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Current clinical management of gastrointestinal stromal tumor

World Journal of Gastroenterology 2018年第26期24卷 2806-2817页

作者： kazuya akahoshi Masafumi Oya Tadashi Koga Yuki Shiratsuchi Department of Gastroenterology Aso Iizuka Hospital Department of Pathology Aso Iizuka Hospital Department of Surgery Aso Iizuka Hospital

Gastrointestinal stromal tumors(GISTs) are the most common malignant subepithelial lesions(SELs) of the gastrointestinal tract. They originate from the interstitial cells of Cajal located within the muscle layer and are characterized by over-expression of the tyrosine kinase receptor KIT. Pathologically, diagnosis of a GIST relies on morphology and immunohistochemistry [KIT and/or discovered on gastrointestinal stromal tumor 1(DOG1) is generally positive]. The prognosis of this disease is associated with the tumor size and mitotic index. The standard treatment of a GIST without metastasis is surgical resection. A GIST with metastasis is usually only treated by tyrosine kinase inhibitors without radical cure; thus, early diagnosis is the only way to improve its prognosis. However, a GIST is usually detected as a SEL during endoscopy, and many benign and malignant conditions may manifest as SELs. Conventional endoscopic biopsy is difficult for tumors without ulceration. Most SELs have therefore been managed without a histological diagnosis. However, a favorable prognosis of a GIST is associated with early histological diagnosis and R0 resection. Endoscopic ultrasonography(EUS) and EUS-guided fine needle aspiration(EUSFNA) are critical for an accurate diagnosis of SELs. EUSFNA is safe and effective in enabling an early histological diagnosis and adequate treatment. This review outlines the current evidence for the diagnosis and management of GISTs, with an emphasis on early management of small SELs.

关键词： Gastrointestinal stromal tumor Endoscopic ultrasonography-guided fine needle aspiration Endoscopic ultrasonography Diagnosis Therapy

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Advances in endoscopic therapy using grasping-type scissors forceps(with video)

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World Journal of Gastrointestinal Surgery 2021年第8期13卷 772-787页

作者： kazuya akahoshi Keishi Komori Kazuaki akahoshi Shinichi Tamura Shigeki Osada Yuki Shiratsuchi Masaru Kubokawa Endoscopy Center Aso Iizuka HospitalIizuka 820-8505Japan Department of Gastroenterology Aso Iizuka HospitalIizuka 820-8505Japan

Endoscopic submucosal dissection(ESD)is a globally accepted minimally invasive therapy for early-stage gastrointestinal tract tumors.Although numerous electrosurgical knives have been developed for ESD,technical difficulties and high complication rates(bleeding and perforation)have limited their use worldwide.The grasping-type scissors forceps[clutch cutter(CC)]is the first forceps-type resection device developed with reference to hemostatic forceps.The aim was to allow easy and safe ESD throughout the gastro-intestinal tract,as a biopsy technique,using one device.The CC can grasp the target tissue accurately and pull it away from the underlying muscle layer prior to energizing the tissue,for safe and effective incision and hemostasis during ESD.Reported clinical studies showed that ESD using the CC(ESD-CC)is a safe(perforation rate:0%-3.6%;delayed bleeding rate:0%-4.2%),technically efficient(en-bloc resection rate:88.9%-100%),and single-device method for dissecting early-stage gastrointestinal tract tumors.The ESD-CC technique is simple and easy to learn because it can be completed simply by repeating the grasp,pull,and coagulate and/or incise actions using an electrosurgical current.The reported self-completion rate by nonexperts was significantly better with the CC than with conventional knives(61.7%vs 24.5%,respectively;P<0.001).Furthermore,the CC is used for other endoscopic therapies,such as endoscopic polypectomy for large pedunculated polyps,endoscopic myotomy for Zenker’s diverticulum,endoscopic treatment of buried bumper syndrome,and endoscopic necrosectomy for wall-off pancreatic necrosis.The initial reports using CC for these therapies have shown favorable results.In this review,we describe the structural features of the CC,how to use the instrument,efficacies of ESD-CC,and other unique endoscopic therapies using the CC.

