru Kawata, Masaki Tanaka, Naomi Kakushima, Kohei Takizawa MD, Hirotoshi Ishiwatari, Hiroyuki Matsubayashi, and Hiroyuki Ono
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background and study aims In colorectal cancer surgery, inadvertent deep injections during endoscopic tattooing can cause India ink leakage into the peritoneum, leading to complications or to poor visualization of the surgical plane. This ex vivo animal study compared the use of novel shorter, minimum caliber needles versus conventional injection needles for endoscopic tattooing. Animals and methods Four endoscopists used the novel needles and conventional needles to make ten endoscopic tattoos (five tattoos/needle type/endoscopist) in harvested porcine rectum using a saline test-injection method. India ink leakage and the success of the tattoo (i. e. visible,
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- 2017
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12. Alcohol abstinence and risk assessment for second esophageal cancer in Japanese men after mucosectomy for early esophageal cancer.
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Akira Yokoyama, Chikatoshi Katada, Tetsuji Yokoyama, Tomonori Yano, Kazuhiro Kaneko, Ichiro Oda, Yuichi Shimizu, Hisashi Doyama, Tomoyuki Koike, Kohei Takizawa, Motohiro Hirao, Hiroyuki Okada, Takako Yoshii, Kazuo Konishi, Takenori Yamanouchi, Takashi Tsuda, Tai Omori, Nozomu Kobayashi, Haruhisa Suzuki, Satoshi Tanabe, Keisuke Hori, Norisuke Nakayama, Hirofumi Kawakubo, Hideki Ishikawa, and Manabu Muto
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Medicine ,Science - Abstract
Alcohol consumption combined with inactive aldehyde dehydrogenase-2 (ALDH2) and the presence of multiple esophageal Lugol-voiding lesions (LVLs; dysplasia) are strong predictors for multiple development of esophageal squamous cell carcinoma (ESCC) in East Asians. We invented a health risk appraisal (HRA) model for predicting the risk of ESCC based on drinking, smoking, dietary habits, and alcohol flushing, i.e., past or present facial flushing after drinking a glass of beer, a surrogate marker for inactive ALDH2.Prospective follow-up examinations (median follow-up time, 50.3 months) were performed in 278 Japanese men after endoscopic mucosectomy for early ESCC (UMIN Clinical Trials Registry ID: UMIN000001676).Sixty-four subjects developed metachronous ESCC. A receiver operating characteristic curve showed that HRA scores ≥12 best predicted the development of metachronous ESCC. The ESCC detection rate per 100 person-years was 9.8 in the high-HRA-score group (n = 104) and 4.5 in the low-HRA-score group (n = 174), and the risk of development of metachronous ESCC was higher in the high-HRA-score group than in the low-HRA-score group (adjusted hazard ratio: 2.00 [95% CI: 1.12-3.30]). Multiple LVLs was a very strong predictor of the development of metachronous SCC, but high HRA scores predicted it independently. The cumulative incidences of metachronous ESCC decreased after drinking cessation in the high-HRA-score drinker group (adjusted hazard ratio: 0.37 [0.14-0.97]).Both the HRA model that included alcohol flushing and the multiple LVL grade predicted the development of metachronous ESCC in Japanese men after endoscopic mucosectomy for ESCC. Drinking cessation in the high-HRA-score drinker group reduced the rate of metachronous ESCC.
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- 2017
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13. A novel wide viewing endoscope for upper gastrointestinal screening: a pilot study
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Naomi Kakushima, Kohei Takizawa, Masaki Tanaka, Noboru Kawata, Sayo Ito, Kenichiro Imai, Kinichi Hotta, Kimihiro Igarashi, Yoshihiro Kishida, Masao Yoshida, Hiroyuki Matsubayashi, and Hiroyuki Ono
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
The feasibility of full-spectrum endoscopy (FUSE) esophagogastroduodenoscopy (EGD), providing a 245-degree field of view with double imagers on the front and left side of the endoscope was evaluated. Twenty-one healthy individuals (15 male, median age, 35 years) underwent upper gastrointestinal screening using FUSE-EGD. The primary end point was the rate of successful visualization of Vater’s papilla. Secondary end points were visualization of the squamo-columnar junction (SCJ) and the anal side of the pyloric ring, and the endoscopists’ subjective evaluation of usability based on maneuverability and imaging of FUSE-EGD. The mean procedure time was 6.5 min, with a median of 91 images captured. The rate of successful visualization of Vater’s papilla was 90 % (19/21). The whole circumference of the SCJ was observed with two video monitors in all cases. The anterior anal side of the pyloric ring was observed in 29 % (6/21) of cases. However, the general impression of the usability of FUSE-EGD was that it was rather inferior to that of a standard front viewing endoscope. Although the usability requires further modification, FUSE-EGD provided excellent results for imaging Vater’s papilla and the SCJ.
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- 2016
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14. Preliminary Experience Using Full-Spectrum Endoscopy for Colorectal Cancer Screening: Matched Case Controlled Study
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Sayo Ito, Kinichi Hotta, Kenichiro Imai, Masao Yoshida, Kimihiro Igarashi, Yuichiro Yamaguchi, Kohei Takizawa, Naomi Kakushima, Masaki Tanaka, Noboru Kawata, Hiroyuki Matsubayashi, Hirotoshi Ishiwatari, and Hiroyuki Ono
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background/Aim. High-quality colonoscopy is needed to reduce the morbidity and mortality of colorectal cancer. Full-spectrum endoscopy (FUSE) has recently shown potential in improving adenoma detection during colonoscopy. This study aimed to evaluate the feasibility and utility of FUSE colonoscopy. Methods. From April 2015 to February 2016, 130 patients underwent FUSE colonoscopy for screening at a tertiary cancer center. Cecal intubation rate (CIR), procedure time, polyp/adenoma detection rate (PDR/ADR), and mean number of adenomas per colonoscopy (APC) were compared in matched-control patients (n=260) who underwent standard colonoscopy (SC). Accordingly, endoscopists subjectively evaluated the utility of FUSE colonoscopy. Results. The CIR of FUSE colonoscopy was 94.6%. Cecal intubation time (8.8 min versus 5.1 min, P
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- 2016
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15. Unilateral multiple metallic stent-in-stent for a case of hilar biliary cancer: An alternative stenting strategy
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Hiroyuki Matsubayashi, Yoshihiro Kishida, Kenichiro Imai, Kinichi Hotta, Naomi Kakushima, Masaki Tanaka, Kohei Takizawa, and Hiroyuki Ono
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Cholangitis ,hilar biliary cancer ,metallic stent ,prognosis ,stent-in-stent ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
The stenting strategy has been discussed in cases with unresectable hilar bile duct cancer (HBDC). We describe here a case of HBDC, 4 cm in size, invading the right portal vein and hepatic artery, which was only treated with repeated metallic stent placement, and the patient survived for a long period (51 months). Against Bismuth type-IV hilar biliary stricture, our strategy was to maintain the drainage of the largest, viable hepatic area (>50% of total liver) by unilateral multiple stent-in-stent.
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- 2014
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16. Trimming of a Migrated Biliary Nitinol Stent Using Argon Plasma
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Hiroyuki Matsubayashi, Noriaki Hasuike, Masaki Tanaka, Kohei Takizawa, Yuichiro Yamaguchi, and Hiroyuki Ono
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Metallic stent ,Migration ,Bile duct ,Argon plasma ,Trimming ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Metallic stent migration is a well-known complication which cannot always be managed by removal or repositioning, especially in case of uncovered stent. We report a patient who developed obstructive jaundice due to migration of an expandable metallic stent (EMS) inserted in the lower bile duct. Trimming of the EMS using argon plasma was performed, with the power setting of 60 W and 2.0 l/min of argon flow. The distal part of the EMS was removed and mechanical cleaning using balloon catheter was performed for remnant EMS. Without additional stent insertion, jaundice was relieved in a few days. No complication was recognized during the procedure and no recurrence of jaundice in the rest of his life.
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- 2009
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17. Diagnosis of bile duct cancer by bile cytology: usefulness of post-brushing biliary lavage fluid
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Shinya Sugimoto, Hiroyuki Matsubayashi, Hirokazu Kimura, Keiko Sasaki, Kaori Nagata, Sachiyo Ohno, Katsuhiko Uesaka, Keita Mori, Kenichiro Imai, Kinichi Hotta, Kohei Takizawa, Naomi Kakushima, Masaki Tanaka, Noboru Kawata, and Hiroyuki Ono
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background: Pathologic evidence of biliary diseases can be obtained from cytology in addition to endoscopic retrograde cholangiopancreatography (ERCP); however, the diagnostic effectiveness is not satisfactory. Study aim: This retrospective, single-center study evaluated the efficacy of various sampling methods for the cytologic diagnosis of bile duct cancer. Patients and methods: Biliary samples included bile that was simply aspirated, brush smear, brush-rinsed saline, and post-brushing biliary lavage fluid. A set of samples was compared for cytologic efficacy in 76 patients with surgically proven bile duct cancer and in 50 patients with benign biliary stricture. Results: The cytologic sensitivity for diagnosing biliary cancer was 34 % with aspirated bile, 32 % with brush smear, 43 % with brush-rinsed saline, and 70 % with post-brushing biliary lavage fluid, in contrast to the null false-positive result in the benign cases. The sensitivity of cytology was significantly higher with post-brushing lavage fluid than with the other three sampling methods (P
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- 2015
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18. Second gastric cancer after curative endoscopic resection of differentiated-type early gastric cancer: post-hoc analysis of a single-arm confirmatory trial
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Masao Yoshida, Kohei Takizawa, Noriaki Hasuike, Hiroyuki Ono, Narikazu Boku, Tomohiro Kadota, Junki Mizusawa, Ichiro Oda, Naohiro Yoshida, Yusuke Horiuchi, Kingo Hirasawa, Yoshinori Morita, Yoshinobu Yamamoto, Manabu Muto, Hisashi Doyama, Seiichiro Abe, Yutaka Saito, Tomonori Yano, Chiko Sato, Satoki Shichijo, Ryu Ishihara, Norifumi Nishide, Shinichiro Hori, Junko Fujisaki, Eiji Umegaki, Shinji Fujieda, Kenji Amagai, Akiko Takahashi, Tsuneo Oyama, Ken Nishimura, Osamu Motohashi, Kenji Ishido, Satoshi Tanabe, Masashi Tamaoki, Jun Konishi, Nozomu Kobayashi, Kou Nagino, Kei Kawagoe, Hiroaki Takeda, Yuriko Fujita, Hirokazu Komatsu, Iichiro Akasaka, Daisuke Kikuchi, Toshiro Iizuka, Masahiro Tajika, Niwa Yasumasa, Yuichi Kojima, Toshihisa Takeuchi, Keiko Yamamoto, Yuichi Shimizu, Tetsuya Sumiyoshi, Hitoshi Kondo, Kenichi Konda, Yutaro Kubota, Tomoaki Yamasaki, Hiroko Nebiki, Masashi Takata, and Masanori Morita
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Stomach Neoplasms ,Gastroenterology ,Humans ,Radiology, Nuclear Medicine and imaging ,Retrospective Studies - Abstract
Endoscopic resection (ER) for early gastric cancer (EGC) can preserve the stomach; however, the remaining stomach can develop second gastric cancer. Few reports have prospectively investigated the incidence and treatment outcomes of second gastric cancer.This post-hoc analysis used the dataset of the single-arm confirmatory trial, JCOG0607. The key inclusion criteria for JCOG0607 were solitary differentiated-type EGC and no previous gastrectomy or endoscopic treatment for EGC. Three hundred seventeen patients who underwent curative ER were included in this study. Surveillance endoscopy was performed 1 to 3 months after the initial ER and subsequently annually for at least 5 years. A lesion detected ≤1 year and1 year after the initial ER was defined as overlooked gastric cancer (OGC) and metachronous gastric cancer (MGC), respectively.During a median follow-up period of 6.0 years (interquartile range, 5.1-7.0), 30 OGCs and 61 MGCs were detected in 24 and 48 patients, respectively. The cumulative incidence of OGC at 1 year and MGC at 5 years was 7.6% and 12.7%, respectively. ER and gastrectomy were performed in 85 lesions and 6 lesions, respectively. Pathologic evaluation showed 78 mucosal cancers, 12 submucosal cancers, and 1 advanced cancer. Eventually, 28 OGCs and 52 MGCs fulfilled the pathologic criteria for curative ER.Our study was the first to reveal the actual incidence of second gastric cancer after curative ER for differentiated-type gastric cancer. Most lesions could be treated with ER. Continuous endoscopic surveillance after curative ER is important to detect second gastric cancer.
