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Novel risk markers for gastric cancer screening: Present status and future prospects

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World Journal of Gastrointestinal Endoscopy 2010年第12期2卷 381-387页

作者： Shotaro Enomoto Takao Maekita Hiroshi Ohata Kimihiko Yanaoka Masashi Oka masao ichinose Second Department of Internal Medicine Wakayama Medical University

Initial identification of populations at high risk of gastric cancer (GC) is important for endoscopic screening of GC. As serum pepsinogen (PG) test-positive subjects with progression of chronic atrophic gastritis (CAG) show a high likelihood of future cancer development, this population warrants careful follow-up observation as a high-risk GC group. By combining the PG test with Helicobacter pylori (HP) antibody titers, the HP-related chronic gastritis stage can be classified, thus identifying not only a GC high-risk group but also a low-risk group. Among PG test-negative patients without CAG, those with high serum PG Ⅱ levels and HP antibody titers are thought to have severe gastric mucosal inflammation and the risk of diffuse-type GC is also high. Meanwhile, in gastric mucosae obtained by endoscopic biopsy, HP infection induces aberrant DNA methylation in CpG islands in multiple gene regions and the extent of methylation clearly correlates with GC risk. By quantifying aberrant DNA methylation in suitable gene markers, we can determine the extent of the epigenetic field for cancerization. These novel concepts and risk markers will have many clinical applications in gastrointestinal endoscopy, including more efficient endoscopic GC screening and a strategic approach to metachronous multiple GCs after endoscopic treatment.

关键词： Gastric cancer Screening Risk Pepsinogen Helicobacter pylori DNA methylation

Ultrasonogram of hepatocellular carcinoma is associated with outcome after radiofrequency ablation

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World Journal of Hepatology 2012年第12期4卷 374-381页

作者： Kosaku Moribata Hideyuki Tamai Naoki Shingaki Yoshiyuki Mori Tatsuya Shiraki Shotaro Enomoto Hisanobu Deguchi Kazuki Ueda Izumi Inoue Takao Maekita Mikitaka Iguchi masao ichinose Second Department of Internal Medicine Wakayama Medical University

AIM: To investigate the association between B-mode ultrasound classification of small hepatocellular carcinoma (HCC) and outcome after radiofrequency ablation (RFA).

关键词： B-mode ultrasound Hepatocellular carcinoma Radiofrequency ablation Recurrence Prognosis

Management of bleeding and artificial gastric ulcers associated with endoscopic submucosal dissection

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World Journal of Gastrointestinal Endoscopy 2012年第1期4卷 1-8页

作者： Yosuke Muraki Shotaro Enomoto Mikitaka Iguchi Mitsuhiro Fujishiro Naohisa Yahagi masao ichinose Second Department of Internal Medicine Wakayama Medical University Department of Endoscopy and Endoscopic Surgery Faculty of Medicine University of Tokyo Division of Research and Development for Minimally Invasive Treatment Cancer Center Keio University School of Medicine

Endoscopic submucosal dissection (ESD), an endoscopic procedure for the treatment of gastric epithelial neoplasia without lymph node metastases, spread rapidly, primarily in Japan, starting in the late 1990s. ESD enables en bloc resection of lesions that are difficult to resect using conventional endoscopic mucosal resection (EMR). However, in comparison to EMR, ESD requires a high level of endoscopic competence and a longer resection time. Thus, ESD is associated with a higher risk of adverse events, including intraoperative and postoperative bleeding and gastrointestinal perforation. In particular, because of a higher incidence of intraoperative bleeding with mucosal incision and submucosal dissection, which are distinctive endoscopic procedures in ESD, a strategy for endoscopic hemostasis, mainly by thermo-coagulation hemostasis using hemostatic forceps, is important. In addition, because of iatrogenic artificial ulcers that always form after ESD, endoscopic hemostasis and appropriate pharma-cotherapy during the healing process are essential.

