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Usefulness of a novel slim type Flush Knife-BT over conventional Flush Knife-BT in esophageal endoscopic submucosal dissection

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World Journal of Gastroenterology 2017年第9期23卷 1657-1665页

作者： Yoshiko Ohara Takashi Toyonaga Namiko Hoshi Shinwa Tanaka Shinichi Baba Hiroshi Takihara Fumiaki Kawara Tsukasa Ishida Yoshinori Morita eiji umegaki Takeshi Azuma Division of Gastroenterology Department of Internal MedicineGraduate School of MedicineKobe University Department of Endoscopy Kobe University Hospital Department of Endoscopy Kishiwada Tokushukai Hospital

AIM To investigated the usefulness of a novel slim type balltipped Flush Knife (Flush Knife-BTS) over ball-tipped Flush Knife (Flush Knife-BT) in functional experiments and clinical practice.METHODS In order to evaluate the functionality of Flush KnifeBTS, water aspiration speed, resistance to knife insertion through the scope, and waterjet flushing speed were compared between Flush Knife-BTS and BT. In clinical practice, esophageal endoscopic submucosal dissection (ESD) performed using Flush Knife-BTS or BT by an experienced endoscopist between October 2015 and January 2016 were retrospectively reviewed. The treatment speed and frequency of removing and reinserting the knife to aspirate fluid and air during ESD sessions were analyzed.RESULTS Functional experiments revealed that water aspiration speed by the endoscope equipped with a 2.8-mm working channel with Flush Knife-BTS was 7.7-fold faster than that with conventional Flush Knife-BT. Resistance to knife insertion inside the scope with a 2.8-mm working channel was reduced by 40% with FlushK nife-BTS. The waterjet flushing speed was faster with the use of Flush Knife-BT. In clinical practice, a comparison of 6 and 7 ESD using Flush Knife-BT and BTS, respectively, revealed that the median treatment speed was 25.5 mm2/min (range 19.6-30.3) in the BT group and 44.2 mm2/min(range 15.5-55.4) in the BTS group (P = 0.0633). However, the median treatment speed was significantly faster with Flush Knife-BTS when the resection size was larger than 1000 m2(n = 4, median 24.2 mm2/min, range 19.6-27.7 vs n = 4, median 47.4 mm2/min, range 44.2-55.4, P = 0.0209). The frequency of knife replacement was less in the BTS group (median 1.76 times in one hour, range 0-5.45) than in the BT group (7.02 times in one hour, range 4.23-15)(P = 0.0065).CONCLUSION Our results indicate that FlushK nife-BTS enhances the performance of ESD, particularly for large lesions, by improving air and fluid aspiration and knife insertion during ESD and reducing the frequency of knife removal and rein

关键词：内视镜的 submucosal 解剖新奇细长的类型付小费给球的 FlushKnife 付小费给球的 FlushKnife 抵抗到刀插入浇渴望速度

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Gastric plexiform fibromyxoma resected by endoscopic submucosal dissection after observation of chronological changes:A case report

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World Journal of Gastrointestinal Oncology 2017年第6期9卷 263-267页

作者： Fumiaki Kawara Shinwa Tanaka Takashi Yamasaki Yoshinori Morita Yoshiko Ohara Yoshihiro Okabe Namiko Hoshi Takashi Toyonaga eiji umegaki Hiroshi Yokozaki Takanori Hirose Takeshi Azuma Division of Gastroenterology Department of Internal MedicineKobe University Graduate School of Medicine Division of Pathology Department of PathologyKobe University Graduate School of Medicine Department of Diagnostic Pathology Hyogo Cancer Center

A 66-year-old man was diagnosed with a gastric submucosal tumor. Endoscopic ultrasound(EUS) revealed an iso/hypoechoic mass in the third layer. No malignant cells were detected in a histological examination. Yearly follow-up endoscopy and EUS showed the slow growth of the tumor. Endoscopic submucosal dissection(ESD) was performed and a glistening tumor was resected. The lesion showed a multinodular plexiform growth pattern consisting of spindle cells with an abundant fibromyxoid stroma that was rich in small vessels. The tumor was diagnosed as plexiform fibromyxoma(PF) by immunohistochemistry. Although difficulties are associated with reaching a diagnosis preoperatively, chronological changes on EUS may contribute to the diagnosis of PF. ESD may also be useful in the diagnosis and treatment of PF.