关键词： Grasping-type scissors forceps Clutch cutter Endoscopic submucosal dissection Endoscopic polypectomy Zenker’s diverticulum Buried bumper syndrome

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Prognostic factors associated with mortality in patients with gastric fundal variceal bleeding

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World Journal of Gastroenterology 2017年第3期23卷 496-504页

作者： Keishi Komori Masaru Kubokawa Eikichi Ihara kazuya akahoshi Kazuhiko Nakamura Kenta Motomura Akihide Masumoto Department of Gastroenterology Aso Iizuka HospitalIizuka 820-8505Japan Department of Medicine and Bioregulatory Science Graduate School of Medical SciencesKyushu UniversityHigashi-kuFukuoka 812-8582Japan Department of Hepatology Aso Iizuka HospitalIizuka 820-8505Japan

AIM To determine the prognostic factors associated with mortality in patients with gastric fundal variceal (GFV) bleeding.METHODS In total, 42 patients were endoscopically diagnosed with GFV bleeding from January 2000 to March 2014. We retrospectively reviewed the patients' medical records and assessed their history, etiology of liver cirrhosis, disease conditions, treatment options for GFV bleeding, medications administered before and after onset of GFV bleeding, blood test results(hemoglobin, albumin, and bilirubin concentrations), and imaging results(including computed tomography and abdominal ultrasonography). We also assessed the prognostic factors associated with short-term mortality(up to 90 d) and long-term mortality in all patients.RESULTS Multivariate analysis showed that prophylactic administration of antibiotics was an independent prognostic factor associated with decreases in short-term mortality (OR = 0.08, 95%CI: 0.01-0.52) and longterm mortality (OR = 0.27, 95%CI: 0.08-0.91) in patients with GFV bleeding. In contrast, concurrent hepatocellular carcinoma (HCC) and regular use of proton pump inhibitors (PPI) were independent prognostic factors associated with increases in shortterm mortality(HCC: OR = 15.4, 95%CI: 2.08-114.75; PPI: OR = 12.76, 95%CI: 2.13-76.52) and long-term mortality (HCC: OR = 7.89, 95%CI: 1.98-31.58; PPI: OR = 10.91, 95%CI: 2.86-41.65) in patients with GFV bleeding. The long-term overall survival rate was significantly lower in patients who regularly used PPI than in those who did not use PPI(P = 0.0074).CONCLUSION Administration of antibiotics is associated with decreased short- and long-term mortality, while concurrent HCC and regular PPI administration are associated with increased short- and long-term mortality.

关键词： Antibiotics Gastric varices Gastric fundus Proton pump inhibitors Hemorrhage

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Vinyl bag cover method to avoid droplet-containing aerosol escape from endoscopic forceps channel caps during COVID-19 pandemic(with Video 1 and Video 2)

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World Journal of Gastrointestinal Endoscopy 2021年第4期13卷 111-114页

作者： kazuya akahoshi Shinichi Tamura Kazuaki akahoshi Yoriko Kaneshiro Reiichi Sashihara Kento Uemura Kenta Sato Endoscopy Center Aso Iizuka HospitalIizuka 820-8505Japan

Endoscopists are at high risk of allowing transmission of coronavirus disease 2019(COVID-19)during gastrointestinal endoscopy(GIE)procedures under pandemic conditions.The main avenues of droplet-containing aerosol generated during GIE are the mouth,anus,and endoscopic forceps channel.Although the usefulness of personal protective equipment for preventing COVID-19 dissemination has been well reported,measures to address infected aerosol escaping during endoscopic forceps use have been neglected.Pathogen-contaminated aerosol from the endoscopic forceps channel,leading into the gastrointestinal lumen,has been confirmed and is a highly problematic source of infection.We developed a technique that entails covering the forceps entry/exit hole with a vinyl bag,thereby preventing contamination of the endoscopy room by the infected aerosol that escapes from this hole.The technique can be used in daily clinical endoscopic practice.Furthermore,this shielding technique is useful for all patients who undergo GIE,regardless of the purpose of the procedure such as for making a diagnosis,administering therapy,or in an urgent situation.In this letter,we introduce our novel,easily performed,inexpensive method of infection prevention by disallowing infected aerosol to escape from a COVID-19-infected patient into the air during a procedure that requires the use of endoscopic forceps.

关键词： Vinyl bag Droplets Endoscopy COVID-19 Infection Contamination

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Endoscopic submucosal dissection of a rectal carcinoid tumor using grasping type scissors forceps

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World Journal of Gastroenterology 2009年第17期15卷 2162-2165页

作者： kazuya akahoshi Yasuaki Motomura Masaru Kubokawa Noriaki Matsui Manami Oda Risa Okamoto Shingo Endo Naomi Higuchi Yumi Kashiwabara Masafumi Oya Hidefumi Akahane Haruo Akiba Department of Gastroenterology Aso Iizuka Hospital Iizuka 820-8505 Japan Department of Pathology Aso Iizuka Hospital Iizuka 820-8505 Japan Fujifilm Corporation Saitama 331-9624 Japan

Endoscopic submucosal dissection (ESD) with a knife is a technically demanding procedure associated with a high complication rate. The shortcomings of this method are the inability to fix the knife to the target lesion, and compression of the lesion. These can lead to major complications such as perforation and bleeding. To reduce the risk of complications related to ESD, we developed a new grasping type scissors forceps (GSF), which can grasp and incise the targeted tissue using electrosurgical current. Colonoscopy on a 55-year-old woman revealed a 10-mm rectal submucosal nodule. The histological diagnosis of the specimen obtained by biopsy was carcinoid tumor. Endoscopic ultrasonography demonstrated a hypoechoic solid tumor limited to the submucosa without lymph node involvement. It was safely and accurately resected without unexpected incision by ESD using a GSF. No delayed hemorrhage or perforation occurred. Histological examination confirmed the carcinoid tumor was completely excised with negative resection margin.