关键词： Artificial ulcer Endoscopic hemostasis Endoscopic submucosal dissection Gastric epithelial neoplasia Hemostatic forceps

Japanese apricot improves symptoms of gastrointestinal dysmotility associated with gastroesophageal reflux disease

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World Journal of Gastroenterology 2015年第26期21卷 8170-8177页

作者： Takao Maekita Jun Kato Shotaro Enomoto Takeichi Yoshida Hirotoshi Utsunomiya Hideyuki Hayashi Toshiko Hanamitsu Izumi Inoue Yoshimasa Maeda Kosaku Moribata Yosuke Muraki Naoki Shingaki Hisanobu Deguchi Kazuki Ueda Mikitaka Iguchi Hideyuki Tamai masao ichinose Department of Gastroenterology School of MedicineWakayama Medical University Department of Japanese Apricot Minabe Town Office Department of Health Welfare Minabe Town Office

AIM: To investigate the effects of Japanese apricot(JA) consumption on gastroesophageal reflux disease(GERD)-related ***: Participants included individuals living in Minabe-cho,a well-known JA-growing region,who received specific medical check-ups by the local community health service in ***-related symptoms were examined in 1303 Japanese individuals using a validated questionnaire,the Frequency Scale for Symptoms of GERD(FSSG),which consists of 7 questions associated with acid reflux symptoms and 5 questions asking about gastrointestinal dysmotility *** question was answered using a 4-point scale,with higher scores indicating more severe GERDrelated *** were divided into two groups according to their intake of dried and pickled JA: daily intake(≥ 1 JA daily)(392 subjects) and none oroccasional intake(< 1 JA daily)(911 subjects).FSSG scores were compared between subjects who consumed JA daily and those who did ***,subjects were stratified by age,gender and Helicobacter pylori(***) status for ***: Those who ate JA daily were significantly older than those who did not(60.6 ± 10.5 years vs 56.0 ± 11.0 years,P < 0.001).Total FSSG scores were significantly lower in subjects with daily JA intake than in those with none or only occasional intake(2.13 ± 3.14 vs 2.70 ± 3.82,P = 0.005).In particular,subjects who consumed JA daily showed significantly improved FSSG dysmotility scores compared with subjects who did not(1.05 ± 1.58 vs 1.46 ± 2.11,P < 0.001).In contrast,the FSSG reflux score did not differ between subjects with and without daily intake of JA(1.08 ± 1.90 vs 1.24 ± 2.11,P = 0.177).Subanalysis indicated that improvement in dysmotility by JA intake was specifically observed in non-elderly(1.24 ± 1.68 vs 1.62 ± 2.22,P = 0.005) and ***-negative subjects(0.99 ± 1.58 vs 1.57 ± 2.06,P < 0.001).GERD patients(total FSSG score ≥ 8) were less frequently observed among subjects with daily intake of JA as

关键词： Japanese apricot Umeboshi Gastroesophagealreflux disease Frequency Scale for Symptomsof gastroesophageal reflux disease Dysmotility

Steakhouse syndrome causing large esophageal ulcer and stenosis

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World Journal of Gastrointestinal Endoscopy 2011年第5期3卷 101-104页

作者： Shotaro Enomoto Kazuyuki Nakazawa Kazuki Ueda Yoshiyuki Mori Yoshimasa Maeda Naoki Shingaki Takao Maekita Uki Ota Masashi Oka masao ichinose Department of Gastroenterology School of MedicineWakayama Medical University811-1 KimiideraWakayama CityWakayama 641-0012Japan Department of Gastroenterology Nishimurakai Koyo Hospital40 TsuhadaWakayama CityWakayama 640-8315Japan Ota Medical Clinic 424-1 OtaWakayama City640-8323 WakayamaJapan

A 66-year-old man developed dysphagia during dinner and was evaluated 2d later in our hospital because of persistent *** gastrointestinal endoscopy showed no impacted food,but advanced esophageal cancer was suspected based on the presence in the upper esophagus of a large irregular ulcerative lesion with a thick white coating and *** imaging studies were performed to evaluate for metastases,revealing circumferential esophageal wall thickening and findings suggestive of lung and mediastinal lymph node ***,dysphagia symptoms and the esophageal ulcer improved after hospital admission,and histopathological examination of the esophageal mucosa revealed only nonspecific *** the timeof symptom onset,the patient had been eating stewed beef tendon(Gyusuji nikomi in Japanese) without chewing *** ulceration due to steakhouse syndrome was therefore *** lung lesion was a primary lung cancer that was surgically *** rare,steakhouse syndrome can cause large esophageal ulceration and stenosis,so care must be taken to distinguish this from esophageal cancer.

