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Novel image-enhanced endoscopy with i-scan technology

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World Journal of Gastroenterology 2010年第9期16卷 1043-1049页

作者： Shinya Kodashima Mitsuhiro Fujishiro Department of Endoscopy and Endoscopic Surgery Graduate School of MedicineThe University of Tokyo

i-scan technology is the newly developed imageenhanced endoscopy technology from PENTAX,Japan.This consists of three types of algorithms:surface enhancement (SE),contrast enhancement (CE),and tone enhancement (TE).SE enhances light-dark contrast by obtaining luminance intensity data for each pixel and applying an algorithm that allows detailed observation of a mucosal surface structure.CE digitally adds blue color in relatively dark areas,by obtaining luminance intensity data for each pixel and applying an algorithm that allows detailed observation of subtle irregularities around the surface.Both enhancement functions work in real time without impairing the original color of the organ,therefore,SE and CE are suitable for screening endoscopy to detect gastrointestinal tumors at an early stage.TE dissects and analyzes the individual RGB components of a normal image.The algorithm then alters the color frequencies of each component and recombines the components to a single,new color image.This is designed to enhance minute mucosal structures and subtle changes in color.TE works in real time and consists of three modes such as TE-g for gastric tumors,TE-c for colonic tumors,and TE-e for esophageal tumors.TE is suitable mainly for detailed examination of the lesions that are detected in a screening endoscopy.i-scan technology leads us to easier detection,diagnosis and treatment of gastroi ntestinal diseases.

关键词： Gastrointestinal tumor Gastrointestinal endoscopy

Endoscopic submucosal dissection for stomach neoplasms

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World Journal of Gastroenterology 2006年第32期12卷 5108-5112页

作者： Mitsuhiro Fujishiro Department of Gastroenterology Graduate School of Medicine University of Tokyo7-3-1HongoBunkyokuTokyoJapan

在为胃瘤的治疗学的内视镜检查法的技术的最近的进展很快被完成。这块地里的主要话题之一是内视镜的粘膜下层解剖(ESD ) 。ESD 是用切设备由下列三步移开肿瘤的一种新内视镜的技术：把液体注入粘膜下层从肌肉层提高肿瘤， pre-cutting ... 详细信息

在为胃瘤的治疗学的内视镜检查法的技术的最近的进展很快被完成。这块地里的主要话题之一是内视镜的粘膜下层解剖(ESD ) 。ESD 是用切设备由下列三步移开肿瘤的一种新内视镜的技术：把液体注入粘膜下层从肌肉层提高肿瘤， pre-cutting 包围肿瘤的粘膜，并且把在肿瘤下面的粘膜下层的结缔组织。肿瘤因此是以一种整块方式能的将切除，不管尺寸，形状，共存的溃疡，和地点。为 ESD 的指示被二个方面严格地限制：节的转移和技术困难的可能性，它取决于操作员。尽管长期的结果数据仍然正在缺乏， ESD 的短期的结果是极其赞成的，有胃切除术的剖腹术为早胃的癌症在治疗学的策略的一些部分被 ESD 代替。

关键词：黏膜下层解剖内窥镜检查胃内新生物疾病检查

Endoscopic submucosal dissection for superficial esophageal neoplasms

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World Journal of Gastrointestinal Endoscopy 2012年第5期4卷 162-166页

作者： Satoshi Ono Mitsuhiro Fujishiro Kazuhiko Koike Center for Epidemiology and Preventive Medicine Graduate School of MedicineUniversity of Tokyo7-3-1HongoBunkyoTokyo 113-8655Japan Department of Endoscopy and Endoscopic Surgery Graduate School of MedicineUniversity of Tokyo7-3-1HongoBunkyoTokyo 113-8655Japan Department of Gastroenterology Graduate School of MedicineUniversity of Tokyo7-3-1HongoBunkyoTokyo 113-8655Japan

Endoscopic submucosal dissection(ESD) is currently accepted as the major treatment modality for superficial neoplasms in the gastrointestinal tract including the esophagus.An important advantage of ESD is its effectiveness in resecting lesions regardless of their size and severity of fibrosis.Based on excellent outcomes for esophageal neoplasms with a small likelihood of lymph node metastasis,the number of ESD candidates has increased.On the other hand,ESD still requires highly skilled endoscopists due to technical difficulties.To avoid unnecessary complications including perforation and postoperative stricture,the indications for ESD require careful consideration and a full understanding of this modality.This article,in the highlight topic series,provides detailed information on the indication,procedure,outcome,complications and their prevention in ESD of superficial esophageal neoplasms.

