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World Journal of Gastroenterology 2020年第34期26卷 5146-5155页

作者： Osamu Toyoshima Toshihiro Nishizawa Shuntaro Yoshida Yoshiki sakaguchi Yousuke Nakai Hidenobu Watanabe Hidekazu Suzuki Chizu Tanikawa Koichi Matsuda kazuhiko Koike Department of Gastroenterology Toyoshima Endoscopy ClinicTokyo 157-0066Japan Department of Gastroenterology Graduate School of MedicineThe University of TokyoTokyo 113-8655Japan Department of Gastroenterology and Hepatology International University of Health and WelfareNarita HospitalChiba 286-8520Japan Department of Endoscopy and Endoscopic Surgery Graduate School of MedicineThe University of TokyoTokyo 113-8655Japan Department of Pathology Pathology and Cytology Laboratory JapanTokyo 166-0003Japan Department of Gastroenterology and Hepatology Tokai University School of MedicineKanagawa 259-1193Japan Laboratory of Molecular Medicine Human Genome CenterInstitute of Medical ScienceThe University of TokyoTokyo 108-8639Japan Department of Computational Biology and Medical Sciences Laboratory of Clinical Genome SequencingGraduate School of Frontier SciencesThe University of TokyoTokyo 108-8639Japan

BACKGROUND Endoscopy-based Kyoto classification for gastritis and pathological topographic distribution of neutrophil infiltration are correlated with gastric cancer *** To investigate the association between Kyoto classification and the topographic distribution of neutrophil *** Kyoto classification score,ranging from 0 to 8,consisted of atrophy,intestinal metaplasia,enlarged folds,nodularity,and diffuse *** activity was scored according to the updated Sydney System using biopsy samples obtained from the greater curvature of the corpus and the *** participants were divided into four categories,inactive stomach,antrumpredominant gastritis,pangastritis,and corpus-predominant gastritis,based on the topographic distribution of neutrophil *** of sex,age,body mass index,drinking habit,smoking habit,family history of gastric cancer,serum Helicobacter pylori(***)antibody,and Kyoto score on topography of neutrophil infiltration were *** A total of 327 patients(comprising 50.7%women,with an average age of 50.2 years)were enrolled in this *** infection rate was 82.9%with a mean Kyoto score of *** Kyoto score was associated with the topographic distribution of neutrophil *** scores were significantly higher in the order of inactive stomach,antrum-predominant gastritis,pangastritis,and corpuspredominant gastritis(3.05,4.57,5.21,and 5.96,respectively).Each individual score of endoscopic findings(i.e.,atrophy,intestinal metaplasia,enlarged folds,nodularity,and diffuse redness)was correlated with the topographic distribution of neutrophil *** multivariate analysis,the Kyoto score,age,and serum *** antibody were independently associated with the topographic distribution of neutrophil *** The Kyoto classification score was associated with the topographic distribution of neutrophil activity.

关键词： Kyoto classification Helicobacter pylori Neutrophil activity Updated Sydney System Gastritis Gastric cancer Endoscopy Pathology

Endoscopic diagnosis for colorectal sessile serrated lesions

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World Journal of Gastroenterology 2021年第13期27卷 1321-1329页

作者： Toshihiro Nishizawa Shuntaro Yoshida Akira Toyoshima Tomoharu Yamada Yoshiki sakaguchi Taiga Irako Hirotoshi Ebinuma Takanori Kanai kazuhiko Koike Osamu Toyoshima Department of Gastroenterology and Hepatology International University of Health and Welfare Narita HospitalNarita 2868520Japan Department of Gastroenterology Toyoshima Endoscopy ClinicTokyo 1570066Japan Department of Colorectal Surgery Japanese Red Cross Medical CenterTokyo 1508935Japan Department of Gastroenterology The University of TokyoTokyo 1138655Japan Department of Gastroenterology Graduate School of MedicineThe University of TokyoTokyo 1138655Japan Department of Internal Medicine Irako ClinicTokyo 1560052Japan Division of Gastroenterology and Hepatology Department of Internal MedicineKeio University School of MedicineShinjuku-ku 1608582TokyoJapan