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- 2022
19. Guidelines for Colorectal Cold Polypectomy (supplement to 'Guidelines for Colorectal Endoscopic Submucosal Dissection/Endoscopic Mucosal Resection')
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Toshio Uraoka, Kohei Takizawa, Shinji Tanaka, Hiroshi Kashida, Yutaka Saito, Naohisa Yahagi, Hiro‐o Yamano, Shoichi Saito, Takashi Hisabe, Takashi Yao, Masahiko Watanabe, Masahiro Yoshida, Yusuke Saitoh, Osamu Tsuruta, Masahiro Igarashi, Takashi Toyonaga, Yoichi Ajioka, Kazuma Fujimoto, and Haruhiro Inoue
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Endoscopic Mucosal Resection ,Gastroenterology ,Colonic Polyps ,Humans ,Radiology, Nuclear Medicine and imaging ,Colonoscopy ,Colorectal Neoplasms ,Endoscopy, Gastrointestinal - Abstract
The Japan Gastroenterological Endoscopy Society published the second edition of the "Guidelines for Colorectal Endoscopic Submucosal Dissection/Endoscopic Mucosal Resection" in 2019 to clarify the indications for colorectal endoscopic mucosal resection (EMR) and endoscopic submucosal dissection and to ensure appropriate preoperative diagnoses as well as effective and safe endoscopic treatment in front-line clinical settings. Endoscopic resection with electrocautery, including polypectomy and EMR, is indicated for colorectal polyps. Recently, the number of facilities introducing and implementing cold polypectomy without electrocautery has increased. Herein, we establish supplementary guidelines for cold polypectomy. Considering that the level of evidence for each statement is limited, these supplementary guidelines must be verified in clinical practice.
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- 2022
20. Pretreatment risk factors for endoscopic noncurative resection of gastric cancers with undifferentiated‐type components
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Yusuke Horiuchi, Kohei Takizawa, Toshiyuki Yoshio, Junki Mizusawa, Hiroyuki Ono, Noriaki Hasuike, Tomonori Yano, Naohiro Yoshida, Hiroto Miwa, Narikazu Boku, Masanori Terashima, and Manabu Muto
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Treatment Outcome ,Endoscopic Mucosal Resection ,Hepatology ,Gastrectomy ,Gastric Mucosa ,Risk Factors ,Stomach Neoplasms ,Gastroenterology ,Humans ,Retrospective Studies - Abstract
Endoscopic submucosal dissection (ESD) is recommended for the treatment of early gastric cancers with an undifferentiated-type component, clinically diagnosed as intramucosal lesions ≤ 2 cm, without ulceration. In the JCOG1009/1010 trial, ESD could be performed with stomach preservation in 70% of such patients whose pathological findings met the curative resection criteria. However, additional gastrectomy was required for the remaining 30%. We identified the pretreatment risk factors for noncurative resection.Post-hoc analysis indicated that 336 patients were identified in the JCOG1009/1010 trial; among them, 243 and 93 patients were categorized into the curative or noncurative resection groups, respectively, based on the pathological findings of the resected specimens. We explored the pretreatment risk factors for noncurative resection and investigated their associated pathological findings.Multivariable analysis revealed that a pretreatment tumor size 1 cm was an independent risk factor for noncurative resection (odds ratio, 3.538; 95% confidence interval, 2.020-6.198, P 0.0001). Patients with a pretreatment tumor size 1 cm (n = 172) had a histological tumor size 2 cm (22.1% vs 4.3%, odds ratio, 6.313; 95% confidence interval, 2.73-14.599, P 0.0001) and submucosal invasion (17.4% vs 9.1%, odds ratio, 2.000; 95% confidence interval, 1.032-3.877, P = 0.040) more frequently as noncurative resection findings compared with those with a tumor size 1 cm (n = 164).Because pretreatment tumor size 1 cm is an independent risk factor for noncurative resection, endoscopists should be aware that noncurative resection is not uncommon in ESD and fully explain the potential necessity for additional gastrectomy to patients before the procedure.
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- 2022
21. Cold snare polypectomy for superficial non-ampullary duodenal epithelial tumor: a prospective clinical trial (pilot study)
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Noboru Kawata, Hirotoshi Ishiwatari, Keita Mori, Yohei Yabuuchi, Masaki Tanaka, Hiroyuki Ono, Kohei Takizawa, Kinichi Hotta, Yoshihiro Kishida, Naomi Kakushima, Sayo Ito, Kenichiro Imai, Masao Yoshida, and Hiroyuki Matsubayashi
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Adenoma ,medicine.medical_specialty ,medicine.medical_treatment ,Common Bile Duct Neoplasms ,Colonic Polyps ,Pilot Projects ,Endoscopic mucosal resection ,Duodenal Neoplasms ,parasitic diseases ,Biopsy ,Duodenal bulb ,medicine ,Clinical endpoint ,Humans ,Prospective Studies ,medicine.diagnostic_test ,business.industry ,Standard treatment ,fungi ,Margins of Excision ,Colonoscopy ,Polypectomy ,Surgery ,Endoscopy ,Pancreatic Neoplasms ,Clinical trial ,medicine.anatomical_structure ,business - Abstract
BACKGOUND Cold snare polypectomy (CSP) can minimize the risk of adverse events and has become a standard treatment for small colorectal polyps. CSP might also be suitable for small superficial non-ampullary duodenal epithelial tumors (SNADETs). This study aimed to evaluate the safety of CSP for SNADETs. METHODS The major indication criteria were as follows: (1) endoscopically diagnosed SNADET, (2) ≤ 10 mm, and (3) a single primary lesion. CSP was performed using an electrosurgical snare without electrocautery. Follow-up endoscopy and scar biopsy were performed 3 months after CSP. The primary endpoint was the delayed adverse events rate. RESULTS In total, 21 patients were enrolled. Two and 19 lesions were located in the duodenal bulb and 2nd portion, respectively; the median lesion size was 8 mm. CSP was attempted for all lesions; three lesions could not be resected without electrocautery and were removed by conventional endoscopic mucosal resection (EMR). The rate of spurting bleeding after CSP was 0%. The median procedure time was 12 min, the median resected specimen size was 12 mm, and the rate of en bloc resection was 81% (17/21). No adverse events were observed intraoperatively, with no delayed adverse events after CSP. Histopathology revealed 15 adenomas, 4 cancers (intramucosal), and 2 non-neoplastic lesions. The horizontal margins were negative/positive/undetermined in 9, 1, and 11 cases, respectively. All vertical margins were negative. Only one recurrence was detected by follow-up endoscopy 3 months after CSP. CONCLUSIONS CSP can be performed safely for small SNADETs. CLINICAL TRIAL REGISTRATION This trial was registered with the University Hospital Medical Information Network Clinical Trials Registry ( http://www.umin.ac.jp/ctr/index.htm ), and the registration number is UMIN000019157.
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- 2021
22. Diagnostic performance of endoscopy for subsquamous extension of superficial adenocarcinoma of the esophagogastric junction
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Kazunori Takada, Yohei Yabuuchi, Tatsunori Minamide, Yoichi Yamamoto, Masao Yoshida, Yuki Maeda, Noboru Kawata, Kohei Takizawa, Yoshihiro Kishida, Sayo Ito, Kenichiro Imai, Kinichi Hotta, Hirotoshi Ishiwatari, Hiroyuki Matsubayashi, and Hiroyuki Ono
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Gastroenterology - Abstract
Extension of adenocarcinoma of the esophagogastric junction under the squamous epithelium may lead to errors when determining lateral margins. However, the characteristics of subsquamous extension are unclear. Herein, we evaluated the prevalence and characteristics of subsquamous extension of adenocarcinoma of the esophagogastric junction and the diagnostic performance of endoscopy for this condition.Eighty-nine consecutive patients with superficial adenocarcinoma of the esophagogastric junction who underwent endoscopic or surgical resection at a tertiary cancer center between January 2010 and December 2017 were retrospectively evaluated. Endoscopic subsquamous extension was defined as a submucosal tumor-like elevation covered by squamous epithelium and/or a brownish area with abnormal microvessels on the squamous epithelium observed using narrow-band imaging. The diagnostic performance of endoscopy for subsquamous extension was evaluated using histological subsquamous extension as gold standard.Thirty-nine patients (44%) had histological subsquamous extension. Proton pump inhibitor use was significantly associated with histological subsquamous extension [odds ratio: 4.65; 95% confidence interval (CI): 1.77-12.2]. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of endoscopic subsquamous extension were 56% (95% CI: 40-72%), 96% (86-99%), 92% (73-99%), 74% (62-84%) and 79% (69-87%), respectively. The median length difference between histological and endoscopic subsquamous extension was 2 mm (range: -6 to 9 mm).The sensitivity of endoscopic diagnosis of subsquamous extension was unsatisfactory. The endoscopic length of subsquamous extension tended to be underestimated. An oral safety margin of one centimeter is reasonable during endoscopic resection of adenocarcinoma of the esophagogastric junction.IMPACT STATEMENT This study will contribute significantly to the literature because this is the first study to determine the difference between the lengths of subsquamous extension detected endoscopically and histologically. This study determines the prevalence of subsquamous extension and identifies characteristics associated with subsquamous extension. An understanding of the risk of subsquamous extension is important when choosing a treatment strategy and planning the resection margins in patients with adenocarcinoma of the esophagogastric junction. This study provides patients with subsquamous extension characteristics and suggests a method for accurately diagnosing this condition.
