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Effectiveness of antibiotic prophylaxis for acute esophageal variceal bleeding in patients with band ligation: A large observational study

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World Journal of Gastroenterology 2024年第3期30卷 238-251页

作者： chikamasa ichita Sayuri Shimizu Tadahiro Goto Uojima Haruki Naoya Itoh Masao Iwagami Akiko Sasaki Gastroenterology Medicine Center Shonan Kamakura General HospitalKamakura 247-8533KanagawaJapan Department of Health Data Science Yokohama City UniversityYokohama 236-0027KanagawaJapan TXP Research TXP Medical Co.Ltd.Chiyoda-ku 101-0042TokyoJapan Department of Clinical Epidemiology and Health Economics School of Public HealthThe University of TokyoBunkyo-ku 113-0033TokyoJapan Department of Genome Medical Sciences Project Research InstituteNational Center for Global Health and MedicineIchikawa 272-8516ChibaJapan Division of Infectious Diseases Aichi Cancer CenterNagoya 464-8681AichiJapan Department of Health Services Research Institute of MedicineUniversity of TsukubaTsukuba 305-8575IbarakiJapan

BACKGROUND Esophageal variceal bleeding is a severe complication associated with liver cirrhosis and typically necessitates endoscopic *** current standard treatment is endoscopic variceal ligation(EVL),and Western guidelines recom-mend antibiotic prophylaxis following ***,given the impro-vements in prognosis for variceal bleeding due to advancements in the management of bleeding and treatments of liver cirrhosis and the global concerns regarding the emergence of multidrug-resistant bacteria,there is a need to reassess the use of routine antibiotic prophylaxis after *** To evaluate the effectiveness of antibiotic prophylaxis in patients treated for *** We conducted a 13-year observational study using the Tokushukai medical database across 46 *** were divided into the prophylaxis group(received antibiotics on admission or the next day)and the non-prophylaxis group(did not receive antibiotics within one day of admission).The primary outcome was composed of 6-wk mortality,4-wk rebleeding,and 4-wk spontaneous bacterial peritonitis(SBP).The secondary outcomes were each individual result and in-hospital mortality.A logistic regression with inverse probability of treatment weighting was used.A subgroup analysis was conducted based on the Child-Pugh classification to determine its influence on the primary outcome measures,while sensitivity analyses for antibiotic type and duration were also *** Among 980 patients,790 were included(prophylaxis:232,non-prophylaxis:558).Most patients were males under the age of 65 years with a median Child-Pugh score of *** composite primary outcomes occurred in 11.2%of patients in the prophylaxis group and 9.5%in the non-prophylaxis *** significant differences in outcomes were observed between the groups(adjusted odds ratio,1.11;95%confidence interval,0.61-1.99;P=0.74).Individual outcomes such as 6-wk mortality,4-wk rebleeding,4-wk onset of SBP,and in-hospital mo

关键词： Esophageal varices Endoscopic hemostasis Antibiotic prophylaxis Liver cirrhosis Inverse probability of treatment weighting

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Giant Brunner's gland hyperplasia of the duodenum successfully resected en bloc by endoscopic mucosal resection: A case report

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World Journal of Gastrointestinal Endoscopy 2024年第6期16卷 368-375页

作者： Makomo Makazu Akiko Sasaki chikamasa ichita Chihiro Sumida Takashi Nishino Miki Nagayama Shinichi Teshima Gastroenterology Medicine Center Shonan Kamakura General HospitalKamakura 247-8533Japan Department of Gastroenterology Shonan Kamakura General HospitalKanagawa 247-8533Japan Department of Pathology Shonan Kamakura General HospitalKamakura 247-8533Japan

BACKGROUND Duodenal Brunner's gland hyperplasia(BGH)is a therapeutic target when complications such as bleeding or gastrointestinal obstruction occur or when malignancy cannot be ruled ***,we present a case of large BGH treated with endoscopic mucosal resection(EMR).CASE SUMMARY An 83-year-old woman presented at our hospital with *** tests revealed severe anemia,esophagogastroduodenoscopy showed a 6.5 cm lesion protruding from the anterior wall of the duodenal bulb,and biopsy revealed the presence of glandular *** ultrasonography(EUS)demonstr-ated relatively high echogenicity with a cystic *** muscularis propria was slightly elevated at the base of the *** was performed without *** formalin-fixed lesion size was 6 cm×3.5 cm×3 cm,showing nodular proliferation of non-dysplastic Brunner's glands compartmentalized by fibrous septa,confirming the diagnosis of *** of EMR or hot snare polypectomy are rare for duodenal BGH>6 *** this case,the choice of EMR was made by obtaining information on the base of the lesion as well as on the internal characteristics through *** Large duodenal lesions with good endoscopic maneuverability and no evident muscular layer involvement on EUS may be resectable via EMR.