关键词： Complications Endoscopic submucosal dissection Esophageal neoplasm Indication Outcome Squamous cell carcinoma

Endoscopic submucosal dissection for gastrointestinal neoplasms

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World Journal of Gastroenterology 2008年第19期14卷 2962-2967页

作者： Naomi Kakushima Mitsuhiro Fujishiro Department of Gastroenterology The University of TokyoGraduate School of Medicine

Endoscopic submucosal dissection (ESD) is an advanced technique of therapeutic endoscopy for superficial gastrointestinal neoplasms. Three steps characterize it:injecting fluid into the submucosa to elevate the lesion, cutting the surrounding mucosa of the lesion, and dissecting the submucosa beneath the lesion. The ESD technique has rapidly permeated in Japan for treatment of early gastric cancer, due to its excellent results of en- bloc resection compared to endoscopic mucosal resection (EMR). Although there is still room for improvement to lessen its technical difficulty, ESD has recently been applied to esophageal and colorectal neoplasms. Favorable short-term results have been reported, but the application of ESD should be well considered by three aspects:(1) the possibility of nodal metastases of the lesion, (2) technical difficulty such as location, ulceration and operator’s skill, and (3) organ characteristics.

关键词：内窥镜检查胃癌食管癌结直肠癌诊断方法

采用深度卷积神经网络对结肠镜影像进行自动解剖定位

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Gastroenterology Report 2021年第3期9卷 226-233,I0002页

作者： Hiroaki Saito Tetsuya Tanimoto Tsuyoshi Ozawa Soichiro Ishihara Mitsuhiro Fujishiro Satoki Shichijo Dai Hirasawa Tomoki Matsuda Yuma Endo Tomohiro Tada Department of Gastroenterology Sendai Kousei HospitalMiyagiJapan Department of Internal Medicine Navitas ClinicTokyoJapan Tada Tomohiro Institute of Gastroenterology and Proctology SaitamaJapan Department of Surgery Teikyo University School of MedicineTokyoJapan Department of Surgical Oncology Graduate School of MedicineThe University of TokyoTokyoJapan Department of Gastroenterology and Hepatology Nagoya University Graduate School of MedicineAichiJapan Department of Gastrointestinal Oncology Osaka International Cancer InstituteOsakaJapan AI Medical Service Inc.TokyoJapan

背景:结肠镜能检出肿瘤、息肉和炎症性肠病等结直肠疾病。应用深度卷积神经网络(CNN)的计算机辅助诊断(CAD)系统在结肠镜检查中能够识别解剖部位,为内镜医生提供支持。本研究旨在建立一个应用CNN的CAD系统,以区分盲肠、升结肠、横结肠... 详细信息

背景:结肠镜能检出肿瘤、息肉和炎症性肠病等结直肠疾病。应用深度卷积神经网络(CNN)的计算机辅助诊断(CAD)系统在结肠镜检查中能够识别解剖部位,为内镜医生提供支持。本研究旨在建立一个应用CNN的CAD系统,以区分盲肠、升结肠、横结肠、降结肠、乙状结肠及直肠等解剖部位的内镜影像。方法:我们用包括9,995个结肠镜影像的训练组来建立CNN,并用5,121个独立的结肠镜影像来进行验证CNN的检测效能。验证组影像根据解剖部位分为七类:回肠末端、盲肠、升结肠至横结肠、降结肠至乙状结肠、直肠、肛门以及无法识别的部位。我们检测了2017年1-11月间单中心的结肠镜影像照片,评估内镜医生与CNN的诊断一致性。本研究主要结局指标是CNN判断内镜下解剖部位的灵敏度和特异度。结果:我们建立的CNN识别内镜下解剖部位的曲线下面积为:回肠末端0.979,盲肠0.940,升结肠至横结肠0.875,降结肠至乙状结肠,0.846,直肠0.835,肛门0.992。在验证过程中,CNN系统能准确识别66.6%的内镜下解剖部位。结论:我们建立了一个临床相关的新的CNN系统,该系统可识别结肠镜下的不同解剖部位,这是构建CAD系统的第一步,后者能给结肠镜检查提供质量保障。