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- 2022
23. Diagnostic ability of magnification endoscope with narrow‐band imaging in screening esophagogastroduodenoscopy
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Hiroyuki Matsubayashi, Kenichiro Imai, Sayo Ito, Naomi Kakushima, Masao Yoshida, Masaki Takinami, Hirotoshi Ishiwatari, Kohei Takizawa, Akifumi Notsu, Noboru Kawata, Yohei Yabuuchi, Yoshihiro Kishida, Kinichi Hotta, and Hiroyuki Ono
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medicine.medical_specialty ,Endoscope ,Population ,Magnification ,Asymptomatic ,Gastroenterology ,Endoscopy, Gastrointestinal ,Narrow Band Imaging ,Internal medicine ,Biopsy ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Neoplasms, Glandular and Epithelial ,education ,Gastrointestinal Neoplasms ,Retrospective Studies ,Endoscopes ,education.field_of_study ,Narrow-band imaging ,medicine.diagnostic_test ,business.industry ,Esophagogastroduodenoscopy ,Retrospective cohort study ,medicine.symptom ,business - Abstract
OBJECTIVES Magnifying endoscopy with narrow-band imaging (M-NBI) is useful for the optical diagnosis of gastrointestinal neoplasms. However, the utility of M-NBI in screening esophagogastroduodenoscopy (EGD) is unclear. We aimed to evaluate the diagnostic ability of the magnification endoscope (ME) in screening EGD for a population with a low prevalence of upper gastrointestinal cancers. METHODS Overall, 4887 asymptomatic examinees without a history of laryngopharyngeal and/or upper gastrointestinal neoplasms who underwent opportunistic screening EGD between April 2011 and December 2017 were enrolled in this retrospective study. The examinees were categorized into two groups depending on whether screening EGD was performed using ME (ME group) or not (non-ME group). Using a propensity score-matched analysis, the diagnostic ability of EGD was compared between the two groups. RESULTS In total, 1482 examinees (30%) were allocated to the ME group and 3405 (70%) to the non-ME group. Thirty-five epithelial neoplasms were detected in 30 examinees (0.6%). The groups were matched for baseline characteristics (1481 pairs). Both groups showed no significant difference in the epithelial neoplasm detection rate (0.8% vs. 0.3%; P = 0.14). The biopsy rate was significantly lower in the ME group than in the non-ME group (12% vs. 15%; P = 0.003). The positive predictive value (PPV) for biopsy was significantly higher in the ME group than in the non-ME group (6.6% vs. 2.8%; P = 0.048). CONCLUSIONS Using an ME for screening EGD in an apparently healthy, asymptomatic population could reduce unnecessary biopsies by improving PPV for biopsy without decreasing the epithelial neoplasm detection rate.
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- 2021
24. Endoscopic submucosal dissection versus surgery in elderly patients with early gastric cancer of relative indication for endoscopic resection
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Sayo Ito, Hirotoshi Ishiwatari, Naomi Kakushima, Yoichi Yamamoto, Kenichiro Imai, Kinichi Hotta, Hiroyuki Matsubayashi, Masao Yoshida, Kohei Takizawa, Hiroyuki Ono, Masanori Terashima, Yoshihiro Kishida, Etsuro Bando, Noboru Kawata, and Yohei Yabuuchi
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Male ,medicine.medical_specialty ,Endoscopic Mucosal Resection ,Lymphovascular invasion ,Stomach Neoplasms ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Endoscopic resection ,Pathological ,Early Detection of Cancer ,Aged ,Retrospective Studies ,business.industry ,Hazard ratio ,Gastroenterology ,Cancer ,Endoscopic submucosal dissection ,medicine.disease ,Surgery ,Early Gastric Cancer ,Treatment Outcome ,Additional Surgery ,Lymphatic Metastasis ,Female ,business - Abstract
OBJECTIVES Surgery is recommended for early gastric cancer (EGC) beyond the endoscopic resection (ER)-indication for the risk of lymph node metastasis; however, ER may be chosen as a "relative ER-indication" considering age and comorbidities. This study aimed to compare outcomes of endoscopic submucosal dissection (ESD) only and surgery (primary surgery and additional surgery after non-curative ESD) among elderly patients with relative ER-indication EGC and to further assess prognostic factors. METHODS Outcomes of ESD and surgery (417 cases; 114 ESD, 303 surgery) in elderly patients (≥75 years) with relative ER-indication EGC were retrospectively analyzed. Prognostic factors were also examined. RESULTS During the observation period (median; ESD, 34 months; surgery, 61 months), 29% of ESD and 35% of surgery patients died, including 4% and 5% from gastric cancer (GC), respectively. ESD showed lower overall survival (OS) than surgery (P = 0.027) but comparable disease-free survival (P = 0.916). OS-associated factors were age and prognostic nutritional index (PNI) in males (age ≥79, hazard ratio [HR] 2.21, P = 0.001; PNI
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- 2021
25. Optimization of Corrugated Horn Antenna Fabricated by Additive Manufacturing and Plating
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Yuta Watanabe, Satoshi Kuwahara, Ryuichi Kobayashi, Kohei Takizawa, Shota Takemura, and Kohei Fujiwara
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- 2022
26. Comparison of treatment outcomes between endoscopic submucosal dissection with the needle-type knife and insulated-tip knife for superficial esophageal neoplasms
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Mitsuru Esaki, Masao Yoshida, Kohei Takizawa, Akifumi Notsu, Satoru Nonaka, Satoki Shichijo, Sho Suzuki, Chiko Sato, Hiroyuki Komori, Takeyoshi Minagawa, Ichiro Oda, Noriya Uedo, Kingo Hirasawa, Kenshi Matsumoto, Tetsuya Sumiyoshi, Seiichiro Abe, Takuji Gotoda, and Hiroyuki Ono
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Gastroenterology ,General Medicine - Abstract
Summary Our study aimed to compare the treatment outcomes between endoscopic submucosal dissection (ESD) with an insulated-tip knife (ESD-IT) and a needle-type knife (ESD-N) for large superficial esophageal neoplasms, as no study of this kind has been previously reported. We used the dataset of a multicenter, randomized controlled trial that compared conventional ESD (C-ESD) and traction-assisted ESD (TA-ESD) for superficial esophageal neoplasms. We compared the procedural outcomes between ESD-IT and ESD-N in a post hoc analysis and conducted sub-analyses based on traction assistance and electrical knife type. We included 223 (EST-IT, n = 169; ESD-N, n = 54) patients with no significant differences in baseline characteristics. The operator handover rate due to ESD difficulties was significantly higher in ESD-N (ESD-IT = 0.6% vs. ESD-N = 13.0%, P = 0.001), while the injection volume was significantly higher in ESD-IT than in ESD-N (40.0 vs. 20.5 mL, P 0.99; and complication rate: 1.8% vs. 3.7%, P = 0.60 for ESD-IT and ESD-N, respectively). In the sub-analyses, the handover rate was significantly lower with TA-ESD than with C-ESD for ESD-N (3.2% vs. 26.1%, P = 0.034), and a significantly smaller injection volume was used in TA-ESD than in C-ESD for ESD-IT (31.5 vs. 47.0 mL, P
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- 2022
27. Tip-in Endoscopic Mucosal Resection for 15- to 25-mm Colorectal Adenomas: A Single-Center, Randomized Controlled Trial (STAR Trial)
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Keita Mori, Yuichiro Yamaguchi, Sayo Ito, Hiroyuki Ono, Takuma Oishi, Naomi Kakushima, Masaki Tanaka, Hirotoshi Ishiwatari, Noboru Kawata, Hiroyuki Matsubayashi, Kinichi Hotta, Yohei Yabuuchi, Kohei Takizawa, Yoshihiro Kishida, Kenichiro Imai, and Masao Yoshida
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Adenoma ,medicine.medical_specialty ,Endoscopic Mucosal Resection ,health care facilities, manpower, and services ,Perforation (oil well) ,Endoscopic mucosal resection ,Postoperative Hemorrhage ,Single Center ,behavioral disciplines and activities ,law.invention ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Randomized controlled trial ,law ,health services administration ,medicine ,Clinical endpoint ,Humans ,Adverse effect ,health care economics and organizations ,Hepatology ,business.industry ,Gastroenterology ,Margins of Excision ,Colonoscopy ,Odds ratio ,Confidence interval ,Tumor Burden ,Surgery ,Logistic Models ,surgical procedures, operative ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Colorectal Neoplasms ,business - Abstract
Introduction One-piece endoscopic mucosal resection (EMR) for lesions >15 mm is still unsatisfactory, and attempted 1-piece EMR for lesions >25 mm can increase perforation risk. Therefore, modifications to ensure 1-piece EMR of 15- to 25-mm lesions would be beneficial. The aim of this study was to investigate whether Tip-in EMR, which anchors the snare tip within the submucosal layer, increases en bloc resection for 15- to 25-mm colorectal lesions compared with EMR. Methods In this prospective randomized controlled trial, patients with nonpolypoid colorectal neoplasms of 15-25 mm in size were recruited and randomly assigned in a 1:1 ratio to undergo Tip-in EMR or standard EMR, stratified by age, sex, tumor size category, and tumor location. The primary endpoint was the odds ratio of en bloc resection adjusted by location and size category. Adverse events and procedure time were also evaluated. Results We analyzed 41 lesions in the Tip-in EMR group and 41 lesions in the EMR group. En bloc resection was achieved in 37 (90.2%) patients undergoing Tip-in EMR and 30 (73.1%) who had EMR. The adjusted odds ratio of en bloc resection in Tip-in EMR vs EMR was 3.46 (95% confidence interval: 1.06-13.6, P = 0.040). The Tip-in EMR and EMR groups did not differ significantly in adverse event rates (0% vs 4.8%) or median procedure times (7 vs 5 minutes). Discussion In this single-center randomized controlled trial, we found that Tip-in EMR significantly improved the en bloc resection rate for nonpolypoid lesions 15-25 mm in size, with no increase in adverse events or procedure time.
