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Serrated polyps of the colon and rectum:Remove or not?

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World Journal of Gastroenterology 2020年第19期26卷 2276-2285页

作者： Wataru Sano Daizen Hirata Akira Teramoto mineo iwatate Santa Hattori Mikio Fujita Yasushi Sano Gastrointestinal Center Sano HospitalHyogo 655-0031Japan

In recent years,the serrated neoplasia pathway where serrated polyps arise as a colorectal cancer has gained considerable attention as a new carcinogenic *** serrated polyps are histopathologically classified into hyperplastic polyps(HPs),sessile serrated lesions,and traditional serrated adenomas;in the serrated neoplasia pathway,the latter two are considered to be *** western countries,all colorectal polyps,including serrated polyps,apart from diminutive rectosigmoid HPs are ***,in Asian countries,the treatment strategy for colorectal serrated polyps has remained ***,in this review,we described the clinicopathological features of colorectal serrated polyps and proposed to remove HPs and sessile serrated lesions≥6 mm in size,and traditional serrated adenomas of any size.

关键词： Hyperplastic polyp Sessile serrated adenoma/polyp Sessile serrated lesion Traditional serrated adenoma Cytological dysplasia Cryptal dysplasia

Effective use of the Japan Narrow Band Imaging Expert Team classification based on diagnostic performance and confidence level

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World Journal of Clinical Cases 2019年第18期7卷 2658-2665页

作者： Daizen Hirata Hiroshi Kashida mineo iwatate Tomomasa Tochio Akira Teramoto Yasushi Sano Masatoshi Kudo Gastrointestinal Center and Institute of Minimally-invasive Endoscopic Care Sano HospitalKobe 6550031Japan Department of Gastroenterology and Hepatology Kindai UniversityOsaka 5895811Japan

Five years have passed since the Japan Narrow Band Imaging Expert Team (JNET) classification was proposed in 2014. However, the diagnostic performance of this classification has not yet been established. We conducted a retrospective study and a systematic search of Medical Literature Analysis and Retrieval System On-Line. There were three retrospective single center studies about the diagnostic performance of this classification. In order to clarify this issue, we reviewed our study and three previous studies. This review revealed the diagnostic performance in regards to three important differentiations.(1) Neoplasia from non-neoplasia;(2) malignant neoplasia from benign neoplasia;and (3) deep submucosal invasive cancer (D-SMC) from other neoplasia. The sensitivity in differentiating neoplasia from non-neoplasia was 98.1%-99.8%. The specificity in differentiating malignant neoplasia from benign neoplasia was 84.7%-98.2% and the specificity in the differentiation D-SMC from other neoplasia was 99.8%-100.0%. This classification would enable endoscopists to identify almost all neoplasia, to appropriately determine whether to perform en bloc resection or not, and to avoid unnecessary surgery. This article is the first review about the diagnostic performance of the JNET classification. Previous reports about the diagnostic performance have all been retrospective single center studies. A large-scale prospective multicenter evaluation study is awaited for the validation.

关键词： Japan Narrow Band Imaging Expert Team Classification Magnifying endoscopy Narrow-band imaging Validation Diagnostic performance Colonoscopy Colorectal neoplasms

Post-colonoscopy colorectal cancer rate in the era of highdefinition colonoscopy

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World Journal of Gastroenterology 2017年第42期23卷 7609-7617页

作者： mineo iwatate Tomoyuki Kitagawa Yasumi Katayama Naohiko Tokutomi Shinichi Ban Santa Hattori Noriaki Hasuike Wataru Sano Yasushi Sano Masaya Tamano Gastrointestinal Center and Institute of Minimally-Invasive Endoscopic Care Sano Hospital Department of Gastroenterology Dokkyo Medical University Koshigaya Hospital Department of Pathology Dokkyo Medical University Koshigaya Hospital