关键词： Plexiform fibromyxoma Plexiform angiomyxoid myofibroblastic 肿瘤内视镜的超声内视镜的 submucosal 解剖胃肠的 stromal 肿瘤

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Efficacy of forced coagulation with low high-frequency power setting during endoscopic submucosal dissection

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World Journal of Gastroenterology 2017年第29期23卷 5422-5430页

作者： Tsukasa Ishida Takashi Toyonaga Yoshiko Ohara Tadao Nakashige Yasuaki Kitamura Ryusuke Ariyoshi Hiroshi Takihara Shinichi Baba Tetsuya Yoshizaki Fumiaki Kawara Shinwa Tanaka Yoshinori Morita eiji umegaki Namiko Hoshi Takeshi Azuma Division of Gastroenterology Department of Internal Medicine Graduate School of Medicine Kobe University Department of Endoscopy Kobe University Hospital Department of Endoscopy Kishiwada Tokushukai Hospital

AIM To investigated the hemostatic ability of the S and F1-10 methods in clinical and ex vivo studies.METHODS The hemostatic abilities of the two methods were analyzed retrospectively in all six gastric endoscopic submucosal dissection cases. The treated vessel diameter, compressed vessel frequency, and bleeding frequency after cutting the vessels were noted by therecorded videos. The coagulation mechanism of the two power settings was evaluated using the data recording program and histological examination on macro-and microscopic levels in the ex vivo experiments using porcine tissues.RESULTS F1-10 method showed a significantly better hemostatic ability for vessels ≥ 2 mm in diameter and a trend of overall better coagulation effect, evaluated by the bleeding rate after cutting the vessels. F1-10 method could sustain electrical current longer and effectively coagulate the tissue wider and deeper than the S method in the porcine model.CONCLUSION F1-10 method is suggested to achieve a stronger hemostatic effect than the S method in clinical procedures and ex vivo models.

关键词：内视镜的 submucosal 解剖电外科学 Endoknife 止血效果强迫的凝结模式

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Feasibility and safety of endoscopic submucosal dissection for lower rectal tumors with hemorrhoids

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World Journal of Gastroenterology 2016年第27期22卷 6268-6275页

作者： Shinwa Tanaka Takashi Toyonaga Yoshinori Morita Namiko Hoshi Tsukasa Ishida Yoshiko Ohara Tetsuya Yoshizaki Fumiaki Kawara eiji umegaki Takeshi Azuma Department of Endoscopy Kobe University Hospital Division of Gastroenterology Department of Internal Medicine Graduate School of Medicine Kobe University

AIM: To evaluate the feasibility and safety of endoscopic submucosal dissection(ESD) for lower rectal lesions with hemorrhoids.METHODS: The outcome of ESD for 23 lesions with hemorrhoids(hemorrhoid group) was compared with that of 48 lesions without hemorrhoids extending to the dentate line(non-hemorrhoid group) during the same study period. RESULTS: Median operation times(ranges) in the hemorrhoid and non-hemorrhoid groups were 121(51-390) and 130(28-540) min. The en bloc resection rate and the curative resection rate in the hemorrhoid group were 96% and 83%, and they were 100% and 90% in the non-hemorrhoid group, respectively. In terms of adverse events, perforation and postoperative bleeding did not occur in both groups. In terms of the clinical course of hemorrhoids after ESD, the rate of complete recovery of hemorrhoids after ESD in lesions with resection of more than 90% was significantly higher than that in lesions with resection of less than 90%.CONCLUSION: ESD on lower rectal lesions with hemorrhoids could be performed safely, similarly to that on rectal lesions extending to the dentate line without hemorrhoids. In addition, all hemorrhoids after ESD improved to various degrees, depending on the resection range.

关键词： Endoscopic submucosal dissection Rectum Hemorrhoid Outcome Bleeding

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Maintenance for healed erosive esophagitis:PhaseⅢcomparison of vonoprazan with lansoprazole

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World Journal of Gastroenterology 2018年第14期24卷 1550-1561页

作者： Kiyoshi Ashida Katsuhiko Iwakiri Naoki Hiramatsu Yuuichi Sakurai Tetsuharu Hori Kentarou Kudou Akira Nishimura eiji umegaki Department of Gastroenterology Rakuwakai Otowa HospitalKyoto 607-8062Japan Department of Gastroenterology Nippon Medical School Graduate School of MedicineTokyo 113-8603Japan Department of Gastroenterology and Hepatology Osaka Rosai HospitalSakaiOsaka 591-8025Japan Takeda Pharmaceutical Company Limited Osaka 540-8645Japan Department of Gastroenterology Kobe University Graduate School of MedicineKobeHyogo 650-0017Japan