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- 2021
28. Clinical factors associated with non-curative endoscopic submucosal dissection for the expanded indication of intestinal-type early gastric cancer: a post hoc analysis of a multi-institutional, single-arm, confirmatory trial (JCOG0607)
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Tomohiro Kadota, Noriaki Hasuike, Hiroyuki Ono, Narikazu Boku, Junki Mizusawa, Ichiro Oda, Tsuneo Oyama, Yusuke Horiuchi, Kingo Hirasawa, Toshiyuki Yoshio, Keiko Minashi, Kohei Takizawa, Kenichi Nakamura, and Manabu Muto
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Gastroenterology ,Radiology, Nuclear Medicine and imaging - Abstract
The multi-institutional, single-arm, confirmatory trial (JCOG0607) showed excellent efficacy of endoscopic submucosal dissection (ESD) for the expanded indication of intramucosal intestinal-type early gastric cancer (EGC), which consists of two groups; the lesions 2 cm if clinical finding of ulcer (cUL)-negative or those ≤ 3 cm if cUL-positive because of the expected low risk of lymph node metastasis. However, the proportion of non-curative resections (NCR) requiring additional surgery was high (32.4%). This post hoc analysis aimed to explore the clinical factors associated with NCR.As the expanded indication includes two different groups, we explored the clinical factors associated with NCR separately in cUL-negative ( 2 cm) and cUL-positive (≤ 3 cm) groups using the log-linear model.Two hundred sixty cUL-negative and 206 cUL-positive EGCs were analyzed. The proportions of NCR were 33.8% in the cUL-negative group and 29.6% in the cUL-positive group. A multivariable analysis demonstrated that moderately differentiated predominant histology diagnosed in pre-treatment biopsy (risk ratio (RR), 1.93, 95%CI 1.34-2.77, P0.001) and lesion in the upper stomach (RR, 1.75, 95%CI 1.03-2.96, P=0.038) in the cUL-negative EGCs, and tumor size 2 cm (RR, 1.78, 95%CI 1.22-2.58, P=0.003) and female sex (RR, 1.62, 95%CI 1.07-2.44, P=0.021) in the cUL-positive EGCs were independent factors associated with NCR.Clinical risk factors associated with NCR were different between cUL-negative and cUL-positive EGCs. To avoid NCR, we need to take these factors into account when deciding expanded indication for ESD.
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- 2022
29. Incidence and treatment outcomes of metachronous gastric cancer occurring after curative endoscopic submucosal dissection of undifferentiated-type early gastric cancer: Japan Clinical Oncology Group study—post hoc analysis of JCOG1009/1010
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Seiichiro Abe, Shinji Nagata, Yusuke Horiuchi, Tomohiro Kadota, Takaki Yoshikawa, Hiroyuki Ono, Junki Mizusawa, Yoshinobu Yamamoto, Ichiro Oda, Tomonori Yano, Manabu Muto, Masanori Terashima, Kohei Takizawa, and Noriaki Hasuike
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Cancer Research ,medicine.medical_specialty ,Endoscopic Mucosal Resection ,medicine.medical_treatment ,Medical Oncology ,Gastroenterology ,Endoscopy, Gastrointestinal ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Stomach Neoplasms ,Surgical oncology ,Internal medicine ,Multicenter trial ,Humans ,Medicine ,Cumulative incidence ,Retrospective Studies ,business.industry ,Incidence ,Stomach ,Incidence (epidemiology) ,Cancer ,General Medicine ,medicine.disease ,Early Gastric Cancer ,Treatment Outcome ,medicine.anatomical_structure ,Oncology ,Gastric Mucosa ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Gastrectomy ,business - Abstract
A drawback of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) is the development of metachronous gastric cancer (MGC). While MGC after ESD for differentiated-type (D-) EGC was well understood, little is known about MGC occurring after ESD for undifferentiated-type (UD-) EGC, because ESD had not been indicated. We evaluated the incidence and treatment outcomes of MGC after ESD of UD-EGC. This study is a post hoc analysis of JCOG1009/1010, a multicenter trial to evaluate the efficacy and safety of ESD for UD-EGC. The patients who underwent curative ESD of index solitary UD-EGC were analyzed. Surveillance endoscopy was performed biannually for the first 3 years and thereafter annually. We assessed the time to MGC occurrence after ESD, lesion characteristics, and treatment outcomes of MGC. Time to MGC occurrence was estimated by cumulative incidence function, with death and total gastrectomy as competing risks. A total of 198 patients were included in this study. During a median follow-up period of 5.8 years, 4 patients (2%) developed MGC. Median time to MGC occurrence was 4.5 years (range: 3.1–5.4). Five-year cumulative incidence of MGC was 1.0% (95% CI: 0.2–3.3%). Two MGCs were histologically D-EGC, and the remaining two were UD-EGC. The median tumor size of MGCs was 1.0 cm (range: 0.7–1.7), and the depth of invasion (M/SM1/SM2) was 2/1/1, respectively. Three patients achieved curative resection with repeated ESD. MGC does not occur commonly after curative ESD of UD-EGC, and repeated ESD could contribute to stomach preservation.
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- 2021
30. Final Analysis of Diagnostic Endoscopic Resection Followed by Selective Chemoradiotherapy for Stage I Esophageal Cancer: JCOG0508
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Keiji Nihei, Keiko Minashi, Tomonori Yano, Tadakazu Shimoda, Haruhiko Fukuda, Manabu Muto, Junki Mizuaswa, Kohei Takizawa, Ikuo Aoyama, Akiyoshi Ishiyama, Noboru Kawata, Daisuke Kikuchi, Noboru Hanaoka, Ichiro Oda, Yoshinori Morita, Masahiro Tajika, Junko Fujiwara, Yoshinobu Yamamoto, Chikatoshi Katada, Shinichiro Hori, Hisashi Doyama, Tsuneo Oyama, Hiroko Nebiki, Kenji Amagai, Yutaro Kubota, Yasuhiro Inokuchi, Nozomu Kobayashi, Takuto Suzuki, Kingo Hirasawa, Toshihisa Takeuchi, and Tomohiro Kadota
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Hepatology ,Gastroenterology - Published
- 2023
31. Bile aspiration during EUS-guided hepaticogastrostomy is associated with lower risk of postprocedural adverse events: a retrospective single-center study
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Junya Sato, Kohei Takizawa, Kinichi Hotta, Hiroyuki Matsubayashi, Junichi Kaneko, Hiroyuki Ono, Hirotoshi Ishiwatari, Kenichiro Imai, Tatsunori Satoh, Masao Yoshida, Noboru Kawata, Yohei Yabuuchi, Sayo Ito, and Yoshihiro Kishida
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medicine.medical_specialty ,Abdominal pain ,medicine.medical_treatment ,Single Center ,Lower risk ,Gastroenterology ,Endosonography ,Internal medicine ,medicine ,Bile ,Humans ,Retrospective Studies ,Cholangiopancreatography, Endoscopic Retrograde ,Cholestasis ,Endoscopic retrograde cholangiopancreatography ,medicine.diagnostic_test ,business.industry ,Bile duct ,Stent ,medicine.disease ,digestive system diseases ,medicine.anatomical_structure ,Pancreatitis ,Acute Disease ,Drainage ,Acute pancreatitis ,Stents ,Surgery ,medicine.symptom ,business ,Abdominal surgery - Abstract
In endoscopic retrograde cholangiopancreatography (ERCP), reduction of pressure inside of the bile duct by bile aspiration is a well-known method to lower the rate of adverse events (AEs) including cholangitis. Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) has been introduced as an alternative to ERCP. The use of self-expandable metallic stents is recommended in EUS-HGS to reduce bile leak; however, other methods to reduce the rate of AEs including bile leak, abdominal pain, fever, and sepsis, have not been elucidated yet. This study investigated whether bile aspiration during EUS-HGS decreased the rate of postprocedural AEs. Consecutive patients who underwent EUS-HGS between July 2016 and April 2020 were retrospectively evaluated in this study. EUS-HGS was performed at a tertiary cancer center. Patient characteristics, site of biliary obstruction, the quantity of bile aspirated during EUS-HGS, type of stent, whether or not antegrade stenting (AS) was performed, procedure time, and AEs were assessed based on a prospectively recorded institutional endoscopy database. Logistic regression analysis was performed to identify factors affecting postprocedural AEs. Ninety-six patients were included in the study. EUS-guided HGS with and without AS was performed in 45 and 51 patients, respectively. Bile was aspirated in 71 patients (74%). The quantity of bile aspirated was 0–10 mL and > 10 mL in 40 and 56 patients, respectively. AEs including fever, abdominal pain, postprocedural cholangitis, sepsis, acute pancreatitis, and bleeding occurred in 45 patients (47%). The AE rates were 65% (26/40) and 34% (19/56), for 0–10 mL and > 10 mL bile, respectively (p = 0.004). Using multivariate analysis, the only independent factor affecting the occurrence of AEs was found to be an aspirated bile amount of 0–10 mL (odds ratio: 4.16; 95% CI 1.6–10.8). Bile aspiration of more than 10 mL during EUS-HGS contributes to reducing the rate of postprocedural AEs.
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- 2021
32. Optimal extent of lymph node dissection in patients with gastric cancer who underwent non-curative endoscopic submucosal dissection with a positive vertical margin
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Etsuro Bando, Satoshi Kamiya, Makoto Hikage, Kohei Takizawa, Akifumi Notsu, Kenichiro Furukawa, Daisuke Aizawa, Hiroyuki Ono, Takanori Kawabata, Yutaka Tanizawa, Masanori Terashima, and Takashi Sugino
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Male ,Reoperation ,medicine.medical_specialty ,Neoplasm, Residual ,Multivariate analysis ,Endoscopic Mucosal Resection ,medicine.medical_treatment ,03 medical and health sciences ,0302 clinical medicine ,Gastrectomy ,Stomach Neoplasms ,Margin (machine learning) ,medicine ,Humans ,Neoplasm Invasiveness ,Lymph node ,Aged ,business.industry ,Incidence (epidemiology) ,Carcinoma ,Margins of Excision ,Cancer ,General Medicine ,Endoscopic submucosal dissection ,Middle Aged ,medicine.disease ,Dissection ,medicine.anatomical_structure ,Oncology ,Lymphatic Metastasis ,030220 oncology & carcinogenesis ,Lymph Node Excision ,Female ,030211 gastroenterology & hepatology ,Surgery ,Lymph Nodes ,Radiology ,business - Abstract
Background The optimal extent of lymph node dissection in patients receiving non-curative endoscopic submucosal dissection (ESD) and diagnosed with a positive vertical margin is unclear. This study attempted to identify optimal candidates for D2 lymph node dissection among these patients. Methods This study included patients who underwent gastrectomy for primary gastric cancer following non-curative ESD with a positive vertical margin between January 2002 and December 2018. We classified the patients according to the positive vertical margin pattern into an obvious exposure group and a non-obvious exposure group. We developed a score model for predicting lymph node metastasis (LNM) using factors selected by multivariate analyses and beta regression coefficients, and the incidence of LNM was evaluated. Results This study included 110 patients. LNM was detected in 17 patients (15%). We developed a predictive scoring system as follows: tumor size >30 mm (0, No; 1, Yes) + undifferentiated type tumor in the invasive front (0, No; 2, Yes) + depth of submucosal invasion > 1500 μm (0, No; 1, Yes) + obvious tumor exposure at the vertical margin (0, No; 1, Yes). In patients with 5 points, the incidence rates of all and group 2 LNM were as high as 60% and 40%, respectively. Conversely, in patients with fewer than 5 points, the incidence rates of all and group 2 LNM were just 11% and 5%, respectively. Conclusion In patients with 5 points according to our score model for predicting LNM, gastrectomy with D2 lymph node dissection is recommended.
