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Endoscopic mucosal resection vs endoscopic submucosal dissection for superficial non-ampullary duodenal tumors

World Journal of Gastrointestinal Oncology 2020年第8期12卷 918-930页

作者： Mitsuru Esaki kazuhiro haraguchi Kazuya Akahoshi Naru Tomoeda Akira Aso Soichi Itaba Haruei Ogino Yusuke Kitagawa Hiroyuki Fujii Kazuhiko Nakamura Masaru Kubokawa Naohiko Harada Yosuke Minoda Sho Suzuki Eikichi Ihara Yoshihiro Ogawa Department of Medicine and Bioregulatory Science Graduate School of Medical SciencesKyushu UniversityFukuoka 8128582Japan Division of Gastroenterology and Hepatology Department of MedicineNihon University School of MedicineTokyo 1738610Japan Department of Gastroenterology Hara-Sanshin HospitalFukuoka 8120033Japan Department of Gastroenterology Aso Iizuka HospitalIizuka 8208502Japan Department of Gastroenterology Clinical Research InstituteNational Hospital Organization Kyushu Medical CenterFukuoka 8108564Japan Department of Gastroenterology Kitakyushu Municipal Medical CenterKitakyushu 8020077Japan Department of Gastroenterology Kyushu Rosai HospitalKitakyushu 8000296Japan Department of Internal Medicine Saiseikai Fukuoka General HospitalFukuoka 8100001Japan Department of Gastroenterology and Hepatology National Hospital Organization Fukuokahigashi Medical CenterKoga 81103195Japan Department of Gastroenterology and Metabolism Graduate School of Medicine SciencesKyushu UniversityFukuoka 8128582Japan

BACKGROUND The selection of endoscopic treatments for superficial non-ampullary duodenal epithelial tumors(SNADETs)is controversial.AIM To compare the efficacy and safety of endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)for SNADETs.METHODS We retrospectively analyzed the data of patients with SNADETs from a database of endoscopic treatment for SNADETs,which included eight hospitals in Fukuoka,Japan,between April 2001 and October 2017.A total of 142 patients with SNADETs treated with EMR or ESD were analyzed.Propensity score matching was performed to adjust for the differences in the patient characteristics between the two groups.We analyzed the treatment outcomes,including the rates of en bloc/complete resection,procedure time,adverse event rate,hospital stay,and local or metastatic recurrence.RESULTS Twenty-eight pairs of patients were created.The characteristics of patients between the two groups were similar after matching.The EMR group had a significantly shorter procedure time and hospital stay than those of the ESD group[median procedure time(interquartile range):6(3-10.75)min vs 87.5(68.5-136.5)min,P<0.001,hospital stay:8(6-10.75)d vs 11(8.25-14.75)d,P=0.006].Other outcomes were not significantly different between the two groups(en bloc resection rate:82.1%vs 92.9%,P=0.42;complete resection rate:71.4%vs 89.3%,P=0.18;and adverse event rate:3.6%vs 17.9%,P=0.19,local recurrence rate:3.6%vs 0%,P=1;metastatic recurrence rate:0%in both).Only one patient in the ESD group underwent emergency surgery owing to intraoperative perforation.CONCLUSION EMR has significantly shorter procedure time and hospital stay than ESD,and provides acceptable curability and safety compared to ESD.Accordingly,EMR for SNADETs is associated with lower medical costs.

关键词： Endoscopic mucosal resection Endoscopic submucosal dissection Superficial non-ampullary duodenal epithelial tumor Short-term Outcome Propensity score matching

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Efficacy of hybrid endoscopic submucosal dissection with SOUTEN in gastric lesions:An ex vivo porcine model basic study

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World Journal of Gastrointestinal Surgery 2021年第6期13卷 563-573页

作者： Mitsuru Esaki Eikichi Ihara Norikazu Hashimoto Shuichi Abe Chihoko Aratono Noriko Shiga Yorinobu Sumida Hiroyuki Fujii kazuhiro haraguchi Shunsuke Takahashi Tsutomu Iwasa Kayoko Nakano Masafumi Wada Shinichi Somada Kei Nishioka Yosuke Minoda Haruei Ogino Yoshihiro Ogawa Department of Medicine and Bioregulatory Science Graduate School of Medical SciencesKyushu UniversityFukuoka 812-8582Japan Department of Gastroenterology and Metabolism Graduate School of Medical SciencesKyushu UniversityFukuoka 812-8582Japan Department of Gastroenterology Fukuoka City HospitalFukuoka 811-1394Japan Department of Gastroenterology Harasanshin HospitalFukuoka 812-0033Japan Department of Gastroenterology and Hepatology National Hospital Organization Fukuokahigashi Medical CenterKoga 811-3195Japan Department of Gastroenterology Fukuokaken Saiseikai Futsukaichi HospitalFutsukaichi 811-8516FukuokaJapan Department of Gastroenterology Clinical Research InstituteNational Hospital Organization Kyushu Medical CenterFukuoka 810-8564Japan Department of Gastroenterology Fukuoka Central HospitalFukuoka 805-0050Japan Department of Gastroenterology National Hospital Organization Beppu Medical CenterBeppu 874-0011Japan