AIM To compare vonoprazan 10 and 20 mg vs lansoprazole 15 mg as maintenance therapy in healed erosive esophagitis(EE).METHODS A total of 607 patients aged ≥ 20 years, with endoscopically-confirmed healed EE following 8 wk of treatment with vonoprazan 20 mg once daily, were randomized 1:1:1 to receive lansoprazole 15 mg(n = 201), vonoprazan 10 mg(n = 202), or vonoprazan 20 mg(n = 204), once daily. The primary endpoint of the study was the rate of endoscopically-confirmed EE recurrence during a 24-wk maintenance period. The secondary endpoint was the EE recurrence rate at Week 12 during maintenance treatment. Additional efficacy endpoints included the incidence of heartburn and acid reflux, and the EE healing rate 4 wk after the initiation of maintenance treatment. Safety endpoints comprised adverse events(AEs), vital signs, electrocardiogram findings, clinical laboratory results, serum gastrin and pepsinogen Ⅰ/Ⅱ levels, and gastric mucosa histopathology results.RESULTS Rates of EE recurrence during the 24-wk maintenance period were 16.8%, 5.1%, and 2.0% with lansoprazole 15 mg, vonoprazan 10 mg, and vonoprazan 20 mg, respectively. Vonoprazan was shown to be non-inferior to lansoprazole 15 mg(P < 0.0001 for both doses). In a post-hoc analysis, EE recurrence at Week 24 was significantly reduced with vonoprazan at both the 10 mg and the 20 mg dose vs lansoprazole 15 mg(5.1% vs 16.8%, P = 0.0002, and 2.0% vs 16.8%, P < 0.0001, respectively); by contrast, the EE recurrence rate did not differ significantly between the two doses of vonoprazan(P = 0.1090). The safety profiles of vonoprazan 10 and 20 mg were similar to that of lansoprazole 15 mg in patients with healed EE. Treatment-related AEs were reported in 11.4%, 10.4%, and 10.3% of patients in the lansoprazole 15 mg, vonoprazan 10 mg, and vonoprazan 20 mg arms, respectively.CONCLUSION Our findings confirm the non-inferiority of vonoprazan 10 and 20 mg to lansoprazole 15 mg as maintenance therapy for patients with healed EE.

关键词： Gastroesophageal reflux disease Erosive esophagitis Lansoprazole Potassium-competitive acid blockers Vonoprazan Maintenance therapy

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Effects of oral tacrolimus as a rapid induction therapy in ulcerative colitis

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World Journal of Gastroenterology 2015年第6期21卷 1880-1886页

作者： Ken Kawakami Takuya Inoue Mitsuyuki Murano Ken Narabayashi Sadaharu Nouda Kumi Ishida Yosuke Abe Koji Nogami Nobuyuki Hida Hirokazu Yamagami Kenji Watanabe eiji umegaki Shiro Nakamura Tetsuo Arakawa Kazuhide Higuchi Second Department of Internal Medicine Osaka Medical College Division of Lower Gastroenterology Department of Internal Medicine Hyogo College of Medicine Department of Gastroenterology Osaka City University Graduate School of Medicine

AIM:To determine the efficacy and safety of rapid induction therapy with oral tacrolimus without a meal in steroid-refractory ulcerative colitis(UC)patients.METHODS:This was a prospective,multicenter,observational study.Between May 2010 and August 2012,49 steroid-refractory UC patients(55 flare-ups)were consecutively enrolled.All patients were treated with oral tacrolimus without a meal at an initial dose of 0.1mg/kg per day.The dose was adjusted to maintain trough whole-blood levels of 10-15 ng/m L for the first 2 wk.Induction of remission at 2 and 4 wk after tacrolimus treatment initiation was evaluated using Lichtiger’s clinical activity index(CAI).RESULTS:The mean CAI was 12.6±3.6 at onset.Within the first 7 d,93.5%of patients maintained high trough levels(10-15 ng/m L).The CAI significantly decreased beginning 2 d after treatment initiation.At 2wk,73.1%of patients experienced clinical responses.After tacrolimus initiation,31.4%and 75.6%of patients achieved clinical remission at 2 and 4 wk,respectively.Treatment was well tolerated.CONCLUSION:Rapid induction therapy with oral tacrolimus shortened the time to achievement of appropriate trough levels and demonstrated a high remission rate 28 d after treatment initiation.Rapid induction therapy with oral tacrolimus appears to be a useful therapy for the treatment of refractory UC.