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- 2020
33. Development of W-band waveguide based on plastic additive manufacturing with Ni electroless plating
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Shota Takemura, Kohei Takizawa, Satoshi Kuwahara, Yuta Watanabe, Kohei Fujiwara, and Ryuichi Kobayashi
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Waveguide (electromagnetism) ,Materials science ,W band ,Electroless plating ,business.industry ,Extremely high frequency ,Optoelectronics ,Development (differential geometry) ,business - Published
- 2020
34. Efficacy and safety of cold-snare endoscopic mucosal resection for colorectal adenomas 10 to 14 mm in size: a prospective observational study
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Kinichi Hotta, Kohei Takizawa, Toru Imai, Hirotoshi Ishiwatari, Yoshihiro Kishida, Yohei Yabuuchi, Naomi Kakushima, Kenichiro Imai, Sayo Ito, Hiroyuki Matsubayashi, Masao Yoshida, Daisuke Aizawa, Noboru Kawata, Hiroyuki Ono, and Takuma Oishi
- Subjects
medicine.medical_specialty ,health care facilities, manpower, and services ,Perforation (oil well) ,Colonoscopy ,Endoscopic mucosal resection ,Colorectal adenoma ,digestive system ,03 medical and health sciences ,0302 clinical medicine ,Interquartile range ,health services administration ,medicine ,Radiology, Nuclear Medicine and imaging ,Prospective cohort study ,health care economics and organizations ,medicine.diagnostic_test ,business.industry ,Incidence (epidemiology) ,Gastroenterology ,medicine.disease ,Surgery ,Clinical trial ,surgical procedures, operative ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,business - Abstract
Background and Aims Cold-snare endoscopic mucosal resection (CS-EMR) has been adapted in a piecemeal fashion as a safe and effective procedure for resection of colorectal polyps ≥10 mm. However, few data are available on en bloc CS-EMR for adenomas of 10 to 14 mm. Thus, this study evaluated the efficacy and safety of CS-EMR for these colorectal adenomas. Methods In this single-arm, prospective, observational study, patients with at least 1 slightly elevated and sessile colorectal adenoma measuring 10 to 14 mm were recruited to undergo CS-EMR. The primary outcome was histological complete resection rate by CS-EMR, which was defined as en bloc resection, with a pathologically negative vertical margin and no neoplastic tissue obtained from 4 quadrants of the mucosal defect margin. Secondary outcomes were en bloc resection rate by CS-EMR, failure rate of CS-EMR, and the incidence of adverse events. Results A total of 80 polyps from 72 patients were included. CS-EMR failed in 11 lesions (13.7%), all of which were resected using a high-frequency electric current. The rates of en bloc resection and histologic complete resection by CS-EMR were 82.5% (66 of 80) and 63.8% (51 of 80), respectively. No bleeding occurred during the CS-EMR procedure, and there was no delayed bleeding or perforation at the site where CS-EMR was performed. Conclusions CS-EMR can be safely performed in an en bloc fashion for some colorectal adenomas measuring 10 to 14 mm. However, there is room for improvement regarding the resectability and evaluation of the vertical margin after CS-EMR. (Clinical trial registration number: UMIN000031248.)
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- 2020
35. Long-term Survival After Endoscopic Resection For Gastric Cancer: Real-world Evidence From a Multicenter Prospective Cohort
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Haruhisa Suzuki, Hiroyuki Ono, Toshiaki Hirasawa, Yoji Takeuchi, Kenji Ishido, Shu Hoteya, Tomonori Yano, Shinji Tanaka, Yosuke Toya, Masahiro Nakagawa, Takashi Toyonaga, Kenichi Takemura, Kingo Hirasawa, Mitsuru Matsuda, Hironori Yamamoto, Yosuke Tsuji, Satoru Hashimoto, Maeda Yuki, Tsuneo Oyama, Ryuta Takenaka, Yoshinobu Yamamoto, Yuji Naito, Katsumi Yamamoto, Nozomu Kobayashi, Yoshiro Kawahara, Masaaki Hirano, Shigeto Koizumi, Shinichiro Hori, Masahiro Tajika, Takuto Hikichi, Kenshi Yao, Chizu Yokoi, Ken Ohnita, Yasuhiro Hisanaga, Tetsuya Sumiyoshi, Shinji Kitamura, Hisao Tanaka, Ryo Shimoda, Taichi Shimazu, Kohei Takizawa, Satoshi Tanabe, Hitoshi Kondo, Hiroyasu Iishi, Motoki Ninomiya, Ichiro Oda, Yumi Mashimo, Masahiro Ishigooka, Kazutoshi Fukase, and Yasuhiko Mizuguchi
- Subjects
Hepatology ,Gastroenterology - Abstract
We aimed to clarify the long-term outcomes of endoscopic resection (ER) for early gastric cancers (EGCs) based on pathological curability in a multicenter prospective cohort study.We analyzed the long-term outcomes of 9054 patients with 10,021 EGCs undergoing ER between July 2010 and June 2012. Primary endpoint was the 5-year overall survival (OS). The hazard ratio for all-cause mortality was calculated using the Cox proportional hazards model. We also compared the 5-year OS with the expected one calculated for the surgically resected patients with EGC. If the lower limit of the 95% confidence interval (CI) of the 5-year OS exceeded the expected 5-year OS minus a margin of 5% (threshold 5-year OS), ER was considered to be effective. Pathological curability was categorized into en bloc resection, negative margins, and negative lymphovascular invasion: differentiated-type, pT1a, ulcer negative, ≤2 cm (Category A1); differentiated-type, pT1a, ulcer negative,2 cm or ulcer positive, ≤3 cm (Category A2); undifferentiated-type, pT1a, ulcer negative, ≤2 cm (Category A3); differentiated-type, pT1b (SM1), ≤3 cm (Category B); or noncurative resections (Category C).Overall, the 5-year OS was 89.0% (95% CI, 88.3%-89.6%). In a multivariate analysis, no significant differences were observed when the hazard ratio of Categories A2, A3, and B were compared with that of A1. In all the pathological curability categories, the lower limit of the 95% CI for the 5-year OS exceeded the threshold 5-year OS.ER can be recommended as a standard treatment for patients with EGCs fulfilling Category A2, A3, and B, as well as A1 (UMIN Clinical Trial Registry, UMIN000005871).
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- 2022
36. Acute Cholangitis and Pancreatitis After Duodenal Stent Placement in the Descending Duodenum: A Retrospective Study
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Junichi Kaneko, Hirotoshi Ishiwatari, Koiku Asakura, Tatsunori Satoh, Junya Sato, Kazuma Ishikawa, Hiroyuki Matsubayashi, Yohei Yabuuchi, Yoshihiro Kishida, Masao Yoshida, Sayo Ito, Noboru Kawata, Kenichiro Imai, Kohei Takizawa, Kinichi Hotta, and Hiroyuki Ono
- Abstract
Background Metallic stents placed in the descending duodenum can cause compression of the major duodenal papilla, resulting in acute cholangitis and pancreatitis. These are notable early adverse events of duodenal stent placement; however, they have been rarely examined. This study aimed to assess the incidence of and risk factors for acute cholangitis and/or pancreatitis after duodenal stent placement in the descending duodenum. Methods We retrospectively reviewed data of consecutive patients who underwent metallic stent placement in the descending duodenum for malignant gastric outlet obstruction at a tertiary referral cancer center between April 2014 and December 2019. Risk factors for acute cholangitis and/or pancreatitis were analyzed using a logistic regression model. Results Sixty-five patients were included. Acute cholangitis and/or pancreatitis occurred in 11 patients (17%): seven with cholangitis, two with pancreatitis, and two with both cholangitis and pancreatitis. Multivariate analysis indicated that female sex (odds ratio: 9.2, 95% confidence interval: 1.4–58.6, P = 0.02), absence of biliary stents (odds ratio: 12.9, 95% confidence interval: 1.8–90.2, P = 0.01), and tumor invasion to the major duodenal papilla (odds ratio: 25.8, 95% confidence interval: 2.0–340.0, P = 0.01) were significant independent risk factors for acute cholangitis and/or pancreatitis. Conclusions The incidence of cholangitis and/or pancreatitis after duodenal stent placement in the descending duodenum was non-negligible. Female sex, absence of biliary stents, and tumor invasion to the major duodenal papilla were the primary risk factors. Risk stratification can allow endoscopists to better identify patients at significant risk and permit detailed informed consent.
