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Helicobacter pylori associated chronic gastritis,clinical syndromes,precancerous lesions,and pathogenesis of gastric cancer development

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World Journal of Gastroenterology 2014年第18期20卷 5461-5473页

作者： Jiro Watari Nancy Chen Peter S Amenta Hirokazu Fukui Tadayuki Oshima Toshihiko Tomita hiroto miwa Kheng-Jim Lim Kiron M Das Division of Gastroenterology Department of Internal MedicineHyogo College of MedicineNishinomiya 663-8501Japan Division of Gastroenterology and Hepatology Departments of Medicine and PathologyRobert Wood Johnson Medical SchoolRutgersCancer Institute of New JerseyNew BrunswickNJ 08903United States

Helicobacter pylori (H. pylori) infection is well known to be associated with the development of precancerous lesions such as chronic atrophic gastritis (AG), or gastric intestinal metaplasia (GIM), and cancer. Various molecular alterations are identified not only in gastric cancer (GC) but also in precancerous lesions. H. pylori treatment seems to improve AG and GIM, but still remains controversial. In contrast, many studies, including meta-analysis, show that H. pylori eradication reduces GC. Molecular markers detected by genetic and epigenetic alterations related to carcinogenesis reverse following H. pylori eradication. This indicates that these changes may be an important factor in the identification of high risk patients for cancer development. Patients who underwent endoscopic treatment of GC are at high risk for development of metachronous GC. A randomized controlled trial from Japan concluded that prophylactic eradication of H. pylori after endoscopic resection should be used to prevent the development of metachronous GC, but recent retrospective studies did not show the tendency. Patients with precancerous lesions (molecular alterations) that do not reverse after H. pylori treatment, represent the “point of no return” and may be at high risk for the development of GC. Therefore, earlier H. pylori eradication should be considered for preventing GC development prior to the appearance of precancerous lesions.

关键词： Helicobacter pylori Gastric atrophy Intestinal metaplasia Gastric cancer Eradication Prevention Molecular alteration

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Clinical outcomes and risk factors for perforation in gastric endoscopic submucosal dissection: A prospective pilot study

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World Journal of Gastrointestinal Endoscopy 2013年第6期5卷 281-287页

作者： Jiro Watari Toshihiko Tomita Fumihiko Toyoshima Jun Sakurai Takashi Kondo Haruki Asano Takahisa Yamasaki Takuya Okugawa Hisatomo Ikehara Tadayuki Oshima Hirokazu Fukui hiroto miwa Division of Upper Gastroenterology Department of Internal Medicine Hyogo College of Medicine

AIM: To evaluate clinical outcomes and risk factors for endoscopic perforation during endoscopic submucosal dissection (ESD) in a prospective study. METHODS: We investigated the clinical outcomes and risk factors for the development of perforation in 98 consecutive gastric neoplasms undergoing ESD regarding. Demographic and clinical parameters including patient-, tumor-, and treatment-related factors, clinical parameters, and duration of hospital stay were analyzed for risk factors for perforation. In subgroup analysis, we also compared the clinical outcomes between perforation and "silent" free air without endoscopically visible perforation detected only by computed ***: Perforation was identified in 8.2% of patients. All patients were managed conservatively by the administration of antibiotics. The mean procedure time was significantly longer in patients with endoscopic perforation than in those without. According to the receiver-operating characteristic analysis, the resulting cutoff value of the procedure time for perforation was 115 min (87.5% sensitivity, 56.7% specificity). Prolonged procedure time (≥ 115 min) was associated with an increased risk of perforation (odds ratio 9.15; 95%CI: 1.08-77.54; P = 0.04). Following ESD, body temperature and C-reactive protein level were significantly higher in patients with perforation than in those without (P = 0.02), whereas there was no difference between these patient groups on the starting day of oral intake or of hospitalization. In subgroup analysis, the post-ESD clinical course was not different between endoscopic perforation and silent free air. CONCLUSION: Only prolonged procedure time (≥ 115 min) was significantly associated with perforation. The clinical outcomes of perforation are favorable and are comparable to those of patients with or without silent free air.

关键词： Gastric cancer Endoscopic submucosal dissection Perforation Risk factors Treatment outcome

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What types of early gastric cancer are indicated for endoscopic ultrasonography staging of invasion depth?