关键词： Ulcerative colitis Tacrolimus Rapid induction ther

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Clinical effects of adalimumab treatment with concomitant azathioprine in Japanese Crohn's disease patients

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World Journal of Gastroenterology 2013年第17期19卷 2676-2682页

作者： Kumi Ishida Takuya Inoue Kaori Fujiwara Taisuke Sakanaka Ken Narabayashi Sadaharu Nouda Toshihiko Okada Kazuki Kakimoto Takanori Kuramoto Ken Kawakami Yosuke Abe Toshihisa Takeuchi Mitsuyuki Murano Satoshi Tokioka eiji umegaki Kazuhide Higuchi the Second Department of Internal Medicine Osaka Medical College Takatsuki City

AIM:To assess adalimumab's efficacy with concomitant azathioprine (AZA) for induction and maintenance of clinical remission in Japanese Crohn's disease (CD) patients. METHODS:This retrospective, observational, singlecenter study enrolled 28 consecutive CD patients treated with adalimumab (ADA). Mean age and mean disease duration were 38.1 ± 11.8 years and 11.8 ± 10.1 years, respectively. The baseline mean Crohn's disease activity index (CDAI) and C-reactive protein were 177.8 ± 82.0 and 0.70 ± 0.83 mg/dL, respectively. Twelve of these patients also received a concomitant stable dose of AZA. ADA was subcutaneously administered:160 mg at week 0, 80 mg at week 2, followed by 40 mg every other week. Clinical response and remission rates were assessed via CDAI and C-reactive protein for 24 wk. RESULTS:The mean CDAI at weeks 2, 4, 8, and 24 was 124.4, 120.2, 123.6, and 135.1, respectively. The CDAI was significantly decreased at weeks 2 and 4 with ADA and was significantly suppressed at 24 wk with ADA/AZA. Overall clinical remission rates at weeks 4 and 24 were 66.7% and 63.2%, respectively. Although no statistically significant difference in C-reactive protein was demonstrated, ADA with AZA resulted in a greater statistically significant improvement in CDAI at 24 wk, compared to ADA alone. CONCLUSION:Scheduled ADA with concomitant AZA may be more effective for clinical remission achievement at 24 wk in Japanese Crohn's disease patients.

关键词： Crohn’s disease Adalimumab Immunomodulator Azathioprine Inflammatory bowel disease

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Enzyme-linked immunosorbent assay of 3 Screen Islet Cell Autoantibody in patients with autoimmune thyroid disease

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World Journal of Diabetes 2024年第5期15卷 935-944页

作者： eiji Kawasaki Hidekazu Tamai Takahiro Fukuyama Yoko Sagara Ryutaro Hidaka Aira Uchida Masayuki Tojikubo Narihito Tatsumoto Yuko Akehi Yuji Hiromatsu The Diabetes Thyroid and Endocrine CenterShin-Koga HospitalKurume 830-8577Japan

BACKGROUND In recent years,the emergence of multiplex technology that can simultaneously measure multiple anti-islet autoantibodies has become particularly valuable for the staging and early diagnosis of immune-mediated type 1 diabetes(T1D).While it has been established that 20%-30%of T1D patients suffer from autoimmune thyroid disease(AITD),there is limited available data regarding the presence of anti-islet autoantibodies in AITD patients.Among commercially available anti-islet autoantibodies,glutamic acid decarboxylase 65 autoantibodies(GADAs)are often the first marker measured in general clinical practice.AIM To investigate the frequency of anti-islet autoantibodies in AITD patients.METHODS Our study involved four hundred ninety-five AITD patients,categorized into three distinct groups:AITD with T1D(n=18),AITD with phenotypic type 2 diabetes(T2D)(n=81),and AITD without diabetes(n=396),and the enzyme-linked immunosorbent assay(ELISA)was employed to determine the frequencies of 3 Screen Islet Cell Autoantibody(3 Screen ICA),GADA,insulinoma-associated antigen-2 autoantibodies(IA-2As),and zinc transporter 8 autoantibodies(ZnT8As)within these groups.RESULTS The frequency of 3 Screen ICA in AITD patients with T1D,T2D,and those without diabetes were 88.9%,6.2%,and 5.1%,respectively,with no significant difference seen between the latter two groups.Notably,the frequency of 3 Screen ICA was 11.1%higher in AITD patients with T1D,1.3%higher in AITD patients with T2D,and 1.1%higher in AITD patients without diabetes compared to GADA,respectively.Furthermore,12.5%,20.0%,and 20.0%of the 3 Screen ICA-positive patients were negative for GADA.Additionally,1.3%of the AITD patients who tested negative for 3 Screen ICA in both the AITD with T2D and non-diabetic AITD groups were found to be positive for individual autoantibodies.Among the 3 Screen ICA-positive patients,there was a significantly higher proportion of individuals with multiple autoantibodies in AITD patients with T1D compared to those without diabetes(37.5%vs 5.0%,P<0