关键词：直肠类癌黏膜下内镜剪刀剥离并发症发生率落刺激因子组织学诊断

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Improved techniques for double-balloon-enteroscopy-assisted endoscopic retrograde cholangiopancreatography

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World Journal of Gastroenterology 2012年第46期18卷 6843-6849页

作者： Takashi Osoegawa Yasuaki Motomura kazuya akahoshi Naomi Higuchi Yoshimasa Tanaka Terumasa Hisano Souichi Itaba Junya Gibo Mariko Yamada Masaru Kubokawa Yorinobu Sumida Hirotada Akiho Eikichi Ihara Kazuhiko Nakamura Department of Gastroenterology Aso Iizuka Hospital Department of Medicine and Bioregulatory Science Graduate School of Medical Sciences Kyushu University

AIM: To investigate the clinical outcome of double balloon enteroscopy (DBE)-assisted endoscopic retrograde cholangiopancreatography (DB-ERCP) in patients with altered gastrointestinal anatomy. METHODS: Between September 2006 and April 2011, 47 procedures of DB-ERCP were performed in 28 patients with a Roux-en-Y total gastrectomy (n = 11), Billroth Ⅱ gastrectomy (n = 15), or Roux-en-Y anastomosis with hepaticojejunostomy (n = 2). DB-ERCP was performed using a short-type DBE combined with several technical innovations such as using an endoscope attachment, marking by submucosal tattooing,selectively applying contrast medium, and CO2 insufflations. RESULTS: The papilla of Vater or hepaticojejunostomy site was reached in its entirety with a 96% success rate (45/47 procedures). There were no significant differences in the success rate of reaching the blind end with a DBE among Roux-en-Y total gastrectomy (96%), Billroth Ⅱ reconstruction (94%), or pancreatoduodenectomy (100%), respectively (P = 0.91). The total successful rate of cannulation and contrast enhancement of the target bile duct in patients whom the blind end was reached with a DBE was 40/45 procedures (89%). Again, there were no significant differences in the success rate of cannulation and contrast enhancement of the target bile duct with a DBE among Roux-en-Y total gastrectomy (88 %), Billroth Ⅱ reconstruction (89%), or pancreatoduodenectomy (100%), respectively (P = 0.67). Treatment was achieved in all 40 procedures (100%) in patients whom the contrast enhancement of the bile duct was successful. Common endoscopic treatments were endoscopic biliary drainage (24 procedures) and extraction of stones (14 procedures). Biliary drainage was done by placement of plastic stents. Stones extraction was done by lithotomy with the mechanical lithotripter followed by extraction with a basket or by the balloon pull-through method. Endoscopic sphincterotomy was performed in 14 procedures with a needle precutting knife using a guidewire. The mean total duration of the

关键词：技术创新双气囊造影剂胆管内镜小肠对比度增强平均时间

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Clinical outcomes of Clutch Cutter endoscopic submucosal dissection for older patients with early gastric cancer

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World Journal of Gastrointestinal Oncology 2017年第10期9卷 416-422页

作者： Yoshihiro Otsuka kazuya akahoshi Kayoko Yasunaga Masaru Kubokawa Junya Gibo Shigeki Osada Kayo Tokumaru Kazuaki Miyamoto Takao Sato Yuki Shiratsuchi Masafumi Oya Hidenobu Koga Eikichi Ihara Kazuhiko Nakamura Department of Gastroenterology Aso Iizuka Hospital Diagnosis Procedure Combination Coding Management Office Aso Iizuka Hospital Department of Pathology Aso Iizuka Hospital Clinical Research Supportive Office Aso Iizuka Hospital Department of Medicine and Bioregulatory Science Graduate School of Medical SciencesKyushu University