关键词： Esophageal stenosis Esophagus Ulcer Dysphagia Steakhouse syndrome

Gastric-and-Intestinal Mixed Intestinal Metaplasia Is Irreversible Point with Eradication of Helicobacter pylori

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Open Journal of Pathology 2016年第2期6卷 93-104页

作者： Yuka Kiriyama Tomomitsu Tahara Tomoyuki Shibata Masaaki Okubo Mitsuru Nakagawa Asako Okabe Naoki Ohmiya Makoto Kuroda Atsushi Sugioka masao ichinose Masae Tatematsu Tetsuya Tsukamoto Department of Diagnostic Pathology School of Medicine Fujita Health University Toyoake Aichi Japan Department of Gastroenterology School of Medicine Fujita Health University Toyoake Aichi Japan Department of Hepatobiliary and Liver Transplant Surgery School of Medicine Fujita Health University Toyoake Japan Second Department of Internal Medicine Wakayama Medical University Wakayama Japan Japan Bioassay Research Center Hadano Japan

Helicobacter pylori (H. pylori) represents an important factor in the development of atrophic gastritis, intestinal metaplasia (IM), and gastric cancer. Eradication of H. pylori has been reported to prevent gastric cancer only in cases without atrophy or IM. However, histological changes with eradication have yet to be fully clarified. We evaluated 38 H. pylori-positive cases before and after eradication at the gland level;pyloric glands were classified as showing gastric proper (G) and IM gland types, with the latter including gastric-and-intestinal mixed IM (GI-IM) and solely intestinal IM (I-IM), depending on the remaining gastric phenotypes. On eradication, acute and chronic inflammation attenuated rapidly and gradually, respectively, whereas levels of MUC5AC and MUC6 expression were not markedly altered. Gland width, size of nuclei and cytoplasm and their ratio in surface foveolar epithelium, the number of Ki-67-positive cells and the length of the proliferating zone in each gland were significantly decreased in G glands after eradication compared with those in GI-IM and I-IM. The number of mitotic phase cells, positive for phosphorylated histone H3 at serine 28, was increased in both types of IM compared to that in G glands in the H. pylori-infected state, but unexpectedly remained unchanged with eradication. These results suggest that GI-IM, as the beginning of IM, could represent a histological irreversible point with eradication and be considered as a “histological point of no return”.

关键词： Helicobacter pylori Chronic Atrophic Gastritis Intestinal Metaplasia Eradication Stomach

Diazepam during endoscopic submucosal dissection of gastric epithelial neoplasias

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World Journal of Gastrointestinal Endoscopy 2012年第3期4卷 80-86页

作者： Yosuke Muraki Shotaro Enomoto Mikitaka Iguchi Toru Niwa Takao Maekita Takeichi Yoshida Kosaku Moribata Naoki Shingaki Hisanobu Deguchi Kazuki Ueda Izumi Inoue Hideyuki Tamai Jun Kato Mitsuhiro Fujishiro masao ichinose Second Department of Internal Medicine Wakayama Medical University Department of Endoscopy and Endoscopic Surgery Faculty of MedicineUniversity of Tokyo

AIM:To investigate risk factors and adverse events related to high-dose diazepam administration during endoscopic submucosal dissection for gastric ***:Between February 2002 and December 2009,a total of 286 patients with gastric epithelial neoplasia underwent endoscopic submucosal dissection in our *** achieve moderate sedation,5-7.5 mg of diazepam was administered intravenously by *** additional administration of 2.5-5 mg diazepam was performed if uncontrollable body movement of the patient was *** patients were classified into groups based on the required diazepam dose:low-dose (≤ 17.5 mg,n=252) and high-dose (> 17.5 mg,n=79).RESULTS:Differences between the low-and highdose diazepam groups were observed in lifetime alcohol consumption (0.30 ± 0.48 vs 0.44 ± 0.52 tons,P=0.032),body weight (58.4 ± 10.3 vs 62.0 ± 9.9 kg,P=0.006),tumor size (15 ± 10 vs 23 ± 18 mm,P < 0.001),lesion location (P < 0.001) and the presence of ulcerative findings (14/238 vs 18/61,P < 0.001).Multivariate analysis identified all five variables as independently related to required diazepam *** terms of adverse reactions to diazepam administration,paradoxical excitement was significantly more frequent in the high-dose diazepam group (P < 0.001).CONCLUSION:Intermittent administration of diazepam enabled safe completion of gastric endoscopic submucosal dissection except in patients who were alcohol abusers or obese,or who showed complicated lesions.

