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Short term results of endoscopic submucosal dissection in superficial esophageal squamous cell neoplasms

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World Journal of Gastrointestinal Endoscopy 2010年第2期2卷 69-74页

作者： kouichi Nonaka shin Arai Keiko Ishikawa Masamitsu Nakao Yousuke Nakai Osamu Togawa Koji Nagata Michio Shimizu Yutaka Sasaki Hiroto Kita Department of Gastroenterology Saitama Medical University International Medical Center Saitama 350-1298 Japan Department of Pathology Saitama Medical University International Medical Center Saitama 350-1298 Japan Department of Gastroenterology Faculty of Medicine Kumamoto University Kumamoto 860-0856 Japan

AIM: To evaluate the efficacy of endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms. METHODS: Between July 2007 and March 2009, 27 consecutive superficial esophageal squamous cell neoplasms in 25 enrolled patients were treated by endoscopic submucosal dissection. The therapeutic efficacy, complications, and follow-up results were assessed. RESULTS: The mean size of the lesions was 21 ± 13 mm (range 2-55 mm); the mean size of the resection specimens was 32 ± 12 mm (range 10-70 mm). The enblock resection rate was 100% (27/27), and en block resection with tumor-free lateral/basal margins was 88.9% (24/27). Perforation occurred in 1 patient who was managed by conservative medical treatments. None of the patients developed local recurrence or distant metastasis in the follow-up period. CONCLUSION: Endoscopic submucosal dissection is applicable to superficial esophageal squamous cell neoplasms with promising results.

关键词： Endoscopic submucosal dissection Esophageal cancer Squamous cell Neoplasm Endoscopy

Usefulness of the DL in ME with NBI for determining the expanded area of early-stage differentiated gastric carcinoma

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World Journal of Gastrointestinal Endoscopy 2012年第8期4卷 362-367页

作者： kouichi Nonaka Masaaki Namoto Hideki Kitada Michio Shimizu Yasutoshi Ochiai Osamu Togawa Masamitsu Nakao Makoto Nishimura Keiko Ishikawa shin Arai Hiroto Kita Department of Gastroenterology Saitama Medical University International Medical Center Saitama 350-1298 Japan Department of Gastroenterology Kitakyushu Municipal Medical Center Fukuoka 802-0077 Japan Department of Gastroenterology Japanese Red Cross Kumamoto Hospital Kumamoto 861-8520 Japan Department of Pathology Saitama Medical University International Medical Center Saitama 350-1298 Japan

AIM: To investigate whether magnifying endoscopy with narrow band imaging (ME-NBI) is useful for evaluating the area of superficial, depressed- or flat-type differentiated adenocarcinoma of the stomach. METHODS: This procedure was performed in Saitama Medical University International Medical Center, Japanese Red Cross Kumamoto Hospital and Kitakyushu Municipal Medical Center. The subjects were 31 patients in whom biopsy findings, from superficial, depressed- or flat-type gastric lesion, suggested differentiated adenocarcinoma in the above 3 hospitals between January and December 2009. Biopsy was performed on the lesion and non-lesion sides of a boundary (imaginary boundary) visualized on ME-NBI. The results were pathologically investigated. We evaluated the accuracy of estimating a demarcation line (DL) on ME-NBI in comparison with biopsy findings as a gold standard. RESULTS: The DL that could be recognized at 2 points on the orifice and anal sides of each lesion during ME-NBI was consistent with the pathological findings in 22 patients with 0-IIc lesions, 7 with 0-IIb lesions, and 2 with 0-IIb + IIc lesions, showing an accuracy of 100%. CONCLUSION: The results suggest the usefulness of ME-NBI for evaluating the area of superficial, depressed- and flat-type differentiated adenocarcinoma of the stomach.