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- 2022
37. Alcohol abstinence and risk assessment for second esophageal cancer in Japanese men after mucosectomy for early esophageal cancer
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Akira, Yokoyama, Chikatoshi, Katada, Tetsuji, Yokoyama, Tomonori, Yano, Kazuhiro, Kaneko, Ichiro, Oda, Yuichi, Shimizu, Hisashi, Doyama, Tomoyuki, Koike, Kohei, Takizawa, Motohiro, Hirao, Hiroyuki, Okada, Takako, Yoshii, Kazuo, Konishi, Takenori, Yamanouchi, Takashi, Tsuda, Tai, Omori, Nozomu, Kobayashi, Haruhisa, Suzuki, Satoshi, Tanabe, Keisuke, Hori, Norisuke, Nakayama, Hirofumi, Kawakubo, Hideki, Ishikawa, Manabu, Muto, Akira, Yokoyama, Chikatoshi, Katada, Tetsuji, Yokoyama, Tomonori, Yano, Kazuhiro, Kaneko, Ichiro, Oda, Yuichi, Shimizu, Hisashi, Doyama, Tomoyuki, Koike, Kohei, Takizawa, Motohiro, Hirao, Hiroyuki, Okada, Takako, Yoshii, Kazuo, Konishi, Takenori, Yamanouchi, Takashi, Tsuda, Tai, Omori, Nozomu, Kobayashi, Haruhisa, Suzuki, Satoshi, Tanabe, Keisuke, Hori, Norisuke, Nakayama, Hirofumi, Kawakubo, Hideki, Ishikawa, and Manabu, Muto
- Abstract
source:Epub 2017 Apr 6, source:https://pubmed.ncbi.nlm.nih.gov/28384229, source:https://cir.nii.ac.jp/crid/1050282810825955712
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- 2022
38. Effectiveness of suction valve button removal in retrieving resected colon polyps for better histological assessment: Propensity score matching analysis
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Hiroyuki Ono, Yohei Yabuuchi, Kohei Takizawa, Yoshihiro Kishida, Noboru Kawata, Hirotoshi Ishiwatari, Kinichi Hotta, Naomi Kakushima, Sayo Ito, Hiroyuki Matsubayashi, Kenichiro Imai, and Masao Yoshida
- Subjects
Suction (medicine) ,medicine.medical_specialty ,Endoscope ,Colon ,medicine.medical_treatment ,Colonic Polyps ,Colonoscopy ,Suction ,behavioral disciplines and activities ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Propensity Score ,Pathological ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,Odds ratio ,medicine.disease ,Polypectomy ,Surgery ,Colon polyps ,030220 oncology & carcinogenesis ,Propensity score matching ,030211 gastroenterology & hepatology ,business - Abstract
BACKGROUND AND AIM Fragmentation of endoscopically resected colorectal polyps during retrieval is one of the limitations for appropriate pathological diagnosis; however, little is known about steps to reduce it. We aimed to evaluate the effect of removing the suction valve button, which is one of the intricate parts of the endoscope, during polyp suction retrieval for fragmentation and pathological diagnosis. METHODS We retrospectively reviewed the polyps retrieved by suctioning. We used the propensity score matching method to adjust for difference between the button-attached and button-removed groups. Outcomes of fragmentation, pathological diagnosis of non-neoplastic polypectomy (NNP), and pathological cut-end among neoplastic lesions were evaluated. RESULTS On the basis of propensity score matching, 322 pairs of cases were selected for analysis. After matching, the difference in the variables between the two groups was closely balanced. The fragmentation rate was significantly different between the groups (button-attached 36.6% vs. button-removed 22.4%, P
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- 2020
39. Diagnostic performance for T1 cancer in colorectal lesions ≥10 mm by optical characterization using magnifying narrow‐band imaging combined with magnifying chromoendoscopy; implications for optimized stratification by Japan Narrow‐band Imaging Expert Team classification
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Kenichiro Imai, Kohei Takizawa, Masao Yoshida, Naomi Kakushima, Sayo Ito, Hiroyuki Ono, Noboru Kawata, Hirotoshi Ishiwatari, Yoshihiro Kishida, Yohei Yabuuchi, Kazuya Hosotani, Hiroyuki Matsubayashi, and Kinichi Hotta
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medicine.medical_specialty ,Narrow-band imaging ,Invasive carcinoma ,medicine.diagnostic_test ,business.industry ,Colorectal cancer ,Gastroenterology ,Colonoscopy ,medicine.disease ,Magnifying chromoendoscopy ,Pit pattern ,Narrow Band Imaging ,03 medical and health sciences ,0302 clinical medicine ,Japan ,030220 oncology & carcinogenesis ,Humans ,Medicine ,030211 gastroenterology & hepatology ,Radiology, Nuclear Medicine and imaging ,Radiology ,Colorectal Neoplasms ,business - Abstract
BACKGROUND Magnifying narrow-band imaging (M-NBI) and magnifying chromoendoscopy (M-CE) enable accurate diagnosis of T1 colorectal cancer, but the diagnostic yields from combined M-NBI and CE have not been fully analyzed. We aimed to evaluate the diagnostic yield of combining Japan NBI Expert Team (JNET) classification using M-NBI and M-CE. METHODS Superficial colorectal lesions ≥10 mm removed at a Japanese tertiary cancer center between February 2016 and December 2018 were included. We analyzed the relationship between JNET classification, M-CE findings, and histological results based on prospectively collected endoscopic and pathologic data. RESULTS A total of 1573 lesions, including 56 superficial submucosal invasive cancers, 160 deep submucosal invasive cancers, and 81 advanced cancers (≥T2) were analyzed. The probability of deeply invasive cancer (95% confidence interval) was 1.8% (1.1-2.8), 30.1% (25.4-35.1), and 96.6% (91.5-99.1) in JNET Types 2A, 2B, and 3, respectively. The probability of deeply invasive cancer in JNET Type 2B lesions with non-V, VL, and VH pit pattern was 4.3%, 16.6%, 76.0%, respectively (P
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- 2020
40. Long-term outcome of endoscopic resection for intramucosal esophageal squamous cell cancer: a secondary analysis of the Japan Esophageal Cohort study
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Atsushi Ochiai, Yasumasa Matsuo, Ichiro Oda, Satoshi Abiko, Nozomu Kobayashi, Tomoyuki Koike, Tadakazu Shimoda, Manabu Muto, Tomonori Yano, Hiroyuki Okada, Takako Yoshii, Atsushi Katagiri, Motohiro Hirao, Hideki Ishikawa, Yuichi Shimizu, Hirofumi Kawakubo, Toshiyuki Yoshio, Chikatoshi Katada, Akira Yokoyama, Kohei Takizawa, Takenori Yamanouchi, Kenichi Takemura, Haruhisa Suzuki, and Tetsuji Yokoyama
- Subjects
medicine.medical_specialty ,Muscularis mucosae ,Esophageal Neoplasms ,Cohort Studies ,Japan ,Secondary analysis ,Humans ,Medicine ,Cumulative incidence ,Aged ,Retrospective Studies ,Intraepithelial neoplasia ,Lamina propria ,business.industry ,Gastroenterology ,Surgery ,Clinical trial ,Treatment Outcome ,medicine.anatomical_structure ,Cohort ,Carcinoma, Squamous Cell ,Esophageal Squamous Cell Carcinoma ,Esophagoscopy ,Neoplasm Recurrence, Local ,business ,Cohort study - Abstract
Background Prospectively collected long-term data of patients undergoing endoscopic resection for superficial esophageal squamous cell carcinoma (ESCC) are limited. The aim of this study was to determine the prospectively collected long-term outcomes of endoscopic resection for ESCC as a secondary analysis of the Japan Esophageal Cohort (JEC) study. Methods Patients who underwent endoscopic resection of intramucosal ESCC at 16 institutions between September 2005 and May 2010 were enrolled in the JEC study. All patients underwent endoscopic examination with iodine staining at 3 and 6 months after resection, and every 6 months thereafter. We investigated clinical courses after endoscopic resection, survival rates, and cumulative incidence of metachronous ESCC. Results 330 patients (mean age 67.0 years) with 396 lesions (mean size 20.4 mm) were included in the analysis. Lesions were diagnosed as high-grade intraepithelial neoplasia in 17.4 % and as squamous cell carcinoma in 82.6 % (limited to epithelium in 28.4 %, to lamina propria in 55.4 %, and to muscularis mucosa in 16.2 %). En bloc resection was achieved in 291 (73.5 %). The median follow-up period was 49.4 months. Local recurrences occurred in 13 patients (3.9 %) and were treated by endoscopic procedures. Lymph node metastasis occurred in two patients (0.6 %) after endoscopic resection. The 5-year overall, disease-specific, and metastasis-free survival rates were 95.1 %, 99.1 %, and 94.6 %, respectively. The 5-year cumulative incidence rate of metachronous ESCC was 25.7 %. Conclusions Our study demonstrated that endoscopic resection is an effective treatment for intramucosal ESCC, with favorable long-term outcomes.
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- 2020
41. A risk‐prediction model for en bloc resection failure or perforation during endoscopic submucosal dissection of colorectal neoplasms
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Keita Mori, Kinichi Hotta, Kohei Takizawa, Hirotoshi Ishiwatari, Hiroyuki Ono, Kenichiro Imai, Yohei Yabuuchi, Hiroyuki Matsubayashi, Masaki Tanaka, Masao Yoshida, Noboru Kawata, Yoshihiro Kishida, Yuichiro Yamaguchi, Naomi Kakushima, and Sayo Ito
- Subjects
medicine.medical_specialty ,Endoscopic Mucosal Resection ,Colorectal cancer ,Perforation (oil well) ,Colonoscopy ,Logistic regression ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Derivation ,Intestinal Mucosa ,Retrospective Studies ,Framingham Risk Score ,medicine.diagnostic_test ,business.industry ,Incidence (epidemiology) ,Gastroenterology ,Odds ratio ,medicine.disease ,Surgery ,Logistic Models ,Treatment Outcome ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Colorectal Neoplasms ,business - Abstract
OBJECTIVES Technical difficulties in colorectal endoscopic submucosal dissections (ESD) result in en bloc resection failure or perforation. This study aimed to develop and validate a risk score for predicting en bloc resection failure or perforation in ESD of colorectal neoplasms. METHODS This single-center observational study included 1133 colorectal neoplasms treated with ESD in a Japanese tertiary cancer center. With a derivation set (n = 716), we performed multiple logistic regression to identify significant risk factors for en bloc resection failure or perforation. Based on odds ratios, we developed a risk score, ranging from 0 to 10: 0-1 'low risk' (LR); 2-4 'moderate risk' (MR); and 5-10 'high risk' (HR). An independent validation set comprised prospectively enrolled subjects (n = 417) that underwent ESDs from January 2014 to August 2016. The performance of the risk score for predicting en bloc resection failure or perforation for each risk tier was evaluated. RESULTS The baseline incidences of en bloc resection failure or perforation were 14.5% and 5.5% in the derivation and validation sets, respectively. We identified the following significant risk factors: endoscopist experience, tumor location, morphology, scope operability, underlying fold, and fold convergence. In the validation set, the incidences of en bloc resection failure or perforation were 0% in the LR tier (n = 62; 14.8%), 2.3% in the MR tier (n = 293; 70.4%), and 25.8% in the HR tier (n = 62; 14.8%) (P < 0.001, Cochran-Armitage trend test). CONCLUSIONS A risk scoring system, which was developed and prospectively validated, can successfully estimate the incidence of en bloc resection failure or perforation.
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- 2020
42. Bilateral Risk Assessments of Surgery and Nonsurgery Contribute to Providing Optimal Management in Early Gastric Cancers after Noncurative Endoscopic Submucosal Dissection: A Multicenter Retrospective Study of 485 Patients
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Eriko Koizumi, Osamu Goto, Kohei Takizawa, Yutaka Mitsunaga, Shu Hoteya, Waku Hatta, Atsushi Masamune, Satoshi Osawa, Hiroya Takeuchi, Sho Suzuki, Jun Omori, Go Ikeda, Tsugumi Habu, Yumiko Ishikawa, Kumiko Kirita, Hiroto Noda, Kazutoshi Higuchi, Takeshi Onda, Teppei Akimoto, Naohiko Akimoto, Mitsuru Kaise, and Katsuhiko Iwakiri
- Subjects
Treatment Outcome ,Endoscopic Mucosal Resection ,Gastrectomy ,Gastric Mucosa ,Stomach Neoplasms ,Lymphatic Metastasis ,Gastroenterology ,Humans ,Risk Assessment ,Retrospective Studies - Abstract
Background and Aims: Surgery is recommended in early gastric cancer (EGC) after noncurative endoscopic submucosal dissection (ESD), although observation can be an alternative. We aimed to develop a tailor-made treatment strategy for noncurative EGCs by comparing the lymph node metastasis risk (LNMR) and the surgical risk. Methods: We retrospectively identified 485 patients with differentiated-type, noncurative EGCs removed by ESD and classified them into two groups: a surgery-preferable group and an observation-preferable group, according to the clinical courses. Subsequently, LNMR and surgery-related death risk were assessed using a published scoring system and a risk calculator for gastrectomy, respectively. Finally, we investigated the optimal cutoff value of the risk difference (LNMR minus surgery-related death risk) to efficiently allocate these cases into either of two groups, surgery-preferable or observation-preferable. Results: In 485 patients (surgery in 322, observation in 163), 57 and 428 patients were classified into the surgery-preferable group and the observation-preferable group, respectively. The optimal cutoff value of the risk difference (LNMR minus surgery-related death risk) to allocate the cases to the two preferable groups was 7.85 with the highest area under the curve (0.689). When cases with >7.85 LNMR over the surgery-related death risk were allocated into the surgery-preferable group and vice versa, the discriminability was 73.2%, which was sufficiently higher than that in the clinical decision (44.5%). Conclusion: Personalized comparison of LNMR and surgery-related death risk is helpful to provide a favorable treatment option for each patient with EGCs after noncurative ESD.