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World Journal of Gastrointestinal Endoscopy 2016年第16期8卷 558-567页

作者： Jiro Watari Shigemitsu Ueyama Toshihiko Tomita Hisatomo Ikehara Kazutoshi Hori Ken Hara Takahisa Yamasaki Takuya Okugawa Takashi Kondo Tomoaki Kono Katsuyuki Tozawa Tadayuki Oshima Hirokazu Fukui hiroto miwa Division of Gastroenterology Department of Internal Medicine Hyogo College of Medicine Department of Inflammatory Bowel Disease Hyogo College of Medicine

AIM To clarify the diagnostic efficacy and limitations of endoscopic ultrasonography(EUS) and the characteristics of early gastric cancers(EGCs) that are indications for EUS-based assessment of cancer invasion *** We retrospectively investigated the cases of 153 EGC patients who underwent conventional endoscopy(CE) and EUS(20 MHz) before *** We found that 13.7% were "inconclusive" cases with low-quality EUS images, including all nine of the cases with protruded(0-I)-type EGCs. There was no significant difference in the diagnostic accuracybetween CE and EUS. Two significant independent risk factors for misdiagnosis by EUS were identified-ulcer scarring [UL(+); odds ratio(OR) = 4.49, P = 0.003] and non-indication criteria for endoscopic resection(ER)(OR = 3.02, P = 0.03). In the subgroup analysis, 23.1% of the differentiated-type cancers exhibiting SM massive invasion(SM2) invasion(submucosal invasion ≥ 500 μm) by CE were correctly diagnosed by EUS, and 23.1% of the undifferentiated-type EGCs meeting the expanded-indication criteria for ER were correctly diagnosed by *** There is no need to perform EUS for UL(+) EGCs or 0-I-type EGCs, but EUS may enhance the pretreatment staging of differentiated-type EGCs with SM2 invasion without UL or undifferentiated-type EGCs revealed by CE as meeting the expanded-indication criteria for ER.

关键词： Gastric cancer Endoscopic ultrasonography Invasion depth diagnosis Conventional endoscopy Endoscopic submucosal dissection

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Prospective postsurgical capsule endoscopy in patients with Crohn's disease

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World Journal of Gastrointestinal Endoscopy 2014年第3期6卷 88-98页

作者： Tomoaki Kono Nobuyuki Hida Koji Nogami Masaki Iimuro Yoshio Ohda Yoko Yokoyama Koji Kamikozuru Katsuyuki Tozawa Mikio Kawai Tomohiro Ogawa Kazutoshi Hori Hiroki Ikeuchi hiroto miwa Shiro Nakamura Takayuki Matsumoto Department of Lower Gastroenterology Hyogo College of Medicine Department of Surgery Hyogo College of Medicine Department of Upper Gastroenterology Hyogo College of Medicine

AIM: To clarify the usefulness of postsurgical capsule endoscopy(CE) in the diagnosis of recurrent small bowel lesions of Crohn's disease(CD). METHODS: This prospective study included 19 patients who underwent ileocolectomy or partial ileal resection for CD. CE was performed 2-3 wk after surgery to check for the presence/absence and severity of lesions remaining in the small bowel, and for any recurrence at the anastomosed area. CE was repeated 6-8 mo after surgery and the findings were compared with those obtained shortly after surgery. The Lewis score (LS) was used to evaluate any inflammatory changes of the small bowel. RESULTS: One patient was excluded from analysis because of insufficient endoscopy data at the initial CE. The total LS shortly after surgery was 428.3 on average(median, 174; range, 8-4264), and was ≥ 135(active stage) in 78%(14 of 18) of the patients. When the remaining unresected small bowel was divided into 3 equal portions according to the transition time(proximal, middle, and distal tertiles), the mean LS was 286.6, 83.0, and 146.7, respectively, without any significant difference. Ulcerous lesions in the anastomosed area were observed in 83% of all patients. In 38% of the 13 patients who could undergo CE again after 6-8 mo, the total LS was higher by ≥ 100 than that recorded shortly after surgery, thus indicating a diagnosis of endoscopic progressive recurrence. CONCLUSION: Our pilot study suggests that CE can be used to objectively evaluate the postoperative recurrence of small bowel lesions after surgery for CD.