关键词： Duodenum Brunner’s gland hyperplasia Brunner’s gland hamartoma Brunner’s gland adenoma Endoscopic mucosal resection Case report

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Clinical features of acute esophageal mucosal lesions and reflux esophagitis Los Angeles classification grade D: A retrospective study

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World Journal of Gastrointestinal Surgery 2023年第3期15卷 408-419页

作者： chikamasa ichita Akiko Sasaki Sayuri Shimizu Department of Gastroenterology Medicine Center Shonan Kamakura General HospitalKamakura 247-8533KanagawaJapan Department of Health Data Science Yokohama City UniversityYokohama 236–0027KanagawaJapan

BACKGROUND Acute esophageal mucosal lesions(AEMLs)are an underrecognized and largely unexplored *** findings are similar,and a higher percentage of AEML could be misdiagnosed as reflux esophagitis Los Angeles classification grade D(RE-D).These diseases could have different pathologies and require different *** To compare AEML and RE-D to confirm that the two diseases are different from each other and to clarify the clinical features of *** We selected emergency endoscopic cases of upper gastrointestinal bleeding with circumferential esophageal mucosal injury and classified them into AEML and RE-D groups according to the mucosal injury’s shape on the oral *** examined patient background,blood sampling data,comorbidities at onset,endoscopic characteristics,and outcomes in each *** Among the emergency cases,the AEML and RE-D groups had 105(3.1%)and 48(1.4%)cases,*** variables exhibited significantly different results,indicating that these two diseases are *** clinical features of AEML consisted of more comorbidities[risk ratio(RR):3.10;95%confidence interval(CI):1.68–5.71;P<0.001]and less endoscopic hemostasis compared with RE-D(RR:0.25;95%CI:0.10–0.63;P<0.001).Mortality during hospitalization was higher in the AEML group(RR:3.43;95%CI:0.82–14.40;P=0.094),and stenosis developed only in the AEML *** AEML and RE-D were clearly distinct diseases with different clinical *** may be more common than assumed,and the potential for its presence should be taken into account in cases of upper gastrointestinal bleeding with comorbidities.

关键词： Acute esophageal mucosal lesion Comorbidities Esophageal reflux Black esophagus Acute necrotizing esophagitis

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Clinical features and progress of ischemic gastritis with high fatalities: Seven case reports

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World Journal of Clinical Cases 2022年第24期10卷 8686-8694页

作者： Kento Shionoya Akiko Sasaki Hidekazu Moriya Karen Kimura Takashi Nishino Jun Kubota Chihiro Sumida Junichi Tasaki chikamasa ichita Makomo Makazu Sakue Masuda Kazuya Koizumi Jun Kawachi ToshitakaTsukiyama Makoto Kako Gastroenterology Medicine Center Shonan Kamakura General HospitalKamakura 247-8533KanagawaJapan Department of General Internal Medicine Shonan Kamakura General HospitalKamakura 247-8533KanagawaJapan Department of General Surgery Shonan Kamakura General HospitalKamakura 247-8533KanagawaJapan Department of Radiology Shonan Kamakura General HospitalKamakura 247-8533Japan

BACKGROUND Ischemic gastritis is a clinically rare and highly fatal disease that occurs when the hemodynamics of a patient with vascular risk is *** diagnosis and treatment are possible only with upper endoscopy after symptom *** report seven cases of ischemic gastritis and its clinical features,prognosis,and indicators that may help in early *** SUMMARY Of the seven patients,six had vascular risk and five died within 2 wk of *** symptoms included hematemesis and *** surgery is a choice for radical treatment,not all patients were *** such patients,conservative treatment was selected,but all of them *** contrast,patients who underwent repeat endoscopy showed improved mucosal findings,suggesting that this improvement may not affect *** ischemic changes such as wall thickening,mural emphysema,and fluid retention in the stomach were observed before diagnosis through endoscopy and computed tomography(CT).The CT scan can be effective for early detection,and improvement in circulatory failure and aggressive treatment may save the lives of patients with this *** The characteristic CT findings enable early detection of ischemic *** diagnosis increases the chance of survival if early therapeutic intervention and improvement of circulatory dynamics can be achieved in this highly fatal disease.