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- 2022
43. Endoscopic features of submucosal invasive non‐ampullary duodenal carcinomas
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Yohei Yabuuchi, Kohei Takizawa, Yoshihiro Kishida, Kenichiro Imai, Keiko Sasaki, Masao Yoshida, Naomi Kakushima, Noboru Kawata, Masaki Takinami, Hirotoshi Ishiwatari, Kinichi Hotta, Hiroyuki Matsubayashi, Sayo Ito, and Hiroyuki Ono
- Subjects
Male ,medicine.medical_specialty ,Lymph node metastasis ,Endoscopy, Gastrointestinal ,03 medical and health sciences ,0302 clinical medicine ,Duodenal Neoplasms ,Carcinoma ,medicine ,Humans ,Neoplasm Invasiveness ,Intestinal Mucosa ,Aged ,Retrospective Studies ,Aged, 80 and over ,Invasive carcinoma ,Hepatology ,Tumor size ,business.industry ,Significant difference ,Gastroenterology ,Cancer ,Middle Aged ,medicine.disease ,Major duodenal papilla ,030220 oncology & carcinogenesis ,Intramucosal carcinoma ,Female ,030211 gastroenterology & hepatology ,Radiology ,business - Abstract
Background and aim It is imperative to distinguish superficial non-ampullary duodenal carcinomas (NADCs) between intramucosal and submucosal invasive carcinoma for treatment selection. The aim of this study was to evaluate the clinicopathological differences of intramucosal and submucosal carcinoma. Methods This was a retrospective, single-center study comprising 134 patients with 137 superficial NADCs during May 2005 and March 2018. Clinicopathological characteristics and treatment outcomes data were used to perform a comparative analysis of endoscopic findings, preoperative diagnoses of depth of cancer, and treatment outcomes of histologically diagnosed intramucosal and submucosal carcinoma. Results Of the 137 NADCs, 125 (91%) were intramucosal, and 12 (9%) were submucosal. The proportion of submucosal carcinoma was significantly higher on the oral side of the papilla than on the anal side (16% vs 1%, P = 0.002). Submucosal tumor-like appearance was more frequent in submucosal than in intramucosal carcinoma (58% vs 13%, P = 0.001). There was no significant difference in tumor diameter between the groups, but 33% of submucosal carcinomas were ≤ 10 mm. Correct preoperative diagnosis of depth was achieved in 33% of submucosal carcinoma. Submucosal carcinoma was frequently underestimated when tumor diameters were ≤ 10 mm. Conversely, intramucosal carcinoma was frequently overestimated when the tumor was ≥ 30 mm and had thickness or giant nodules. Lymph node metastasis was found in one submucosal carcinoma patient. Conclusions The possibility of submucosal invasion should be considered when NADCs are located on the oral side of the papilla or have submucosal tumor-like appearance even if tumor diameters are ≤ 10 mm.
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- 2019
44. Effect of chemoradiation on the development of second primary cancers after endoscopic resection of T1 esophageal squamous cell carcinoma
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Toshiyuki Yoshio, Keiko Minashi, Junki Mizusawa, Yoshinori Morita, Masahiro Tajika, Junko Fujiwara, Yoshinobu Yamamoto, Chikatoshi Katada, Shinichiro Hori, Tomonori Yano, Kohei Takizawa, Haruhiko Fukuda, and Manabu Muto
- Subjects
Esophageal Neoplasms ,Gastroenterology ,Humans ,Neoplasms, Second Primary ,Chemoradiotherapy ,Esophageal Squamous Cell Carcinoma ,Prospective Studies - Abstract
Patients with early esophageal squamous cell carcinoma (ESCC) may develop multiple second primary ESCC and cancers in other organs even after curative endoscopic resection (ER). We investigated whether administration of chemoradiotherapy (CRT) after ER decreases the incidence of second primary cancers.We conducted a post hoc analysis of the prospective study. Among the registered 170 patients with clinical submucosal ESCC, 74 underwent ER alone, and 96 underwent ER followed by CRT (ER + CRT) because of pathological results of submucosal or lympho-vascular invasion. We compared the incidence of second primary cancers in esophagus and in other organs between two treatment groups. A univariate analysis was performed to investigate the related risk factors. All patients were followed up with esophagogastroduodenoscopy and CT every 4 months for the first 3 years and every 6 months thereafter.Sixty-one ESCC were detected in 32 patients, and the 3-year cumulative incidence of multiple ESCCs was not different between ER + CRT and ER alone (10.4% vs. 13.5%). Sixty-three second primary cancers in other organs were detected in 45 patients, and there was no difference in the cumulative incidence between two groups. The risk factors for multiple ESCCs were high alcohol consumption and grade C multiple Lugol-voiding lesions. Heavy drinker or patients with grade C multiple Lugol-voiding lesion rather than CRT were at risk for second primary ESCC.CRT after ER did not decrease the cumulative incidence of second primary ESCC nor cancers in other organs comparing with ER alone.
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- 2021
45. A novel, simple, and dedicated device for endoscopic mucosal defect closure
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Yohei Nose, Kohei Takizawa, Kazuo Shiotsuki, Tsuyoshi Yamaguchi, Masaomi Agatsuma, Shun Nitta, Kotaro Yamashita, Takuro Saito, Koji Tanaka, Kazuyoshi Yamamoto, Tomoki Makino, Tsuyoshi Takahashi, Yukinori Kurokawa, Hidetoshi Eguchi, Yuichiro Doki, and Kiyokazu Nakajima
- Abstract
Endoscopic submucosal dissection (ESD) has become popular, but complications such as postoperative bleeding remain an issue. Although some methods of closing a mucosal defect with a snare and clips have been reported to be effective and safe, the snare is not a dedicated device, and the procedure is difficult and time-consuming. We aimed to find an alternative method for defect closure after ESD by developing a dedicated device.We have improved five prototypes. The load on the stopper when starting to tighten and loosen a loop and the maximum load on the stopper and the movement distance of the thread when sliding the stopper were measured five times for each prototype. With the 5th prototype, we finalized the design and named it FLEXLOOP. Additionally, the material and shape of the outer tube were improved. Then, the usability of FLEXLOOP was evaluated in pigs. The operation time for closing mucosal defects with the snare or FLEXLOOP was measured five times.We made FLEXLOOP, which had a lower load when sliding and a higher load when loosening than the snare. The improvement of the outer tube significantly reduced the load on the sheath when sliding it. We confirmed the feasibility of mucosal defect closure with FLEXLOOP in pigs. The median operation time was 563 s (range 340-679 s) with the snare and 355 s (range 303-455 s) with FLEXLOOP (FLEXLOOP can be a promising option for defect closure after ESD.
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- 2021
46. Tip-in EMR as an alternative to endoscopic submucosal dissection for 20- to 30-mm nonpedunculated colorectal neoplasms
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Kazunori Takada, Kinichi Hotta, Kenichiro Imai, Sayo Ito, Yoshihiro Kishida, Tatsunori Minamide, Yoichi Yamamoto, Yohei Yabuuchi, Masao Yoshida, Yuki Maeda, Noboru Kawata, Kohei Takizawa, Hirotoshi Ishiwatari, Hiroyuki Matsubayashi, Takanori Kawabata, and Hiroyuki Ono
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Treatment Outcome ,Endoscopic Mucosal Resection ,Gastroenterology ,Humans ,Radiology, Nuclear Medicine and imaging ,Colonoscopy ,Intestinal Mucosa ,Neoplasm Recurrence, Local ,Colorectal Neoplasms ,Retrospective Studies - Abstract
Tip-in EMR, which includes anchoring the snare tip, has recently shown a favorable en-bloc and R0 resection rate for colorectal neoplasms. Thus, Tip-in EMR may be an alternative to endoscopic submucosal dissection (ESD). We aimed to compare clinical outcomes between Tip-in EMR and ESD for large colorectal neoplasms.This retrospective study evaluated consecutive patients who underwent Tip-in EMR or ESD for 20- to 30-mm nonpedunculated colorectal neoplasms at a Japanese tertiary cancer center between January 2014 and December 2019. Baseline characteristics, treatment results, and long-term outcomes were analyzed using 1:1 propensity score matching.Seven hundred nine lesions were evaluated. The Tip-in EMR group included 1 lesion with a nonlifting sign but no lesions with fold convergence. After propensity score matching, each group included 140 lesions. The ESD group showed significantly higher en-bloc resection rates (99.3% vs 85.0%) and R0 resection rates (90.7% vs 62.9%). Procedure time was significantly shorter in the Tip-in EMR group (8 minutes vs 60 minutes). The Tip-in EMR and ESD groups did not differ significantly with respect to local recurrence rate (2.1% vs 0%).Tip-in EMR is comparable with ESD with respect to the local recurrence rate but has a shorter procedure time, despite the lower en-bloc and R0 resection rates for 20- to 30-mm nonpedunculated colorectal neoplasms without fold convergence or nonlifting sign. Thus, Tip-in EMR could be a feasible alternative to ESD in these lesions.
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- 2022
47. Predicting the depth of superficial adenocarcinoma of the esophagogastric junction
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Yohei Yabuuchi, Yoichi Yamamoto, Kazunori Takada, Kohei Takizawa, Hirotoshi Ishiwatari, Noboru Kawata, Takanori Kawabata, Kenichiro Imai, Yoshihiro Kishida, Masao Yoshida, Hiroyuki Matsubayashi, Kinichi Hotta, Sayo Ito, and Hiroyuki Ono
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Surgical resection ,Invasion depth ,medicine.medical_specialty ,Hepatology ,Esophageal Neoplasms ,business.industry ,Gastroenterology ,Endoscopic mucosal resection ,Endoscopy ,Adenocarcinoma ,medicine.disease ,Macroscopic type ,Lesion ,Treatment modality ,medicine ,Humans ,Radiology ,Esophagogastric Junction ,medicine.symptom ,Esophagogastric junction ,business ,Retrospective Studies - Abstract
BACKGROUND AND AIM Preoperative determination of the invasion depth of superficial adenocarcinoma of the esophagogastric junction is important for appropriate endoscopic or surgical resection. There are no objective criteria regarding this; therefore, we investigated the factors associated with the invasion depth of superficial adenocarcinoma of the esophagogastric junction. METHODS This retrospective study evaluated patients with superficial adenocarcinoma of the esophagogastric junction who had undergone endoscopic or surgical resection at a Japanese tertiary cancer center between April 2004 and December 2017. We analyzed endoscopic features of intramucosal to slight submucosal (M-SM1; < 500 μm) and deep submucosal (SM2; ≥500 μm) adenocarcinoma of the esophagogastric junction and extracted significant factors associated with and assessed the diagnostic performance of endoscopic features for SM2 lesion. RESULTS A total of 106 cases were included in this study. Multivariate analysis indicated that depressed or protruded type (odds ratio [OR], 11.1), lesion size ≥15 mm (OR, 3.11), uneven surface (OR, 6.31), and subsquamous extension (OR, 5.41) were significantly associated with SM2 adenocarcinomas of the esophagogastric junction. When the macroscopic type was depressed or protruded, high sensitivity (97%) but fair specificity (46%) were observed for SM2 adenocarcinoma of the esophagogastric junction, whereas uneven surface and subsquamous extension showed high specificity (96% and 87%) but fair sensitivity (36% and 46%). CONCLUSIONS Depressed or protruded type, lesion size ≥15 mm, uneven surface, and subsquamous extension were significantly associated with the invasion depth of superficial adenocarcinoma of the esophagogastric junction. These endoscopic features are useful in determining the treatment modality preoperatively.
