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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

Current state of practice for colonic diverticular bleeding in 37 hospitals in Japan: A multicenter questionnaire study

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World Journal of Gastrointestinal Endoscopy 2016年第20期8卷 785-794页

作者： Ryota Niikura Naoyoshi Nagata Hisashi Doyama Ryosuke Ota Naoki Ishii Katsuhiro Mabe Tsutomu Nishida Takuto Hikichi Kazuki Sumiyama Jun Nishikawa Toshio Uraoka Shu Kiyotoki mitsuhiro fujishiro Kazuhiko Koike Department of Gastroenterology Graduate School of Medicinethe University of Tokyo Bunkyo-ku Tokyo 113-8655 Japan Department of Gastroenterology and Hepatology National Center for Global Health and MedicineShinjuku-ku Tokyo 162-8655 Japan Department of Gastroenterology Ishikawa Prefectural Central Hospital Kanazawa-shiIshikawa 920-8201 Japan Department of Gastroenterology St. Luke’s International Hospital Chuo-ku Tokyo 104-8560 Japan Division of Endoscopy Hokkaido University Hospital Kita-ku Sapporo 060-0808 Hokkaido Japan Department of Gastroenterology National Hospital Organization Hakodate Hospital KawaharachouHakodate-shi 041-0844 Hokkaido Japan Department of Gastroenterology Toyonaka Municipal Hospital Toyonaka-shi Osaka 560-0055 Japan Department of Endoscopy Fukushima Medical University Hospital Fukushima-shi Fukushima 960-1295 Japan Department of Endoscopy the Jikei University School of Medicine Minato-ku Tokyo 105-8471Japan Department of Clinical Laboratory Science Yamaguchi University Graduate School of Medicine Ube-shiYamaguchi 755-0046 Japan Department of Gastroenterology National Hospital Organization Tokyo Medical Center Meguro-ku Tokyo 150-0021 Japan Department of Gastroenterology Shuto General Hospital Yanai-shi Yamaguchi 742-0032 Japan Endoscopy and Endoscopic Surgery the University of Tokyo Hospital Bunkyo-ku Tokyo 113-8655 Japan

AIM To clarify the current state of practice for colonic diverticular bleeding(CDB) in Japan.METHODS We conducted multicenter questionnaire surveys of the practice for CDB including clinical settings(8 questions),diagnoses(8 questions),treatments(7 questions),and outcomes(4 questions) in 37 hospitals across Japan.The answers were compared between hospitals with high and low number of inpatient beds to investigate which factor influenced the answers.RESULTS Endoscopists at all 37 hospitals answered the questions,and the mean number of endoscopists at these hospitals was 12.7.Of all the hospitals,computed tomography was performed before colonoscopy in 67% of the hospitals.The rate of bowel preparation was 46.0%.Early colonoscopy was performed within 24 h in 43.2% of the hospitals.Of the hospitals,83.8% performed clipping as first-line endoscopic therapy.More than half of the hospitals experienced less than 20% rebleeding events after endoscopic hemostasis.No significant difference was observed in the annual number of patients hospitalized for CDB between high-(≥700 beds) and low-volume hospitals.More emergency visits(P=0.012) and endoscopists(P=0.015),and less frequent participation of nursing staff in early colonoscopy(P=0.045) were observed in the high-volume hospitals.CONCLUSION Some practices unique to Japan were found,such as performing computed tomography before colonoscopy,no bowel preparation,and clipping as first-line therapy.Although,the number of staff differed,the practices for CDB were common irrespective of hospital size.

关键词： colonic diverticular hemorrhage lower gastrointestinal bleeding computed tomography endoscopy bowel preparation

Bleeding after endoscopic submucosal dissection: Risk factors and preventive methods

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World Journal of Gastroenterology 2016年第26期22卷 5927-5935页

作者： Yosuke Kataoka Yosuke Tsuji Yoshiki Sakaguchi Chihiro Minatsuki Itsuko Asada-Hirayama Keiko Niimi Satoshi Ono Shinya Kodashima Nobutake Yamamichi mitsuhiro fujishiro Kazuhiko Koike Department of Gastroenterology Graduate School of Medicine The University of Tokyo Center for Epidemiology and Preventive Medicine Graduate School of Medicine The University of Tokyo Department of Endoscopy and Endoscopic Surgery Graduate School of Medicine The University of Tokyo