关键词： Celiac artery Gastrointestinal bleeding Ischemic gastritis Superior mesenteric artery Vascular risk Case report

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Comprehensive review on small common bile duct stones

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World Journal of Gastroenterology 2023年第13期29卷 1955-1968页

作者： Sakue Masuda Kazuya Koizumi Kento Shionoya Ryuhei Jinushi Makomo Makazu Takashi Nishino Karen Kimura Chihiro Sumida Jun Kubota chikamasa ichita Akiko Sasaki Masahiro Kobayashi Makoto Kako Uojima Haruki Department of Gastroenterology Shonan Kamakura General HospitalKanagawa 247-8533Japan Department of Gastroenterology Kitasato University School of MedicineKanagawa 252-0375Japan

Common bile duct stones are among the most common conditions encountered by ***,it is well researched;however,some items,such as indications for endoscopic papillary balloon dilatation(EPBD),safety of EPBD and endoscopic sphincterotomy in patients receiving dual antiplatelet therapy or direct oral anticoagulant,selection strategy for retrieval balloons and baskets,lack adequate ***,the guidelines have been updated with new research,while others remain unchanged due to weak *** this review,we comprehensively summarize the standard methods in guidelines and new findings from recent studies on papillary dilation,stone retrieval devices,difficult-to-treat cases,troubleshooting during the procedure,and complicated cases of cholangitis,cholecystolithiasis,or distal biliary stricture.

关键词： Choledocholithotomy Choledocholithiasis Common bile duct stones Endoscopic papillary balloon dilation Endoscopic sphincterotomy Small common bile duct stones

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Comprehensive review on endoscopic ultrasound-guided tissue acquisition techniques for solid pancreatic tumor

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World Journal of Gastroenterology 2023年第12期29卷 1863-1874页

作者： Sakue Masuda Kazuya Koizumi Kento Shionoya Ryuhei Jinushi Makomo Makazu Takashi Nishino Karen Kimura Chihiro Sumida Jun Kubota chikamasa ichita Akiko Sasaki Masahiro Kobayashi Makoto Kako Uojima Haruki Department of Gastroenterology Shonan Kamakura General HospitalKanagawa 247-8533Japan Department of Gastroenterology Internal MedicineKitasato University School of MedicineKanagawa 252-0375Japan

Pancreatic ductal adenocarcinoma is speculated to become the second leading cause of cancer-related mortality by 2030,a high mortality rate considering the number of *** and chemotherapy are the main treatment options,but they are burdensome for patients.A clear histological diagnosis is needed to determine a treatment plan,and endoscopic ultrasound(EUS)-guided tissue acquisition(TA)is a suitable technique that does not worsen the cancer-specific prognosis even for lesions at risk of needle tract *** the development of personalized medicine and precision treatment,there has been an increasing demand to increase cell counts and collect specimens while preserving tissue structure,leading to the development of the fine-needle biopsy(FNB)***-FNB is rapidly replacing EUS-guided fine-needle aspiration(FNA)as the procedure of choice for EUS-TA of pancreatic ***,EUS-FNA is sometimes necessary where the FNB needle cannot penetrate small hard lesions,so it is important clinicians are familiar with *** these recent developments,we present an up-to-date review of the role of EUS-TA in pancreatic ***,technical aspects,such as needle caliber,negative pressure,and puncture methods,for obtaining an adequate specimen in EUS-TA are discussed.

关键词： Endoscopic ultrasound-guided fine needle biopsy Endoscopic ultrasoundguided tissue acquisition Personalized medicine Genomic profiling test Pancreatic cancer Puncture procedure

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Effectiveness of early colonoscopy in patients with colonic diverticular hemorrhage:A single-center retrospective cohort study

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World Journal of Gastrointestinal Endoscopy 2022年第12期14卷 759-768页

作者： chikamasa ichita Sayuri Shimizu Akiko Sasaki Chihiro Sumida Takashi Nishino Karen Kimura Department of Gastroenterology Medicine Center Shonan Kamakura General HospitalKamakura 247-8533KanagawaJapan Department of Health Data Science Yokohama City UniversityYokohama 236-0027KanagawaJapan

BACKGROUND Current guidelines recommend colonoscopy within 24 h for acute lower gastrointestinal bleeding;however,the evidence in support for colonic diverticular hemorrhage(CDH)indications remains *** To investigate the effectiveness of early colonoscopy on the length of hospital stay for CDH *** We conducted a single-center retrospective cohort *** who underwent colonoscopy within 24 h of presentation(early group)were compared with those who underwent colonoscopy beyond 24 h of presentation(elective group).The primary outcome was the length of hospital stay,and secondary outcomes were the identification of stigmata of recent hemorrhage(SRH),rebleeding,red blood cell transfusion more than 4 units,and interventional radiology and abdominal surgery after *** We identified 574 CDH *** were divided into the early(n=328)and elective(n=226)*** propensity score matching,191 pairs were *** length of hospital stay did not significantly differ between the two groups(early group vs elective group;median,7 vs 8 d;P=0.10).The early group had a significantly high identification of SRH(risk difference,11.6%;95%CI:2.7 to 20.3;P=0.02).No significant differences were found in the rebleeding(risk difference,4.7%;95%CI:-4.1 to 13.5;P=0.35),red blood cell transfusion more than 4 units(risk difference,1.6%;95%CI:-7.5 to 10.6;P=0.82),and interventional radiology and abdominal surgery rate after colonoscopy(risk difference,0.5%;95%CI:-2.2 to 3.2;P=1.00).CONCLUSION Early colonoscopy within 24 h,on arrival for CDH,could not improve the length of hospital stay.