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- 2021
48. Assessment of the Diagnostic Performance of Endoscopic Ultrasonography After Conventional Endoscopy for the Evaluation of Esophageal Squamous Cell Carcinoma Invasion Depth
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Seiichiro Abe, Ryu Ishihara, Noriko Matsuura, Ryoji Kushima, Manabu Muto, Toshiyuki Yoshio, Naohiro Yoshida, Shinji Nagata, Tomonori Yano, Noboru Hanaoka, Kohei Takizawa, Tomoko Kataoka, Masashi Tamaoki, Junki Mizusawa, Hiroyuki Ono, Yoshinobu Yamamoto, and Haruhiko Fukuda
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Endoscopic ultrasound ,medicine.medical_specialty ,Esophageal Neoplasms ,Overdiagnosis ,medicine.medical_treatment ,Gastroenterology and Hepatology ,Sensitivity and Specificity ,Endosonography ,Interquartile range ,Submucosa ,medicine ,Humans ,Neoplasm Invasiveness ,Prospective Studies ,Original Investigation ,Aged ,medicine.diagnostic_test ,business.industry ,Research ,Cancer ,Endoscopy ,General Medicine ,Esophageal cancer ,Middle Aged ,medicine.disease ,Online Only ,medicine.anatomical_structure ,Esophagectomy ,Radiology ,Esophageal Squamous Cell Carcinoma ,business - Abstract
Key Points Question Is the performance of endoscopic ultrasonography after conventional endoscopy associated with improvements in diagnosing the invasion depth of esophageal squamous cell carcinoma? Findings In this diagnostic study of 372 patients with esophageal cancer, the performance of endoscopic ultrasonography after nonmagnifying and magnifying endoscopy was not associated with improvements in diagnostic performance for differentiating between submucosal and mucosal cancers in terms of overdiagnosis and accuracy. Meaning This study suggests that endoscopic ultrasonography after nonmagnifying and magnifying endoscopy is not helpful for evaluating the invasion depth of T1 esophageal squamous cell carcinoma., Importance Distinguishing between mucosal and submucosal cancers is important for selecting the optimal treatment for patients with esophageal squamous cell carcinoma (ESCC); however, standard procedures for diagnosing cancer invasion depth have not yet been determined. Objective To evaluate the diagnostic performance of endoscopic ultrasonography (EUS) after conventional endoscopy for the evaluation of ESCC invasion depth. Design, Setting, and Participants This prospective single-arm confirmatory diagnostic study comprising 372 patients with T1 esophageal cancer was conducted at 41 secondary or tertiary hospitals in Japan. Enrollment began on July 20, 2017; patients were enrolled in 2 steps, with the first registration occurring from August 4, 2017, to December 11, 2019, and the second from August 9, 2017, to December 11, 2019. After the completion of all first and second registration examinations, patients received treatment and were followed up for 30 days, with follow-up ending on February 14, 2020. Patients were eligible for inclusion if they had pathologically or endoscopically diagnosed esophageal cancer with T1 clinical depth of invasion. Interventions In the first registration, nonmagnifying endoscopy (non-ME) and magnifying endoscopy (ME) were used to diagnose cancer invasion depth. In the second registration, patients from the first registration who had cancers invading the muscularis mucosa or submucosa were enrolled and received EUS. After completion of the protocol examinations, patients received treatment with endoscopic resection or esophagectomy. The pathological results of the resected specimens were used as the reference standard for evaluating cancer invasion depth. Main Outcomes and Measures The primary end point was the proportion of overdiagnosis of submucosal cancer (defined as invasion depth >200 μm) after receipt of non-ME and ME, with or without the addition of EUS. The secondary end points were underdiagnosis, sensitivity, and specificity. Results Among 372 patients enrolled in the first registration, 371 received non-ME and ME. Of those, 300 patients were enrolled in the second registration, and 293 patients received EUS. A total of 269 patients (217 men [80.7%]; median age, 69 years; interquartile range, 62-75 years) were included in the final analysis. The addition of EUS was associated with a 6.6% increase in the proportion of overdiagnosis (from 16 of 74 patients [21.6%; 95% CI, 12.9%-32.7%] after non-ME and ME to 29 of 103 patients [28.2%; 95% CI, 19.7%-37.9%] after the addition of EUS; 1-sided P = .93). All subgroup analyses found similar increases in overdiagnosis of submucosal cancer. The addition of EUS was associated with a 4.5% reduction in the proportion of underdiagnosis (from 57 of 195 patients [29.2%; 95% CI, 23.0%-36.2%] after non-ME and ME to 41 of 166 patients [24.7%; 95% CI, 18.3%-32.0%] after the addition of EUS). After non-ME and ME, diagnostic sensitivity was 50.4% (95% CI, 41.0%-59.9%), specificity was 89.6% (95% CI, 83.7%-93.9%), and accuracy was 72.9% (95% CI, 67.1%-78.1%). After the addition of EUS, diagnostic sensitivity was 64.3% (95% CI, 54.9%-73.1%), specificity was 81.2% (95% CI, 74.1%-87.0%), and accuracy was 74.0% (95% CI, 68.3%-79.1%). Conclusions and Relevance This study found that the addition of EUS was not associated with improvements in the diagnostic accuracy of cancer invasion depth. These findings do not support the routine use of EUS after conventional endoscopy for evaluating the invasion depth among patients with T1 ESCC., This study assesses the performance of endoscopic ultrasonography after nonmagnifying and magnifying endoscopy for the diagnosis of cancer invasion depth among patients with esophageal squamous cell carcinoma.
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- 2021
49. Endoloop closure following gastric endoscopic submucosal dissection to prevent delayed bleeding in patients receiving antithrombotic therapy
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Kohei Takizawa, Akifumi Notsu, Hirotoshi Ishiwatari, Kenichiro Imai, Noboru Kawata, Yohei Yabuuchi, Hiroyuki Ono, Hiroyuki Matsubayashi, Masao Yoshida, Kinichi Hotta, Naomi Kakushima, Yoshihiro Kishida, Sayo Ito, and Kazuo Shiotsuki
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medicine.medical_specialty ,Endoscopic Mucosal Resection ,business.industry ,Gastroenterology ,Retrospective cohort study ,Endoscopic submucosal dissection ,Postoperative Hemorrhage ,Early Gastric Cancer ,Surgery ,Fibrinolytic Agents ,Stomach Neoplasms ,Antithrombotic ,medicine ,Humans ,In patient ,Submucosal dissection ,CLIPS ,business ,computer ,Prophylactic treatment ,computer.programming_language ,Retrospective Studies - Abstract
OBJECTIVES Given the high risk of bleeding in post-endoscopic submucosal dissection (ESD) patients receiving antithrombotic therapy, a new effective method is needed to prevent delayed bleeding among such patients. The aim of this study was to assess the efficacy of endoloop closure, using an endoloop and clips, after gastric ESD to prevent bleeding among patients receiving antithrombotic therapy. METHODS This retrospective study enrolled patients taking antithrombotic agents who underwent ESD for early gastric cancer between March 2016 and January 2019. Patients were classified into two groups: the endoloop closure group and the control group (no prophylactic treatment). We compared the rates of post-endoscopic submucosal dissection bleeding between the two groups. RESULTS Overall, 178 patients were included, with 37 patients in the endoloop closure group and 141 patients in the control group. The rate of post-endoscopic submucosal dissection bleeding was in general lower in the endoloop closure group than in the control group; however, the difference was not statistically significant (8% vs. 23%, p = 0.06). Among patients with a resected specimen size
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- 2021
50. Efficacy of polyglycolic acid sheeting with fibrin glue for perforations related to gastrointestinal endoscopic procedures: a multicenter retrospective cohort study
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Toshiro Iizuka, Tomohiko Mannami, Hiroyuki Aoyagi, Shinichiro Hori, Naoyuki Yamaguchi, Hisanobu Saegusa, Kenji Yamazaki, Hiroshi Araki, Hiroyuki Ono, Kengo Takimoto, Yasuaki Nagami, Hirohito Mori, Kingo Hirasawa, Noriko Matsuura, Yoshiko Nakano, Yoji Takeuchi, Yosuke Tsuji, Yoshinori Morita, Noboru Hanaoka, Hideki Kobara, Tamotsu Matsuhashi, and Kohei Takizawa
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medicine.medical_specialty ,Percutaneous ,medicine.diagnostic_test ,business.industry ,Perforation (oil well) ,Retrospective cohort study ,Fibrin Tissue Adhesive ,medicine.disease ,Endoscopy, Gastrointestinal ,Surgery ,Endoscopy ,Catheter ,Treatment Outcome ,Gastrointestinal perforation ,Medicine ,Humans ,Tissue Adhesives ,business ,Fibrin glue ,Polyglycolic Acid ,Abdominal surgery ,Retrospective Studies - Abstract
OBJECTIVES Gastrointestinal (GI) perforations are one of the major adverse events of endoscopic procedures. Polyglycolic acid (PGA) sheets with fibrin glue have been reported to close GI perforations. However, its clinical outcome has not yet been fully investigated; thus, we conducted a multicenter retrospective observational study to assess the efficacy of PGA sheeting for GI perforation. METHODS The medical records of patients who underwent PGA sheeting for endoscopic GI perforations between April 2013 and March 2018 in 18 Japanese institutions were retrospectively analyzed. PGA sheeting was applied when the clip closure was challenging or failed to use. Perforations were filled with one or several pieces of PGA sheets followed by fibrin glue application through an endoscopic catheter. Nasal or percutaneous drainage and endoscopic clipping were applied as appropriate. Clinical outcomes after PGA sheeting for intraoperative or delayed perforations were separately evaluated. RESULTS There were 66 intraoperative and 24 delayed perforation cases. In intraoperative cases, successful closure was attained in 60 cases (91%). The median period from the first sheeting to diet resumption was 6 days (interquartile range [IQR], 4-8.8 days). Large perforation size (≥ 10 mm) and duodenal location showed marginal significant relationship to higher closure failure of intraoperative perforations. In delayed perforation cases, all cases had successful closure. The median period from the first sheeting to diet resumption was 10 days (IQR, 6-37.8 days). No adverse events related to PGA sheeting occurred. CONCLUSION Endoscopic PGA sheeting could be a therapeutic option for GI perforations related to GI endoscopic procedures.
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- 2021
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