Endoscopic submucosal dissection(ESD) has become widely accepted as a standard method of treatment for superficial gastrointestinal neoplasms because it enables en block resection even for large lesions or fibrotic lesions with minimal invasiveness, and decreases the local recurrence rate. Moreover, specimens resected in an en block fashion enable accurate histological assessment. Taking these factors into consideration, ESD seems to be more advantageous than conventional endoscopic mucosal resection(EMR), but the associated risks of perioperative adverse events are higher than in EMR. Bleeding after ESD is the most frequent among these adverse events. Although post-ESD bleeding can be controlled by endoscopic hemostasis in most cases, it may lead to serious conditions including hemorrhagic shock. Even with preventive methods including administration of acid secretion inhibitors and preventive hemostasis, post-ESD bleeding cannot be completely prevented. In addition high-risk cases for post-ESD bleeding, which include cases with the use of antithrombotic agents or which require large resection, are increasing. Although there have been many reports about associated risk factors and methods of preventing post-ESD bleeding, many issues remain unsolved. Therefore, in this review, we have overviewed risk factors and methods of preventing post-ESD bleeding from previous studies. Endoscopists should have sufficient knowledge of these risk factors and preventive methods when performing ESD.

关键词： Endoscopic submucosal dissection Risk factor Bleeding Prevention Antithrombotic agents

Subserosal injection of hyaluronic acid may prevent perforation after endoscopic resection

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World Journal of Gastrointestinal Endoscopy 2009年第1期1卷 61-64页

作者： Keiko Niimi mitsuhiro fujishiro Shinya Kodashima Satoshi Ono Osamu Goto Nobutake Yamamichi Kazuhiko Koike Department of Gastroenterology Graduate School of MedicineUniversity of TokyoTokyo 113-8655Japan

AIM:To investigate the protective effect of subserosal injection of hyaluronic acid(HA) after endoscopic resection(ER) using ex vivo and in vivo studies.METHODS:As the first examination,technical application of subserosal injection was tested 10 times using resected porcine stomachs.As the second examination,ER was applied to make six mucosal defects per stomach in three live minipigs and thermal damage was given on the proper muscle layer by using hemostatic forceps.Following the thermocoagulation,1 mL of normal saline and HA,respectively,was injected targeting the subserosal layer in two mucosal defects each and the rest kept no injection as the control.The minipigs were recovered from the anesthesia and kept fasting until euthanasia which was carried out around 24 h after the procedures.RESULTS:Ex vivo study revealed that complete and partial subserosal injection was possible two(20%) and four(40%) times,respectively.In vivo study revealed that no postoperative perforation occurred at any point of the thermocoagulation.Apparent retention of hyaluronic acid was identified at only two(33%) points where HA was injected.CONCLUSION:This study failed to show preventative effects of subserosal injection of HA on postoperative perforation due to technical faults.However,this concept has a possibility to change strategy of ER with further technical innovation.

关键词： Subserosal injection Endoscopic submucosal dissection Endoscopic mucosal resection Animal model Thermal injury Perforation

Evaluation of preferable insertion routes for esophagogastroduodenoscopy using ultrathin endoscopes

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World Journal of Gastroenterology 2014年第17期20卷 5045-5050页

作者： Satoshi Ono Keiko Niimi mitsuhiro fujishiro Yu Takahashi Yoshiki Sakaguchi Chiemi Nakayama Chihiro Minatsuki Rie Matsuda Itsuko Hirayama-Asada Yosuke Tsuji Satoshi Mochizuki Shinya Kodashima Nobutake Yamamichi Atsuko Ozeki Lumine Matsumoto Yumiko Ohike Tsutomu Yamazaki Kazuhiko Koike Center for Epidemiology and Preventive Medicine Graduate School of MedicineUniversity of TokyoTokyo 113-8655Japan Department of Gastroenterology Graduate School of MedicineUniversity of TokyoTokyo 113-8655Japan Department of Endoscopy and Endoscopic Surgery Graduate School of MedicineUniversity of TokyoTokyo 113-8655Japan