关键词： Crohn’s disease Postoperative recurrence Capsule endoscopy Lewis score Small bowel

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Diagnosis of small intramucosal signet ring cell carcinoma of the stomach by non-magnifying narrow-band imaging: A pilot study

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World Journal of Gastrointestinal Endoscopy 2015年第12期7卷 1070-1077页

作者： Jiro Watari Toshihiko Tomita Hisatomo Ikehara Masato Taki Tomohiro Ogawa Takahisa Yamasaki Takashi Kondo Fumihiko Toyoshima Jun Sakurai Tomoaki Kono Katsuyuki Tozawa Yoshio Ohda Tadayuki Oshima Hirokazu Fukui Seiichi Hirota hiroto miwa Division of Gastroenterology Department of Internal Medicine Hyogo College of Medicine NishinomiyaHyogo 663-8501 Japan Department of Surgical Pathology Hyogo College of Medicine Nishinomiya Hyogo 663-8501 Japan Division of Gastroenterology Department of Internal Medicine Hyogo College of MedicineNishinomiyaHyogo 663-8501 Japan

AIM: To examine the efficacy of non-magnifying narrow-band imaging(NM-NBI) imaging for small signet ring cell carcinoma(SRC).METHODS: We retrospectively analyzed 14 consecutive small intramucosal SRCs that had been treated with endoscopic submucosal dissection(ESD) and 14 randomly selected whitish gastric ulcer scars(control). The strength and shape of the SRCs and whitish scars by NM-NBI and white-light imaging(WLI) were assessed with Image J(NIH, Bethesda).RESULTS: NM-NBI findings of SRC showed a clearly isolated whitish area amid the brown color of the surrounding normal mucosa. The NBI index, which indicates the potency of NBI for visualizing SRC, was significantly higher than the WLI index(P = 0.001), indicating SRC was more clearly identified by NM-NBI. Although the NBI index was not significantly different between SRCs and controls, the circle(C)-index, as an index of circularity of tumor shape, was significantly higher in SRCs(P = 0.001). According to the receiveroperating characteristic analysis, the resulting cut-off value of the circularity index(C-index) for SRC was 0.60(85.7% sensitivity, 85.7% specificity). Thus a lesion with a C-index ≥ 0.6 was significantly more likely to be an SRC than a gastric ulcer scar(OR = 36.0; 95%CI: 4.33-299.09; P = 0.0009).CONCLUSION: Small isolated whitish round area by NM-NBI endoscopy is a useful finding of SRCs which is the indication for ESD.

关键词： Gastric cancer Signet ring cell carcinoma Narrow-b

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Histological diagnosis of gastric submucosal tumors: A pilot study of endoscopic ultrasonography-guided fine-needle aspiration biopsy vs mucosal cutting biopsy

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World Journal of Gastrointestinal Endoscopy 2015年第14期7卷 1142-1149页

作者： Hisatomo Ikehara Zhaoliang Li Jiro Watari Masato Taki Tomohiro Ogawa Takahisa Yamasaki Takashi Kondo Fumihiko Toyoshima Tomoaki Kono Katsuyuki Tozawa Yoshio Ohda Toshihiko Tomita Tadayuki Oshima Hirokazu Fukui Ikuo Matsuda Seiichi Hirota hiroto miwa Division of Gastroenterology Department of Internal Medicine Hyogo College of Medicine Department of Surgical Pathology Hyogo College of Medicine

AIM: To compare the usefulness of endoscopic ultrasonography-guided fine-needle aspiration biopsy(EUS-FNAB) without cytology and mucosal cutting biopsy(MCB) in the histological diagnosis of gastric submucosal tumor(SMT).METHODS: We prospectively compared the diagnostic yield, feasibility, and safety of EUS-FNAB and those of MCB based on endoscopic submucosal dissection. The cases of 20 consecutive patients with gastric SMT ≥1 cm in diameter. who underwent both EUS-FNAB and MCB were ***: The histological diagnoses were gastrointestinal stromal tumors(n = 7), leiomyoma(n =6), schwannoma(n = 2), aberrant pancreas(n = 2), and one case each of glomus tumor, metastatic hepatocellular carcinoma, and no-diagnosis. The tumors' mean size was 23.6 mm. Histological diagnosis was made in 65.0% of the EUS-FNABs and 60.0% of the MCBs, a nonsignificant difference. There were no significant differences in the diagnostic yield concerning the tumor location or tumor size between the two methods. However, diagnostic specimens were significantly more frequently obtained in lesions with intraluminal growth than in those with extraluminal growth by the MCB method(P = 0.01). All four SMTs with extraluminal growth were diagnosed only by EUSFNAB(P = 0.03). No complications were found in either ***: MCB may be chosen as an alternative diagnostic modality in tumors showing the intraluminal growth pattern regardless of tumor size, whereas EUSFNAB should be performed for SMTs with extraluminal growth.

关键词： Submucosal tumor Endoscopic ultrasonography-guided

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