AIM To investigate the post-colonoscopy colorectal cancer(PCCRC) rate for high-definition(HD) colonoscopy compared with that for standard-definition colonoscopy reported *** Using medical records at Sano Hospital(SH) and Dokkyo Medical University Koshigaya Hospital(DMUKH), we retrospectively obtained data on consecutive patients diagnosed as having CRC between January 2010 andDecember 2015. The definition of PCCRC was diagnosis of CRC between 7 and 36 mo after initial high-definition colonoscopy that had detected no cancer, and patients were divided into a PCCRC group and a non-PCCRC group. The primary outcome was the rate of PCCRC for HD colonoscopy. The secondary outcomes were factors associated with PCCRC and possible reason for occurrence of early and advanced *** Among 892 CRC patients, 11 were diagnosed as having PCCRC and 881 had non-PCCRC. The PCCRC rate was 1.7%(8/471) at SH and 0.7%(3/421) at DMUKH. In comparison with the non-PCCRC group, the PCCRC group had a significantly higher preponderance of smaller tumors(39 mm vs 19 mm, P = 0.002), a shallower invasion depth(T1 rate, 25.4% vs 63.6%, P = 0.01), a non-polypoid macroscopic appearance(39.0% vs 85.7%, P = 0.02) and an earlier stage(59.7% vs 90.9%, P = 0.03). Possible reasons for PCCRC were "missed or new" in 9 patients(82%), "incomplete resection" in 1(9%), and "inadequate examination'" in 1(9%). Among 9 "missed or new" PCCRC, the leading cause was non-polypoid shape for early PCCRC and blinded location for advanced *** The PCCRC rate for HD colonoscopy was 0.7%-1.7%, being lower than that for standard-definition colonoscopy(1.8%-9.0%) reported previously employing the same methodology.

关键词： Post-colonoscopy colorectal cancer Highdefinition Post-colonoscopy colorectal cancer rate Associated factor Possible explanation

Prospective real-time evaluation of diagnostic performance using endocytoscopy in differentiating neoplasia from nonneoplasia for colorectal diminutive polyps(≤ 5 mm)

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World Journal of Gastrointestinal Oncology 2018年第4期10卷 96-102页

作者： Takahiro Utsumi Yasushi Sano mineo iwatate Hironori Sunakawa Akira Teramoto Daizen Hirata Santa Hattori Wataru Sano Noriaki Hasuike Kazuhito Ichikawa Takahiro Fujimori Gastrointestinal Center and Institute of Minimally Invasive Endoscopic Care (iMEC) Sano Hospital Department of Pathology Shinko Hospital

AIM To clarify the diagnostic performance of endocytoscopy for differentiation between neoplastic and nonneoplastic colorectal diminutive *** Patients who underwent endocytoscopy between October and December 2016 at Sano Hospital were prospectively recruited. When diminutive polyps(≤5 mm) were detected, the lesions were evaluated by endocytoscopy after being stained with 0.05% crystal violet and 1% methylene blue. The diminutivepolyps were classified into five categories(EC 1 a, 1 b, 2, 3 a, and 3 b). Endoscopists were asked to take a biopsy from any lesion diagnosed as EC1 b(indicator of hyperplastic polyp) or EC2(indicator of adenoma). We have assessed the diagnostic performance of endocytoscopy for EC2 and EC1 b lesions by comparison with the histopathology of the biopsy specimen. RESULTS A total of 39 patients with 63 diminutive polyps were analyzed. All polyps were evaluated by endocytoscopy. The mean polyp size was 3.3 ± 0.9 mm. Among the 63 diminutive polyps, 60 were flat and 3 were pedunculated. The mean time required for EC observation, including the time for staining with crystal violet and methylene blue, was 3.0 ± 1.9 min. Histopathologic evaluation showed that 13 polyps were hyperplastic and 50 were adenomas. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of EC2 for adenoma compared with EC1 b for hyperplastic polyp were 98.0%, 92.3%, 96.8%, 98.0% and 92.3%, respectively. There were only two cases of disagreement between the endoscopic diagnosis made by endocytoscopy and the corresponding histopathological *** Endocytoscopy showed a high diagnostic performance for differentiating between neoplastic and non-neoplastic colorectal diminutive polyps, and therefore has the potential to be used for "real-time histopathology".

关键词： Endocytoscopy Diagnostic performance Diminutive polyp Endocytoscopic classification Realtime histopathology

Feasibility of single-incision laparoscopic cholecystectomy for acute cholecystitis

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World Journal of Gastrointestinal Endoscopy 2015年第19期7卷 1327-1333页

作者： Taro Ikumoto Hidetsugu Yamagishi mineo iwatate Yasushi Sano Masahito Kotaka Yasuo Imai Gastrointestinal Cancer Center and Institute of Minimally-invasive Endoscopic Care Sano Hospital Department of Diagnostic Pathology Dokkyo Medical University Department of Anatomic and Diagnostic Pathology Dokkyo Medical University