AIM:To evaluate the discomfort associated with esophagogastroduodenoscopy(EGD)using an ultrathin endoscope through different insertion routes.METHODS:This study(January 2012-March 2013)included 1971 consecutive patients[male/female(M/F),1158/813,57.5±11.9 years]who visited a single institute for annual health checkups.Transnasal EGD was performed in 1394 patients and transoral EGD in 577.EGD-associated discomfort was assessed using a visual analog scale score(VAS score:0-10).RESULTS:Multivariate analysis revealed gender(M vs F:4.02±2.15 vs 5.06±2.43)as the only independent predictor of the VAS score in 180 patients who underwent EGD for the first time;whereas it revealed gender(M vs F 3.60±2.20 vs 4.84±2.37),operator,age group(A:70 years;A/B/C/D/E:4.99±2.32/4.34±2.49/4.19±2.31/3.99±2.27/3.63±2.31),and type of insertion as independent predictors in the remaining patients.Subanalysis for gender,age group,and insertion route revealed that the VAS score decreased with age regardless of gender and insertion route,was high in female patients regardless of age and insertion route,and was low in males aged over60 years who underwent transoral insertion.CONCLUSION:Although comprehensive analysis revealed that the insertion route may not be an independent predictor of the VAS score,transoral insertion may reduce EGD-associated discomfort in elderly patients.

关键词： Esophagogastroduodenoscopy Ultrathin endoscope Vis

Ultrathin endoscope flexibility can predict discomfort associated with unsedated transnasal esophagogastroduodenoscopy

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World Journal of Gastrointestinal Endoscopy 2013年第7期5卷 346-351页

作者： Satoshi Ono Keiko Niimi mitsuhiro fujishiro Tomoko Nakao Kazushi Suzuki Yumiko Ohike Shinya Kodashima Nobutake Yamamichi Tsutomu Yamazaki Kazuhiko Koike Center for Epidemiology and Preventive Medicine Graduate School of Medicine the University of TokyoTokyo 113-8655 Japan Department of Gastroenterology Graduate School of Medicine the University of TokyoTokyo 113-8655 Japan Department of Endoscopy and Endoscopic Surgery Graduate School of Medicine the University of TokyoTokyo 113-8655 Japan

AIM: To evaluate the effects of choice of insertion route and ultrathin endoscope types. METHODS: This prospective study (January-June 2012) included 882 consecutive patients who underwent annual health checkups. Transnasal esophagogastroduodenoscopy (EGD) was performed in 503 patients and transoral EGD in 235 patients using six types of ultrathin endoscopes. Patients were given a choice of insertion route, either transoral or transnasal, prior to EGD examination. For transoral insertion, the endo-scope was equipped with a thin-type mouthpiece and tongue depressor. Conscious sedation was not used for any patient. EGD-associated discomfort was assessed using a visual analog scale (VAS; no discomfort 0maximum discomfort 10). RESULTS: Rates of preference for transnasal insertion were significantly higher in male (male/female 299/204 vs 118/117) and younger patients (56.8 ± 11.2 years vs 61.3 ± 13.0 years), although no significant difference was found in VAS scores between transoral and transnasal insertion (3.9 ± 2.3 vs 4.1 ± 2.5). Multivariate analysis revealed that gender, age, operator, and endoscope were independent significant predictors of VAS for transnasal insertion, although gender, age, and endoscope were those for transoral insertion. Further analysis revealed only the endoscopic flexibility index (EFI) as an independent significant predictor of VAS for transnasal insertion. Both EFI and tip diameter were independent significant predictors of VAS for transoral insertion. CONCLUSION: Flexibility of ultrathin endoscopes can be a predictor of EGD-associated discomfort, especially in transnasal insertion.

关键词： Esophagogastroduodenoscopy Ultrathin endoscope Visual analog scale Discomfort Surveillance

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 neoplasias.METHODS:Between February 2002 and December 2009,a total of 286 patients with gastric epithelial neoplasia underwent endoscopic submucosal dissection in our hospital.To achieve moderate sedation,5-7.5 mg of diazepam was administered intravenously by non-anesthesiologists.Intermittent additional administration of 2.5-5 mg diazepam was performed if uncontrollable body movement of the patient was observed.All 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 dosage.In 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

Assessment of gastroesophageal reflux disease by serodiagnosis of Helicobacter pylori-related chronic gastritis stage

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World Journal of Gastrointestinal Endoscopy 2011年第4期3卷 71-77页

作者： Shotaro Enomoto Masashi Oka Hiroshi Ohata Chizu Mukoubayashi Mika Watanabe Kosaku Moribata Yosuke Muraki Naoki Shingaki Hisanobu Deguchi Kazuki Ueda Izumi Inoue Takao Maekita Mikitaka Iguchi Kimihiko Yanaoka Hideyuki Tamai mitsuhiro fujishiro Osamu Mohara Masao Ichinose Second Department of Internal Medicine Wakayama Medical UniversityWakayama641-0012Japan Wakayama Wellness Foundation Wakayama640-8404Japan Department of Endoscopy and Endoscopic Surgery Faculty of MedicineUniversity of TokyoTokyo113-8655Japan