AIM To evaluate the clinical outcome of endoscopic submucosal dissection using the Clutch Cutter(ESDCC) in older patients. METHODS We reviewed 232 consecutive patients with early gastric cancer who underwent ESDCC between June 2010 and February 2014 at Aso Iizuka Hospital. We divided patients into two groups according to age: Older patients(> 80 years, n = 64) and non-older patients(≤ 80 years, n = 168). We retrospectively compared the prevalence rates of pre-existing comorbidities, anticoagulant therapy, en bloc resection, mean duration of hospitalization, incidence of ESDCC-related complications, change in performance status(PS) before and after ESDCC, and financial cost of admission. RESULTS The older group comprised 64 patients with a mean age of 84.1 years, and the non-older group comprised 168 patients with a mean age of 69.5 years. Older patients had significantly more pre-existing comorbidities than did non-older patients, specifically heart disease(P < 0.05). The en bloc resection rate in non-older patients was significantly higher than that in older patients(100% vs 95.3%, P = 0.02). There were no significant differences between the older and non-older groups in the incidence of ESDCC-related complications(i.e., postoperative bleeding and perforation) and the post-ESDCC change in PS. There were also no significant differences between the older and non-older groups in the mean duration of hospitalization(11.4 and 10.7 d, respectively) and financial cost of admission(657040 JPY and 574890 JPY, respectively).CONCLUSION ESDCC has a good clinical outcome in older patients.

关键词： Older patients Clutch Cutter Endoscopic submucosal dissection Early gastric cancer Financial cost Duration of hospitalization

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

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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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Double-balloon endoscopy in the diagnosis and management of GI tract diseases:Methodology,indications,safety,and clinical impact

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World Journal of Gastroenterology 2006年第47期12卷 7654-7659页

作者： kazuya akahoshi Masaru Kubokawa Masahiro Matsumoto Shingo Endo Yasuaki Motomura Jiro Ouchi Mitsuhide Kimura Atsuhiko Murata Michiaki Murayama Department of Gastroenterology Aso Iizuka Hospital Iizuka 820-8505 Japan

AIM: To prospectively evaluate the indications, method-ology, safety, and clinical impact of double-balloon en-doscopy.METHODS: A total of 60 patients with suspected or documented small- or large-bowel diseases were investi-gated by double balloon endoscopy. A total of 103 proce-dures were performed (42 from the oral route, 60 from the anal route, and 1 from the stoma route). The main outcome measurements were the time of insertion and the entire examination, complications, diagnostic yields, and the ability to successfully perform treatment.RESULTS: Observation of the entire small intestine was possible in 10 (40%) of 25 patients with total enteros-copy. The median insertion time was 122 min (range, 74-199 min). Observation of the entire colon was possi-ble in 13 (93%) of 14 patients after failure of total colo-noscopy using a conventional colonoscope. Small-intes-tine abnormalities were found in 20 (43%) of 46 patients with indications of suspected or documented small bowel diseases, obscure GI tract bleeding, or a history of ileus. Endoscopic procedures including tattooing (n = 33), bite biopsy (n = 17), radiographic examination (n = 7), EUS (n = 5), hemostasis (n = 1), polypectomy (n = 5), balloon dilatation (n = 1), endoscopic mucosal resection (n = 1) and lithotripsy (n = 1) were all successfully performed. No relevant technical problems or severe complications were encountered.CONCLUSION: Double balloon endoscopy is a feasible technique that allows adequate small and large bowel examination and potentially various endoscopic proce-dures of small-intestinal lesions. It is safe, useful, and also provides a high clinical impact.

关键词：内窥镜检查法肠病病理特征诊断方法

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Endoscopic submucosal dissection of gastric adenomas using the clutch cutter

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World Journal of Gastrointestinal Endoscopy 2017年第7期9卷 334-340页

作者： kazuya akahoshi Masaru Kubokawa Junya Gibo Shigeki Osada Kayo Tokumaru Eriko Yamaguchi Hiroko Ikeda Takao Sato Kazuaki Miyamoto Yusuke Kimura Yuki Shiratsuchi Kazuaki akahoshi Masafumi Oya Hidenobu Koga Eikichi Ihara Kazuhiko Nakamura Department of Gastroenterology Aso Iizuka Hospital Department of Pathology Aso Iizuka Hospital Clinical Research Support Office Aso Iizuka Hospital Department of Medicine and Bioregulatory Science Graduate School of Medical SciencesKyushu University

AIM To evaluate the efficacy and safety of endoscopic submucosal dissection(ESD) using the clutch cutter(CC)(ESD-CC) for gastric adenoma(GA).METHODS From June 2007 to August 2015,122 consecutive patients with histological diagnoses of GA from specimens resected by ESD-CC were enrolled in this prospective study.The CC was used for all ESD steps(marking,mucosal incision,submucosal dissection,and hemostatic treatment),and itstherapeutic efficacy and safety were assessed.RESULTS Both the en-bloc resection rate and the R0 resection rate were 100%(122/122).The mean surgical time was 77.4 min,but the time varied significantly according to tumor size and location.No patients suffered perforation.Post-ESD-CC bleeding occurred in six cases(4.9%) that were successfully resolved by endoscopic hemostatic treatment.CONCLUSION ESD-CC is a technically efficient,safe,and easy method for resecting GA.

关键词：内视镜的 submucosal 解剖离合器切割器胃的腺瘤

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