关键词：结肠镜检查曲线下面积解剖定位内镜下回肠末端深度卷积神经网络结局指标炎症性肠病

Endoscopic submucosal dissection for colorectal neoplasms

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World Journal of Gastrointestinal Endoscopy 2009年第1期1卷 32-38页

作者： Mitsuhiro Fujishiro Department of Gastroenterology Graduate School of MedicineUniversity of TokyoTokyo 113-8655Japan

Although endoscopic submucosal dissection(ESD) gains acceptance as one of the standard treatments for esophageal and stomach neoplasms in Japan,it is still in the developing stage for colorectal neoplasms.In terms of indications,little likelihood of nodal metastasis and technical resectability are principally considered.Some of intramucosal neoplasms,carcinomas with minute submucosal invasion,and carcinoid tumors,which are technically unresectable by conventional endoscopic treatments,may become good candidates for ESD,considering substantial risks and obtained benefits.ESD as a staging measure to obtain histological information of the invasion depth and lymphovascular infiltration is acceptable because preoperative prediction is difficult in some cases.In terms of techniques,advantages of ESD in comparison with other endoscopic treatments are to be controllable in size and shape,and to be resectable even in large and fibrotic neoplasms.The disadvantages may be longer procedure time,heavier bleeding,and higher possibility of perforation.However,owing to refinement of the techniques,invention of devices,and the learning curve,acceptable technical safety has been achieved.Colorectal ESD is very promising and become one of the standard treatments for colorectal neoplasms in the near future.

关键词： Colorectal neoplasm Early colorectal cancer Endoscopic submucosal dissection Endoscopic mucosal resection Endoluminal surgery

Gastric cancer incidence based on endoscopic Kyoto classification of gastritis

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世界胃肠病学杂志:英文版 2023年第31期29卷 4763-4773页

作者： Osamu Toyoshima Toshihiro Nishizawa Shuntaro Yoshida Tatsuya Matsuno Gota Fujisawa Akira Toyoshima Hirotoshi Ebinuma Mitsuhiro Fujishiro Yutaka Saito Hidekazu Suzuki Department of Gastroenterology Toyoshima Endoscopy ClinicTokyo 157-0066Japan Department of Gastroenterology and Hepatology International University of Health and WelfareNarita HospitalNarita 286-8520Japan Department of Colorectal Surgery Japanese Red Cross Medical CenterTokyo 150-8935Japan Department of Gastroenterology Graduate School of MedicineThe University of TokyoTokyo 113-8655Japan Division of Endoscopy National Cancer Center HospitalTokyo 104-0045Japan Division of Gastroenterology and Hepatology Department of Internal MedicineTokai University School of MedicineIsehara 259-1193Japan

BACKGROUND Gastric cancer(GC)incidence based on the endoscopic Kyoto classification of gastritis has not been systematically investigated using time-to-event analysis.AIM To examine GC incidence in an endoscopic surveillance cohort.METHODS This study was retrospectively conducted at the Toyoshima Endoscopy Clinic.Patients who underwent two or more esophagogastroduodenoscopies were enrolled.GC incidence was based on Kyoto classification scores,such as atrophy,intestinal metaplasia(IM),enlarged folds(EFs),nodularity,diffuse redness(DR),and total Kyoto scores.Hazard ratios(HRs)adjusted for age and sex were calculated using a Cox hazard model.RESULTS A total of 6718 patients were enrolled(median age 54.0 years;men 44.2%).During the follow-up period(max 5.02 years;median 2.56 years),GC developed in 34 patients.The average frequency of GCs per year was 0.19%.Kyoto atrophy scores 1[HR with score 0 as reference:3.66,95%confidence interval(CI):1.06 to 12.61],2(11.60,3.82-35.27),IM score 2(9.92,4.37-22.54),EF score 1(4.03,1.63-9.96),DR scores 1(6.22,2.65-14.56),and 2(10.01,3.73-26.86)were associated with GC incidence,whereas nodularity scores were not.The total Kyoto scores of 4(HR with total Kyoto scores 0-1 as reference:6.23,95%CI:1.93 to 20.13,P=0.002)and 5-8(16.45,6.29-43.03,P<0.001)were more likely to develop GC,whereas the total Kyoto scores 2-3 were not.The HR of the total Kyoto score for developing GC per 1 rank was 1.75(95%CI:1.46 to 2.09,P<0.001).CONCLUSION A high total Kyoto score(≥4)was associated with GC incidence.The endoscopy-based diagnosis of gastritis can stratify GC risk.