AIM: To assess the safety of single-incision laparoscopic cholecystectomy(SILC) for acute ***: All patients who underwent SILC at Sano Hospital(Kobe, Japan) between January 2010 and December 2014 were included in this retrospective study. Clinical data related to patient characteristics and surgical outcomes were collected from medical records. The parameters for assessing the safety of the procedure included operative time, volume of blood loss, achievement of the critical view of safety, use of additional trocars, conversion to laparotomy, intraoperative and postoperative complications, and duration of postoperative hospital stay. Patient backgrounds were statistically compared between those with and without conversion to ***: A total of 100 patients underwent SILC for acute cholecystitis during the period. Preoperative endoscopic treatment was performed for suspected choledocholithiasis in 41 patients(41%). The mean time from onset of acute cholecystitis was 7.7 d. According to the Updated Tokyo Guidelines(TG13) for the severity of cholecystitis, 86 and 14 patients had grade Ⅰ and grade Ⅱ acute cholecystitis, respectively. The mean operative time was 87.4 min. The mean estimated blood loss was 80.6 mL. The critical view of safety was obtained in 89 patients(89%). Conversion laparotomy was performed in 12 patients(12%). Postoperative complications of Clavien-Dindo grade Ⅲ or greater were observed in 4 patients(4%). The mean duration of postoperative hospital stay was 5.7 d. Patients converted from SILC to laparotomy tended to have higher days after ***: SILC is feasible for acute cholecystitis; in addition, early surgical intervention may reduce the risk of laparotomy conversion.

关键词： Acute cholecystitis Single-port accesssurgery Single incision laparoscopic cholecystectomy Single incision laparoscopic surgery Laparo-endoscopicsingle-site surgery

New application of endocytoscope for histopathological diagnosis of colorectal lesions

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World Journal of Gastrointestinal Endoscopy 2022年第8期14卷 495-501页

作者： Fumihiro Inoue Daizen Hirata mineo iwatate Santa Hattori Mikio Fujita Wataru Sano Tamotsu Sugai Hiroshi Kawachi Kazuhito Ichikawa Yasushi Sano Gastrointestinal Center and Institute of Minimally-invasive Endoscopic Care(i-MEC) Sano HospitalKobe 655-0031HyogoJapan Molecular Diagnostic Pathology Iwate Medical University School of MedicineShiwa-gun 028-3694IwateJapan Department of Pathology Cancer Institute Hospital of Japanese Foundation for Cancer ResearchKoto 135-8550TokyoJapan Department of Pathology Noda HospitalNoda 270-0237ChibaJapan

BACKGROUND The endocytoscope with ultra-high magnification(x 520)allows us to observe the cellular structure of the colon epithelium during colonoscopy,known as virtual *** hypothesized that the endocytoscope could directly observe colorectal histopathological specimens and store them as endocyto-pathological images by the endoscopists without a microscope,potentially saving the burden on *** To assess the feasibility of endocyto-pathological images taken by an endoscopist as adequate materials for histopathological *** Three gastrointestinal pathologists were invited and asked to diagnose 40 cases of endocyto-pathological images of colorectal *** case contained seven endocyto-pathological images taken by an endoscopist,consisting of one loupe image,three low-magnification images,and three ultra-high magnification *** participants chose hyperplastic polyp or low-grade adenoma for 20 cases of endocyto-pathological images(10 hyperplastic polyps,and 10 Low-grade adenomas in conventional histopathology)in study 1 and high-grade adenoma/shallow invasive cancer or deep invasive cancer for 20 cases[10 tumor in situ/T1a and 10 T1b]in study *** investigated the agreement between the histopathological diagnosis using the endocyto-pathological images and conventional histopathological *** Agreement between the endocyto-pathological and conventional histopathological diagnosis by the three gastrointestinal pathologists was 100%(95%CI:94.0%–100%)in studies 1 and *** interobserver agreement among the three gastrointestinal pathologists was 100%,and theκcoefficient was 1.00 in both *** Endocyto-pathological images were adequate and reliable materials for histopathological diagnosis.