关键词： Colonic diverticular hemorrhage Colonic diverticular bleeding Diverticular hemorrhage Diverticular bleeding Early colonoscopy Colonoscopy

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Efficacy of combination therapy with natriuretic and aquaretic drugs in cirrhotic ascites patients: A randomized study

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World Journal of Gastroenterology 2017年第45期23卷 8062-8072页

作者： Haruki Uojima Hisashi Hidaka Tsuyoshi Nakayama Ji Hyun Sung chikamasa ichita Shinnosuke Tokoro Sakue Masuda Akiko Sasaki Kazuya Koizumi Hideto Egashira Makoto Kako Department of Gastroenterology Shonan Kamakura General Hospital Department of Gastroenterology Internal MedicineKitasato University School of Medicine Department of Gastroenterology Shonan Atsugi Hospital

AIM To assess the effects of a combination therapy with natriuretic and aquaretic drugs in cirrhotic ascites *** A two-center,randomized,open-label,prospective study was conducted. Japanese patients who met the criteria were randomized to trial group and the combination diuretic group(received 7.5 mg of tolvaptan) or the conventional diuretic group(received 40 mg of furosemide) for 7 d in addition to the natriuretic drug which was used prior to enrolment in this study. The primary endpoint was the change in body weight from the baseline. Vital signs,fluid intake,and laboratory and urinary data were assessed to determine the pharmacological effects after administration of aquaretic and natriuretic *** A total of 56 patients were randomized to receive either tolvaptan(n = 28) or furosemide(n = 28). In the combination and conventional diuretic groups,the average decrease in body weight from the baseline was 3.21 ± 3.17 kg(P < 0.0001) and 1.75 ± 2.36 kg(P = 0.0006),respectively,when measured on the final dosing day. Following 1 wk of treatment,a significantly greater reduction in body weight was observed in the combination diuretic group compared to that in the conventional diuretic group(P = 0.0412).CONCLUSION Compared to a conventional diuretic therapy with only a natriuretic drug,a combination diuretic therapy with natriuretic and aquaretic drugs is more effective for patients with cirrhotic ascites.

关键词： Tolvaptan 肝肝硬化利尿的效果腹水肝的浮肿

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Condyloma acuminatum of the anal canal,treated with endoscopic submucosal dissection

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World Journal of Gastroenterology 2016年第8期22卷 2636-2641页

作者： Akiko Sasaki Takeshi Nakajima Hideto Egashira Kotaro Takeda Shinnosuke Tokoro chikamasa ichita Sakue Masuda Haruki Uojima Kazuya Koizumi Takeshi Kinbara Taku Sakamoto Yutaka Saito Makoto Kako Gastroenterology Medicine Center Shonan Kamakura General Hospital 1370-1 Okamoto Kamakura Endoscopy Division National Cancer Center Hospital5-1-1 Tsukiji Chuoku Diagnostic Pathology Shonan Kamakura General Hospital 1370-1 Okamoto Kamakura

Condyloma acuminatum(CA) is a common sexually transmitted disease caused by human papilloma virus infection. Not all individuals develop persistent, progressive disease, but careful follow up is required with moderate-to-severe dysplasia to prevent progression to malignancy. Standard therapies include surgical treatments(trans-anal resection and transanal endoscopic microsurgery) and immunotherapeutic and topical methods(topical imiquimod); however, local recurrence remains a considerable problem. Here, we report a case with superficial CA of the anal canal, treated with endoscopic submucosal dissection(ESD). A 28-year-old man presented with a chief complaint of hematochezia. Digital exam did not detect a tumor. Screening colonoscopy revealed 10-mm long, whitish condyles extending from the anal canal to the lower rectum. The lesion covered almost the whole circumference, and only a small amount of normal mucosa remained. Magnifying endoscopy with narrow band imaging showed brownish hairpin-shaped, coiled capillaries. Although histopathological diagnosis by biopsy revealed CA, accurate histological differentiation between CA, papilloma, and squamous cell carcinoma can be difficult with a small specimen. Therefore, weperformed diagnostic ESD, which provides a complete specimen for precise histopathological evaluation. The pathological diagnosis was CA, with moderate dysplasia(anal intraepithelial neoplasia 2). There was no recurrence at 16 mo after the initial ESD. Compared to surgical treatment, endoscopic diagnosis and resection could be performed simultaneously and the tumor margin observed clearly with a magnifying chromocolonoscopy, resulting in less recurrence. These findings suggest that endoscopic resection may be an alternative method for CA that prevents recurrence.

关键词： Condylomata acuminate Recurrence Endoscopy Dissection Carcinoma in situ

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