关键词： Gastric cancer Gastritis Endoscopy Atrophy Intestinal metaplasia Kyoto classification

流血和与内视镜的 submucosal 解剖联系的人工的胃的溃疡的管理

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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

Brown slits for colorectal adenoma crypts on conventional magnifying endoscopy with narrow band imaging using the X1 system

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World Journal of Gastroenterology 2022年第24期28卷 2748-2757页

作者： Osamu Toyoshima Toshihiro Nishizawa Shuntaro Yoshida Hidenobu Watanabe Nariaki Odawara Kosuke Sakitani Toru Arano Hirotoshi Takiyama Hideyuki Kobayashi Hirofumi Kogure Mitsuhiro Fujishiro Department of Gastroenterology Toyoshima Endoscopy ClinicTokyo 157-0066Japan Department of Gastroenterology and Hepatology International University of Health and WelfareNarita HospitalChiba 286-8520Japan Department of Pathology Pathology and Cytology Laboratory JapanTokyo 166-0003Japan Department of Gastroenterology Graduate School of MedicineThe University of TokyoTokyo 113-8655Japan Department of Gastroenterology Sakitani Endoscopy ClinicChiba 275-0026Japan Department of Gastroenterology The Fraternity Memorial HospitalTokyo 130-8587Japan Department of Surgical Oncology The University of TokyoTokyo 113-8655Japan Department of Internal Medicine Umegaoka Ekimae ClinicTokyo 154-0022Japan

BACKGROUND Accurate diagnosis of colorectal premalignant polyps,including adenomas,is vital in clinical practice.AIM To investigate the diagnostic yields of novel findings of brown slits for adenomas.METHODS Patients who underwent colonoscopy at the Toyoshima Endoscopy Clinic were enrolled.Polyps sized≥5 mm suspected of adenomas or clinically significant serrated polyps were included in the study.We defined the surface structures of colorectal polyps,which were brown curves inside and along the tubular glands identified using a combination of a new X1 system(Olympus Corporation)and a conventional magnifying colonoscope with non-staining narrow band imaging(NBI),as brown slits.The brown slits corresponded to slit-like lumens on endocytoscopy and histological crypt openings of an adenoma.We evaluated the diagnostic performance of brown slits for adenoma.RESULTS A total of 108 Lesions from 62 patients were eligible.The average age was 60.4 years and 41.9%were male.The mean polyp size was 7.45±2.83 mm.Fifty-seven lesions were positive for brown slits.Histopathological diagnosis comprised 59 low-grade tubular adenomas,16 sessile serrated lesions,and 33 hyperplastic polyps.Among 59 adenomas,56(94.9%)were positive for brown slits.Among 16 sessile serrated lesions,0(0%)was positive for brown slits.Among 33 hyperplastic polyps,1(3.0%)was positive for brown slits.The sensitivity,specificity,and accuracy of brown slits for adenoma were 94.9%,98.0%,and 96.3%,respectively.The positive predictive value and negative predictive value of brown slits for adenoma were also excellent for 98.2%,and 94.1%,respectively.CONCLUSION Brown slits on conventional magnifying endoscopy with non-staining NBI using the X1 system were useful for diagnosing colorectal adenoma.The new endoscopy system could be examined using new standards.

关键词： Adenoma Colonoscopy Narrow band imaging Magnifying endoscopy X1 Serrated polyp Colorectal neoplasm Endocytoscopy