关键词： Cancer Colon Endocytoscopy Histopathology Specimen

Narrow-band imaging observation of colorectal lesions using NICE classification to avoid discarding significant lesions

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World Journal of Gastrointestinal Endoscopy 2014年第12期6卷 600-605页

作者： Santa Hattori mineo iwatate Wataru Sano Noriaki Hasuike Hidekazu Kosaka Taro Ikumoto Masahito Kotaka Akihiro Ichiyanagi Chikara Ebisutani Yasuko Hisano Takahiro Fujimori Yasushi Sano Gastrointestinal Center and Institute of Minimally Invasive Endoscopic Care Sano Hospital Department of Gastroenterology Kobe Minimally Invasive Treatment Center of Cancer Medical Oncology/Hematology Kobe University Graduate School of Medicine Department of Pathology Shinko Hospital

AIM: To assess the risk of failing to detect diminutive and small colorectal cancers with the "resect and discard" ***: Patients who received colonoscopy and polypectomy were recruited in the retrospective study. Probable histology of the polyps was predicted by six colonoscopists by the use of NICE classification. The incidence of diminutive and small colorectal cancersand their endoscopic features were assessed. RESULTS: In total, we found 681 cases of diminutive(1-5 mm) lesions in 402 patients and 197 cases of small(6-9 mm) lesions in 151 patients. Based on pathology of the diminutive and small polyps, 105 and 18 were non-neoplastic polyps, 557 and 154 were low-grade adenomas, 18 and 24 were high-grade adenomas or intramucosal/submucosal(SM) scanty invasive carcinomas, 1 and 1 were SM deeply invasive carcinoma, respectively. The endoscopic features of invasive cancer were classified as NICE type 3 ***: The risk of failing to detect diminutive and small colorectal invasive cancer with the "resect and discard" strategy might be avoided through the use of narrow-band imaging observation with the NICE classification scheme and magnifying endoscopy.

关键词： Image-enhanced endoscopy Narrow-band imaging Resect and discard NICE classification Magnifying endoscope Colonoscopy SM-d

Study on dynamic response of embedded long span corrugated steel culverts using scaled model shaking table tests and numerical analyses

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Journal of Zhejiang University-Science A(Applied Physics & Engineering) 2006年第3期7卷 430-435页

作者：车爱兰 iwatate Takahiro 葛修润 School of Naval Architecture Ocean and Civil Engineering Shanghai Jiao Tong University Shanghai 200030 China Civil and Environmental Engineering Tokyo Metropolitan University Tokyo 192-0397 Japan

A series of scaled-model shaking table tests and its simulation analyses using dynamic finite element method were performed to clarify the dynamic behaviors and the seismic stability of embedded corrugated steel culverts due to strong earth-quakes like the 1995 Hyogoken-nanbu earthquake. The dynamic strains of the embedded culvert models and the seismic soil pressure acting on the models due to sinusoidal and random strong motions were investigated. This study verified that the cor-rugated culvert model was subjected to dynamic horizontal forces (lateral seismic soil pressure) from the surrounding ground, which caused the large bending strains on the structure; and that the structures do not exceed the allowable plastic deformation and do not collapse completely during strong earthquake like Hyogoken-nanbu earthquake. The results obtained are useful for design and construction of embedded long span corrugated steel culverts in seismic regions.

关键词： Embedded corrugated steel culverts Shaking table tests Hyogoken-nanbu earthquake Dynamic analyses

Evaluation of Dynamic Soil-Structure Interaction and Dynamic Seismic Soil Pressures Acting on It Subjected to Strong Earthquake Motions

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Journal of Shanghai Jiaotong university(Science) 2006年第4期11卷 530-536页

作者：车爱兰 iwatate Takahiro 葛修润 School of Naval Architecture Ocean and Civil Eng. Shanghai Jiaotong Univ. Civil and Environmental Eng. Tokyo Metropolitan Univ.

In order to clarify the damage mechanism of the subway structure, the dynamic soil-structure interaction and the dynamic forces acting on the structure, a series of shaking table tests and simulation analyses were performed. The seismic response of the structure and the dynamic forces acting on the structure due to sinusoidal and random waves were investigated with special attention to the dynamic soil-structure interaction. The result shows that the compression seismic soil pressures and extension seismic soil pressures simultaneously act on the sidewalls, and big shear stress also acts on the ceiling slab due to horizontal excitation. The seismic soil pressure could be approximated to hyperbola curve, and reached a peak value with increase of the shear strain of the model ground. In addition, a slide and exfoliation phenomenon between the structure and the surrounding ground was simulated, using the nonlinear analyses. The foundation is provided for amending the calculation method of seismic soil pressure and improving the anti-earthquake designing level of underground structure.

关键词： subway structure dynamic seismic soil pressure dynamic soil-structure interaction shaking table tests dynamic analyses nonlinear characteristics