BACKGROUND Hybrid endoscopic submucosal dissection(ESD)that comprises mucosal incision and partial submucosal dissection followed by snaring in a planned manner,has been developed for endoscopic resection of gastrointestinal neoplasms to overcome the technical barrier of ESD.Although the superiority of hybrid ESD with SOUTEN,a single multifunctional device,over conventional ESD has been indicated,the actual effect of snaring itself remains unclear since SOUTEN could be applied to hybrid ESD group,but not to the conventional ESD group,due to ethical issue in clinical practice.AIM To determine whether and how hybrid ESD was superior to conventional ESD in the endoscopic treatment of gastric lesions in an ex vivo porcine model basic study.METHODS Sixteen endoscopists participated in this basic study in August 2020 at Kyushu University,performing 32 procedures each for hybrid ESD and conventional ESD.Mock lesions(10-15 mm,diameter)were created in the porcine stomach.The primary outcome was total procedure time and secondary outcomes were en bloc or complete resection,perforation,procedure time/speed for both,mucosal incision,and submucosal dissection.Factors associated with difficulty in ESD including longer procedure time,incomplete resection,and perforation,were also investigated.Categorical and continuous data were analyzed using the chi-square test or Fisher’s exact test and the Mann-Whitney U test,respectively.RESULTS The median total procedure time of hybrid ESD was significantly shorter than that of conventional ESD(median:8.3 min vs 16.2 min,P<0.001).Time,speed,and the amount of hyaluronic acid during submucosal dissection were more favorable in hybrid ESD than conventional ESD(time,5.2 min vs 10.4 min,P<0.001;speed,43.7 mm^(2)/min vs 23.8 mm^(2)/min,P<0.00;injection volume,1.5 mL vs 3.0 mL,P<0.001),although no significant differences in those factors were observed between both groups during mucosal incision.There was also no significant difference between both groups in the en bloc/complete resection rate an

关键词： Endoscopic mucosal resection Hybrid Stomach neoplasms Treatment outcome Animal experimentation Logistic models

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Hepcidin/ferroportin expression levels involve efficacy of pegylated-interferon plus ribavirin in hepatitis C virusinfected liver

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World Journal of Gastroenterology 2015年第11期21卷 3291-3299页

作者： Motoyuki Kohjima Tsuyoshi Yoshimoto Munechika Enjoji Nobuyoshi Fukushima Kunitaka Fukuizumi Tsukasa Nakamura Miho Kurokawa Nao Fujimori Yusuke Sasaki Yasushi Shimonaka Yusuke Murata Susumu Koyama Ken Kawabe kazuhiro haraguchi Yorinobu Sumida Naohiko Harada Masaki Kato kazuhiro Kotoh Makoto Nakamuta Department of Gastroenterology and Clinical Research Center National Hospital Organization Kyushu Medical Center Health Care Center Fukuoka University Product Research Department Chugai Pharmaceutical Co.Ltd. Department of Medicine and Bioregulatory Science Kyushu University

AIM:To investigate the relationship between the ironmetabolism-related gene expression profiles and efficacy of antiviral therapy in chronic hepatitis C patients.METHODS:The hepatic expression profile of ironmetabolism-related genes was analyzed and its association with virological response to pegylated-interferon plus ribavirin combination therapy was evaluated.A hundred patients with chronic hepatitis C(genotype1b,n = 50; genotype 2,n = 50) were enrolled and retrospectively analyzed.Liver biopsy samples were subjected to quantitative polymerase chain reaction for iron-metabolismrelated genes and protein expression(Western blotting analysis) for ferroportin.As a control,normal liver tissue was obtained from 18 living donors of liver transplantation.Serum hepcidin level was measured by sensitive liquid chromatography/electrospray ionization tandem mass spectrometry.RESULTS:Iron overload is associated with liver damage by increasing oxidative stress and hepatitis C virus(HCV)is reported to induce iron accumulation in hepatocytes in vivo.Conversely,iron administration suppresses HCV replication in vitro.Therefore,the association between HCV infection and iron metabolism remains unclear.Compared with controls,patients had significantly higher gene expression for transferrin,iron-regulatoryproteins 1 and 2,divalent metal transporter 1,and ferroportin,but similar for transferrin receptors 1 and2,and hepcidin.When the expression profiles were compared between sustained virological response(SVR)and non-SVR patients,the former showed significantly lower transcription and protein expression of hepcidin and ferroportin.Expression of hepcidin-regulating genes,BMPR1,BMPR2,and hemojuvelin,was significantly increased,whereas BMP2 was decreased in HCV-infected liver.BMPR2 and hemojuvelin expression was significantly lower in the SVR than non-SVR group.HCV infection affects the expression of iron-metabolism-related genes,leading to iron accumulation in hepatocytes.CONCLUSION:Decreased expression of hepcidin and ferroportin in SV

关键词： Chronic hepatitis C Iron-metabolism Hepcidin Ferro

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