BACKGROUND Hyperplastic polyps are considered non-neoplastic, whereas sessile serrated lesions(SSLs) are precursors of cancer via the ‘‘serrated neoplastic pathway’’. The clinical features of SSLs are tumor size(> 5 mm), location in the proximal colon, coverage with abundant mucus called the ‘‘mucus cap’’, indistinct borders, and a cloud-like surface. The features in magnifying narrow-band imaging are varicose microvascular vessels and expanded crypt openings. However, accurate diagnosis is often *** To develop a diagnostic score system for *** We retrospectively reviewed consecutive patients who underwent endoscopic resection during colonoscopy at the Toyoshima endoscopy clinic. We collected data on serrated polyps diagnosed by endoscopic or pathological examination. The significant factors for the diagnosis of SSLs were assessed using logistic regression analysis. Each item that was significant in multivariate analysis was assigned 1 point, with the sum of these points defined as the endoscopic SSL diagnosis score. The optimal cut-off value of the endoscopic SSL diagnosis score was determined by receiver-operating characteristic curve *** Among 1288 polyps that were endoscopically removed, we analyzed 232 diagnosed as serrated polyps by endoscopic or pathological examination. In the univariate analysis, the location(proximal colon), size(> 5 mm), mucus cap, indistinct borders, cloud-like surface, and varicose microvascular vessels were significantly associated with the diagnosis of SSLs. In the multivariate analysis, size(> 5 mm;P = 0.033), mucus cap(P = 0.005), and indistinct borders(P = 0.033) were independently associated with the diagnosis of SSLs. Size > 5 mm, mucus cap, and indistinct borders were assigned 1 point each and the sum of these points was defined as the endoscopic SSL diagnosis score. The receiver-operating characteristic curve analysis showed an optimal cut-off score of 3, which predicted pathological SSLs with 75

关键词： Sessile serrated lesion Mucus cap Indistinct borders Hyperplastic polyp Endoscopic features Size

Gender differences of low-dose aspirin-associated gastroduodenal ulcer in Japanese patients

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World Journal of Gastroenterology 2010年第15期16卷 1896-1900页

作者： Kazuhisa Okada Masahiko Inamori Kento Imajyo Hideyuki Chiba Takashi Nonaka Tadahiko Shiba Takashi sakaguchi kazuhiko Atsukawa Hisao Takahashi Etsuo Hoshino Atsushi Nakajima Department of Gastroenterology and Hepatology Hiratsuka City Hospital Gastroenterology Division Yokohama City University School of Medicine Division of Endoscopy Cancer Institute Hospital of Japanese Foundation for Cancer Research

AIM:To clarify the gender differences about the clini-cal features and risk factors of low-dose aspirin (LDA) (81-100 mg daily)-associated peptic ulcer in Japanese ***: There were 453 patients under treatment with LDA (298 males, 155 females) who underwent esophagogastroduodenoscopy at the Department of Gastroenterology and Hepatology of Hiratsuka City Hospital between January 2003 and December 2007. They had kept taking the LDA or started treatmentduring the study period and kept taking LDA during the whole period of observation. Of these, 119 patients (87 males, 32 females) were diagnosed as having LDA-associated peptic ulcer. We examined the clinical factors associated with LDA-associated peptic ulcer in both ***: A history of peptic ulcer was found to be the risk factor for LDA-associated peptic ulcer common to both sexes. In female patients, age greater than 70 years (prevalence ORs 8.441, 95% CI: 1.797-33.649, P = 0.0069) was found to be another significant risk fac-tor, and the time to diagnosis as having LDA-associat-ed peptic ulcer by endoscopy was significantly shorter than that in the male patients (P = 0.0050). CONCLUSION: We demonstrated gender differences about the clinical features and risk factors of LDA-asso-ciated peptic ulcer. Special attention should be paid to aged female patients taking LDA.

关键词： Low-dose aspirin Gender Peptic ulcer

Sessile serrated adenoma detection rate is correlated with adenoma detection rate

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World Journal of Gastrointestinal Oncology 2018年第3期10卷 82-90页

作者： Daisuke Ohki Yosuke Tsuji Tomohiro Shinozaki Yoshiki sakaguchi Chihiro Minatsuki Hiroto Kinoshita Keiko Niimi Satoshi Ono Yoku Hayakawa Shuntaro Yoshida Atsuo Yamada Shinya Kodashima Nobutake Yamamichi Yoshihiro Hirata Tetsuo Ushiku Mitsuhiro Fujishiro Masashi Fukayama kazuhiko Koike Department of Gastroenterology Graduate School of Medicinethe University of Tokyo Department of Biostatistics School of Public Healththe University of Tokyo Center for Epidemiology and Preventive Medicine Graduate School of Medicinethe University of Tokyo Department of Endoscopy and Endoscopic Surgery Graduate School of Medicinethe University of Tokyo Department of Pathology Graduate School of Medicine the University of Tokyo