关键词： Narrow band imaging Magnifying endoscopy Endoscopic submucosal dissection Gastric carcinoma

A case of gastric mucosa-associated lymphoid tissue lymphoma in which magnified endoscopy with narrow band imaging was useful in the diagnosis

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World Journal of Gastrointestinal Endoscopy 2012年第4期4卷 151-156页

作者： kouichi Nonaka Keiko Ishikawa shin Arai Masamitsu Nakao Michio Shimizu Takaki Sakurai Koji Nagata Makoto Nishimura Osamu Togawa Yasutoshi Ochiai Yutaka Sasaki Hiroto Kita Department of Gastroenterology Saitama Medical University International Medical Center Saitama 350-1298 Japan Department of Pathology Saitama Medical University International Medical Center Saitama 350-1298 Japan Department of Gastroenterology and Hepatology Graduate School of Medical Sciences Kumamoto University Kumamoto 860-8556 Japan

Recently, we reported a case of gastric mucosaassociated lymphoid tissue (MALT) lymphoma presenting with unique vascular features. In the report, we defined the tree-like appearance (TLA) on the images of abnormal blood vessels which resembled branches from the trunk of a tree in the shiny mucosa, in which the glandular structure was lost. The 67-year-old female was diagnosed with gastric MALT lymphoma. The patient received eradication therapy for H. pylori. Conventional endoscopy revealed multiple ill-delineated brownish depressions in the stomach and cobblestonelike mucosa was observed at the greater curvature to the posterior wall of the upper gastric body 7 mo after successful eradication. Unsuccessful treatment of gastric MALT lymphoma was suspected on conventional endoscopy. Conventional endoscopic observations found focal depressions and cobblestone-like appearance, and these lesions were subsequently observed using magnified endoscopy combined with narrow band imaging to identify abnormal vessels presenting with a TLA within the lesions. Ten biopsies were taken from the area where abnormal vessels were present within these lesions. Ten biopsies were also taken from the lesions without abnormal vessels as a control. A total of 20 biopsy samples were evaluated to determine whether the diagnosis of MALT lymphoma could be obtained histologically from each sample. A positive diagnosis was obtained in 8/10 TLA (+) sites and in 2/10 TLA(-) sites. Target biopsies of the site with abnormal blood vessels can potentially improve diagnostic accuracy of gastric MALT lymphoma.

关键词： Mucosa associated-lymphoid tissue Magnified endoscopy Narrow band imaging Tree-like appearance

Histopathological confirmation of similar intramucosal distribution of fluorescein in both intravenous administration and local mucosal application for probebased confocal laser endomicroscopy of the normal stomach

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World Journal of Clinical Cases 2015年第12期3卷 993-999页

作者： kouichi Nonaka Ken Ohata shinichi Ban shin Ichihara Rumi Takasugi Yohei Minato Tomoaki Tashima Yasushi Matsuyama Maiko Takita Nobuyuki Matsuhashi Helmut Neumann Department of Gastroenterology NTT Medical Center Tokyo Department of Pathology Dokkyo Medical University Koshigaya Hospital Department of Pathology Sapporo-Kosei General Hospital Division of Technical Service Department of Medicine 1 University of Erlangen-Nuremberg

Probe-based confocal laser endomicroscopy(p CLE) is capable of acquiring in vivo magnified cross-section images of the gastric mucosa. Intravenous injection of fluorescein sodium is used for confocal imaging. However, it is still under debate if local administration of the dye to the mucosa is also effective for confocal imaging as it is not yet clear if topical application also reveals the intramucosal distribution of fluorescein. The objective of this study was to evaluate the intramucosal distribution of fluorescein sodium after topical application and to compare the distribution to the conventional intravenous injection used for confocal imaging. p CLE of the stomach uninfected with Helicobacter pylori was performed in a healthy male employing intravenous administration and local mucosal application of fluorescein. The mucosa of the lower gastric body was biopsied 1 min and 5 min after intravenous administration or local mucosal application of fluorescein, and the distribution of fluorescein in the biopsy samples was examined histologically. Green fluorescence was already observed in the cytoplasm of fundic glandular cells in the biopsied deep mucosa 1 min after local mucosal application of fluorescein. It was also observed in the foveolar lumen and inter-foveolar lamina propria, although it was noted at only a few sites. In the tissue biopsied 5 min after the local mucosal application of fluorescein, green fluorescence was more frequently noted in the cytoplasm of fundic glandular cells than in that 1 min after the local mucosal application of fluorescein, although obvious green fluorescence was not identified in the foveolar lumen or inter-foveolar lamina propria. The distribution of intravenously administered fluorescein in the cytoplasm of fundic glandular cells was also clearly observed similarly to that after local mucosal application of fluorescein. Green fluorescence in more cells was observed in many cells 5 min after intravenous administration compared

关键词： Confocal laser endomicroscopy Fluorescein Local application Intravenous Distribution