AIM:To evaluate the association of Helicobacter pylori(H.pylori)-related chronic gastritis stage with upper gastro-intestinal symptoms and gastro-eso-phageal reflux disease(GERD).METHODS:Subjects underwent upper gastrointestinal endoscopy,a questionnaire using a frequency scale for symptoms of GERD(FSSG),and measurements of serum H.pylori-antibody and pepsinogen(PG)levels.They were classified into the following 4 groups in terms of H.pylori-related chronic gastritis stage:Group A(n = 219),H.pylori(-)PG(-);Group B(n = 310),H.pylori(+)PG(-);Group C(n = 279),H.pylori(+)PG(+);and Group D(n = 17),H.pylori(-)PG(+).RESULTS:Reflux esophagitis occurred in 30.6% of Group A,14.5% of Group B,6.8% of Group C,and 0% of Group D(P < 0.001).Scores for acid reflux sympto-ms decreased significantly with chro-nic gastritis stage(from Group A to D)(P < 0.05),while scores for dysmotility symptoms did no-t differ significantly.The prevalence of nonerosive reflux disease(NERD)did not differ amo-ng groups.However,in subjects with GERD,the prevalence of NERD tended to increase with chronic gastritis stage(P = 0.081).CONCLUSION:Acid reflux sympto-ms and the prevalen-ce of reflux esophagitis can be assessed by measuring both serum H.pylori-antibody and PG levels.

关键词： Gastro-eso-phageal reflux disease Helicobacter pylori Pepsinogen Screening and diagnosis

在屏蔽胃的 mucosal 瘤形成的 Transnasal 和标准 transoral 内视镜检查法

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World Journal of Gastrointestinal Endoscopy 2011年第8期3卷 162-170页

作者： Hiroya Nakata Shotaro Enomoto Takao Maekita Izumi Inoue Kazuki Ueda Hisanobu Deguchi Naoki Shingaki Kosaku Moribata Yoshimasa Maeda Yoshiyuki Mori Mikitaka Iguchi Hideyuki Tamai Hiroya Nakata Nobutake Yamamichi mitsuhiro fujishiro Jun Kato Masao Ichinose Department of Gastroenterology School of Medicine Wakayama Medical University Wakayama City Wakayama 641-0012 Japan Nakata Medical Clinic Wakayama 641-0006 Japan Department of Gastroenterology Graduate School of Medicine The University of Tokyo Tokyo 113-8655 Japan

AIM: To compare the diagnostic performances of transnasal and standard transoral esophagogastroduodenoscopy (EGD) in gastric cancer screening of asymptomatic healthy subjects. METHODS: Between January 2006 and March 2010, atotal of 3324 subjects underwent examination of the upper gastrointestinal tract by EGD for cancer screening, with 1382 subjects (41.6%) screened by transnasal EGD and the remaining 1942 subjects (58.4%) by standard transoral EGD. Clinical profiles of the screened subjects, detection rates of gastric neoplasia and histopathology of the detected neoplasias were compared between groups according to the stage of Helicobacter pylori (H. pylori )-related chronic gastritis. RESULTS: Clinical profiles of subjects did not differ significantly between the two EGD groups, except that there were significantly more men in the transnasal EGD group. During the study period, 55 cases of gastric mucosal neoplasias were detected. Of these, 23 cases were detected by transnasal EGD and 32 cases by standard transoral EGD. The detection rate for gastric mucosal neoplasia in the transnasal EGD group was thus 1.66%, compared to 1.65% in the standard transoral EGD group, with no significant difference between the two groups. Detection rates using the two endoscopies were likewise comparable, regardless of H. pylori infection. However, detection rates when screening subjects without extensive chronic atrophic gastritis (CAG) were significantly higher with standard transoral EGD (0.70%) than with transnasal EGD (0.12%, P < 0.05). In particular, standard transoral EGD was far better for detecting neoplasia in subjects with H. pylorirelated non-atrophic gastritis, with a detection rate of 3.11% compared to 0.53% using transnasal EGD (P < 0.05). In the screening of subjects with extensive CAG, no significant differences in detection of neoplasia were evident between the two endoscopies, although the mean size of detected cancers was significantly smaller and the percentage of early cancers was significantly higher wi

关键词： Transnasal endoscopy Gastric cancer Gastric adenoma Atrophic gastritis Helicobacter pylori Cancer screening