AIM To investigated the association between adenoma detection rate(ADR) and sessile serrated ADR(SSADR) and significant predictors for sessile serrated adenomas(SSA) *** This study is a retrospective, single-center analysis. Total colonoscopies performed by the gastroenterologists at the University of Tokyo Hospital between January and December 2014 were retrospectively identified. Polyps were classified as low-grade or high-grade adenoma, cancer, SSA, or SSA with cytological dysplasia, and the prevalence of each type of polyp was investigated. Predictors of adenoma and SSA detection were examined using logistic generalized estimating equation models. The association between ADR and SSADR for each gastroenterologist was investigated by calculating a correlation coefficient weighted by the number of each gastroenterologist's *** A total of 3691 colonoscopies performed by 35 gastroenterologists were assessed. Overall, 978 (26.5%) low-and 84 (2.2%) high-grade adenomas, 81 (2.2%) cancers, 66 (1.8%) SSAs, and 2 (0.1%) SSAs with cytological dysplasia were detected. Overall ADR was 29.5%(men 33.2%, women 23.8%) and overall SSADR was 1.8%(men 1.7%, women 2.1%). In addition, 672 low-grade adenomas (68.8% of all the detected lowgrade adenomas), 58 (69.9%) high-grade adenomas, 29 (34.5%) cancers, 52 (78.8%) SSAs, and 2 (100%) SSAs with cytological dysplasia were found in the proximal colon. Adenoma detection was the only significant predictor of SSA detection (adjusted OR: 2.53, 95%CI: 1.53-4.20; P < 0.001). The correlation coefficient between ADR and SSADR weighted by the number of each gastroenterologist's examinations was 0.606(P < 0.001).CONCLUSION Our results demonstrated that ADR is correlated to SSADR. In addition, patients with adenomas had a higher prevalence of SSAs than those without adenomas.

关键词： Sessile serrated adenoma Sessile serrated adenoma detection rate Adenoma detection rate Colonoscopy Interval colorectal cancer

Evaluation of preferable insertion routes for esophagogastroduodenoscopy using ultrathin endoscopes

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World Journal of Gastroenterology 2014年第17期20卷 5045-5050页

作者： Satoshi Ono Keiko Niimi Mitsuhiro Fujishiro Yu Takahashi Yoshiki sakaguchi Chiemi Nakayama Chihiro Minatsuki Rie Matsuda Itsuko Hirayama-Asada Yosuke Tsuji Satoshi Mochizuki Shinya Kodashima Nobutake Yamamichi Atsuko Ozeki Lumine Matsumoto Yumiko Ohike Tsutomu Yamazaki kazuhiko Koike Center for Epidemiology and Preventive Medicine Graduate School of MedicineUniversity of TokyoTokyo 113-8655Japan Department of Gastroenterology Graduate School of MedicineUniversity of TokyoTokyo 113-8655Japan Department of Endoscopy and Endoscopic Surgery Graduate School of MedicineUniversity of TokyoTokyo 113-8655Japan

AIM: To evaluate the discomfort associated with esophagogastroduodenoscopy (EGD) using an ultrathin endoscope through different insertion routes.

关键词： Esophagogastroduodenoscopy Ultrathin endoscope Visual analog scale

Bleeding after endoscopic submucosal dissection: Risk factors and preventive methods

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World Journal of Gastroenterology 2016年第26期22卷 5927-5935页

作者： Yosuke Kataoka Yosuke Tsuji Yoshiki sakaguchi Chihiro Minatsuki Itsuko Asada-Hirayama Keiko Niimi Satoshi Ono Shinya Kodashima Nobutake Yamamichi Mitsuhiro Fujishiro kazuhiko Koike Department of Gastroenterology Graduate School of Medicine The University of Tokyo Center for Epidemiology and Preventive Medicine Graduate School of Medicine The University of Tokyo Department of Endoscopy and Endoscopic Surgery Graduate School of Medicine The University of Tokyo

Endoscopic submucosal dissection(ESD) has become widely accepted as a standard method of treatment for superficial gastrointestinal neoplasms because it enables en block resection even for large lesions or fibrotic lesions with minimal invasiveness, and decreases the local recurrence rate. Moreover, specimens resected in an en block fashion enable accurate histological assessment. Taking these factors into consideration, ESD seems to be more advantageous than conventional endoscopic mucosal resection(EMR), but the associated risks of perioperative adverse events are higher than in EMR. Bleeding after ESD is the most frequent among these adverse events. Although post-ESD bleeding can be controlled by endoscopic hemostasis in most cases, it may lead to serious conditions including hemorrhagic shock. Even with preventive methods including administration of acid secretion inhibitors and preventive hemostasis, post-ESD bleeding cannot be completely prevented. In addition high-risk cases for post-ESD bleeding, which include cases with the use of antithrombotic agents or which require large resection, are increasing. Although there have been many reports about associated risk factors and methods of preventing post-ESD bleeding, many issues remain unsolved. Therefore, in this review, we have overviewed risk factors and methods of preventing post-ESD bleeding from previous studies. Endoscopists should have sufficient knowledge of these risk factors and preventive methods when performing ESD.

关键词： Endoscopic submucosal dissection Risk factor Bleeding Prevention Antithrombotic agents