关键词： Diazepam Endoscopic submucosal dissection Gastric epithelial neoplasias Moderate sedation Non-anesthesiologists

Usefulness of continuous suction mouthpiece during esophagogastroduodenoscopy: A single-center, prospective,randomized study

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World Journal of Gastrointestinal Endoscopy 2013年第10期5卷 508-513页

作者： Takao Maekita Jun Kato Yukihiko Nakatani Shotaro Enomoto Ema Takano Masahiro Tsuji Tsuyoshi Nakaya Kosaku Moribata Yosuke Muraki Naoki Shingaki Toru Niwa Hisanobu Deguchi Kazuki Ueda Izumi Inoue Mikitaka Iguchi Hideyuki Tamai masao ichinose Department of Gastroen-terology School of Medicine Wakayama Medical UniversityWakayama Department of Internal Medicine Nakaya HospitalWakayama

AIM: To develop a new continuous suction mouthpiece(CSM) and evaluate its usefulness for screening esophagogastroduodenoscopy(EGD).METHODS: A total of 196 patients who were scheduled to undergo screening EGD were assigned to one of two groups: a group using the CSM and a group using a conventional mouthpiece. Extent of salivary flow,frequency of saliva suction, number of choking episodesduring the examination, and incidence of aspiration pneumonia after the examination were evaluated and compared between the two groups. Adverse events during and after EGD were also examined. In addition, the oral cavity was meticulously examined after the ***: The same number of patients was randomly allocated to each group. There were no significant differences between the two groups in sex, age,biopsy procedure, duration of procedure and depth of sedation. Aspiration pneumonia and other significant adverse events were not observed in either group. The grade of extent of salivary flow was significantly lower in patients with the CSM than in patients with the conventional mouthpiece(P < 0.001). Although there was no significant difference, less frequent suctioning and fewer choking episodes were observed in patients with the CSM than in patients with the conventional mouthpiece(P = 0.082 and P = 0.084, respectively). In addition, there were no patients in the CSM group who required saliva suctioning during the ***: Use of the CSM during screening EGD can reduce the extent of salivary flow. The device is expected to reduce complications and contamination with saliva.

关键词： Mouthpiece Esophagogastroduodenoscopy Aspiration Saliva Suction

A case of chronic pancreatitis in which endoscopic ultrasonography was effective in the diagnosis of a pseudoaneurysm

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World Journal of Gastrointestinal Endoscopy 2012年第7期4卷 335-338页

作者： Kazuhiro Fukatsu Kazuki Ueda Hiroki Maeda Yasunobu Yamashita Masahiro Itonaga Yoshiyuki Mori Kosaku Moribata Naoki Shingaki Hisanobu Deguchi Shotaro Enomoto Izumi Inoue Takao Maekita Mikitaka Iguchi Hideyuki Tamai Jun Kato masao ichinose Second Department of Internal Medicine Wakayama Medical University811-1 Kimiidera Wakayama City Wakayama 641-0012 Japan

Endoscopic ultrasonography (EUS) was performed on a patient being treated for chronic pancreatitis because a submucosal tumor was observed in the stomach during gastrointestinal endoscopy. As internal pulsa- tile blood flow on Doppler was present, the diagnosis of an aneurysm was made. The pseudoaneurysm of the left gastric artery was embolized with histoacryl and lipiodol and the splenic artery was embolized with coils at the location of the pseudoaneurysm to prevent hemorrhage. Follow up EUS confirmed the cessation of blood flow from the pseudoaneurysm. Clinicians encountering a gastric submucosal tumor-like protrusion in a patient with chronic pancreatitis should use EUS to investigate the possibility of a pseudoaneurysm, which must be treated as quickly as possible once identified.

关键词： Chronic pancreatitis Endoscopic ultraso- nography Pseudoaneurysm