关键词： Anti-islet autoantibodies Autoimmune thyroid disease Real-world practice Retrospective study Type 1 diabetes

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Postoperative functional evaluation of gastrectomy for gastric cancer

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Chinese Journal of Cancer Research 2022年第6期34卷 567-574页

作者： eiji Nomura Department of Gastroenterological and General Surgery Tokai University Hachioji HospitalTokyo 192-0032Japan

To improve the quality of surgical procedures for gastric cancer,it is essential to consider many components comprehensively,including gastric motility,small intestinal absorption,hormones that affect gastric motility and appetite,presence or absence of vagus nerve preservation,esophageal regurgitation on endoscopic findings,in addition to whether or not there is a physiological route for food passage through the duodenum.Furthermore,proper functional evaluation cannot be performed without considering the form and amount of energy in the nutritional supplement to be loaded,and the posture at the time of investigation.The results of functional evaluation vary according to the method selected from many available options,but we believe that use of the most physiologically accurate,appropriate and selectable option will enable us to arrive at the best resection/reconstruction technique.We have reported that it is important to consider the preservation of three elements when performing gastrectomy:1)reduction of the extent of gastrectomy,2)preservation of the pylorus,and 3)preservation of the vagus nerve;among which preservation of the remnant stomach is the most important.Furthermore,the selection of a reconstruction method that maintains secretion of hormones beneficial to gastric motility preserves the energy balance inherent in the human body,and also provides better quality of life.

关键词： Gastric cancer gastrectomy functional evaluation

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Dilute long period stacking/order(LPSO)-variant phases along the composition gradient in a Mg-Ho-Cu alloy

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Journal of Magnesium and Alloys 2022年第6期10卷 1573-1580页

作者： Kai Guan Daisuke Egusa eiji Abe Department of Materials Science and Engineering The University of TokyoTokyo 113-8656Japan Research Center for Structural Materials National Institute for Materials ScienceTsukuba 305-0047Japan

We have systematically investigated the microstructures of as-cast Mg_(97.49)Ho_(1.99)Cu_(0.43)Zr_(0.09)alloy by atomic resolution high-angle annular dark field scanning transmission electron microscopy(HAADF-STEM), revealing the coexistence of 18R, 14H and 24R long period stacking/order(LPSO) phases with fully coherent interfaces along step-like composition gradient in a blocky intermetallic compound distributed at grain boundary. The short-range order(SRO) L1_(2)-type Cu_(6)Ho_(8)clusters embedded across AB’C’A-stacking fault layers are directly revealed at atomic scale. Importantly, the order degree of SRO clusters in the present dilute alloy is significant lower than previous 6M and 7M in-plane order reported in ternary Mg-TM(transition metal)-RE(rare earth) alloys, which can be well matched by 9M in-plane order. This directly demonstrates that SRO in-plane L1_(2)-type clusters can be expanded into more dilute composition regions bounded along the definite TM/RE ratio of 3/4. In addition, the estimated chemical compositions of solute enriched stacking fault(SESF) in all LPSO variants are almost identical with the ideal SESF composition of 9M in-plane order, regardless of the type of LPSO phases. The results further support the viewpoint that robust L1_(2)-type TM_(6)RE_(8)clusters play an important role in governing LPSO phase formation.

关键词： Magnesium alloys Long period stacking/order(LPSO)phases Short-range order(SRO)clusters High-angle annular dark field scanning transmission electron microscopy(HAADF-STEM)

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