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World Journal of Gastroenterology 2018年第2期24卷 211-215页

作者： Hirohito Mori Hideki Kobara noriko nishiyama Tsutomu Masaki Departments of Gastroenterology and Neurology Kagawa University

AIM To evaluate appropriate and rapid polyglycolic acid sheet(PGAs) covering time using device delivery station system(DDSS).METHODS This pilot basic study was conducted to evaluate the potential of accurate and rapid PGAs delivery using DDSS. Three 11-month-old female Beagle dogs were used in this study. Two endoscopic submucosal dissections(ESDs) 4 cm in diameter were performed in lesser curvature of middle gastric body and greater curvature of antrum(total 6 ESDs performed). DDSS(3 cm length, 12 mm in outer diameter) has 2 chambers which 16 cm^2 large 2 PGAs were stored, and DDSS was attached post ESD ulcers, respectively. Beriplast P?(CSL Behring K.K., Tokyo, Japan)(combination of fibringlue and thrombin) was applied equally to the artificial ulcer, and tight attachment of 2 PGAs with DDSS were completed. The evaluation items were covering times, post ESD bleeding and perforation during *** The covering time of PGAs(defined as the duration from the beginning of endoscope insertion into the mouth to the end of the fibrin glue coating process) was 6.07(4.86-8.29) min. There was no postESD bleeding(1-7 d after ESD), and there was no perforation during *** DDSS was very useful for rapid delivering and tight attachment of PGAs, and has potentials of multipurpose delivery station system.

关键词： Post-endoscopic submucosal dissection ulcers Bleeding Polyglycolic acid sheet Rapidly delivery Tightly attachment

Oval mucosal opening bloc biopsy after incision and widening by ring thread traction for submucosal tumor

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World Journal of Gastroenterology 2017年第39期23卷 7185-7190页

作者： Hirohito Mori Hideki Kobara Yu Guan Yasuhiro Goda Nobuya Kobayashi noriko nishiyama Tsutomu Masaki Department of Gastroenterology and Neurology Kagawa University Departments of Pharmacology Kagawa University

Gastric submucosal tumors(SMTs) less than 2 cm are generally considered benign neoplasms, and endoscopic observation is recommended, but SMTs over 2 cm, 40% of which are gastrointestinal stromal tumors(GISTs), have malignant potential. Although the Japanese Guidelines for GIST recommend partial surgical resection for GIST over 2 cm with malignant potential as well as en bloc large tissue sample to obtain appropriate and large specimens of SMTs, several reports have been published on tissue sampling of SMTs, such as with endoscopic ultrasound sound fine needle aspiration, submucosal tunneling bloc biopsy, and the combination of bite biopsy and endoscopic mucosal resection. Because a simpler, more accurate method is needed for appropriate treatment, we developed oval mucosal opening bloc biopsy after incision and widening by ring thread traction for submucosal tumor(OMOB) approach. OMOB was simple and enabled us to obtain large samples under direct procedure view as well as allowed us to restore to original mucosa.

关键词： Gastric submucosal tumors Gastrointestinal stromal tumor Reversible opening biopsy Endoscopic ultrasonography Large sample

Accurate hemostasis with a new endoscopic overtube for emergency endoscopy

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World Journal of Gastroenterology 2013年第17期19卷 2723-2726页

作者： Hirohito Mori Hideki Kobara Shintaro Fujihara noriko nishiyama Makoto Oryu Kazi Rafiq Tsutomu Masaki Departments of Gastroenterology and Neurology Kagawa Medical University School of Medicine Departments of Pharmacology Kagawa Medical University School of Medicine

Endoscopic hemostasis performed in the emergency room is difficult due to the presence of blood clots and food residue that makes obtaining a clear view of the bleeding vessel difficult. We experienced the efficacy of a newly developed inverted overtube to shorten the hemostatic time and obtain a clear endoscopic view with upper gastrointestinal bleeding patient who were transferred by ambulance car and required emergency endoscopy. The technique improved the endoscopic views and enabled us to perform the hemostatic procedures from the conventional standing position while freely and easily changing the patient's position. The presence of blood clots and food residue in the gastric fornix or upper gastric body makes identifying a bleeding exposed vessel impossible. This set-up significantly shortened the procedure time. The inverted overtube helped us obtain a clear view in patients who were laid in the right lateral position. Rapid identification of ex-posed vessels resulted in success of hemostasis.

关键词： Emergency endoscopic hemostasis Right lateral decubitus position Identification of exposed vessel Newly developed inverted overtube Clear endoscopic view

Case of pediatric traditional serrated adenoma resected via endoscopic submucosal dissection

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World Journal of Gastroenterology 2017年第24期23卷 4462-4466页

作者： Sonoko Kondo Hirohito Mori noriko nishiyama Takeo Kondo Ryuichi Shimono Hitoshi Okada Takashi Kusaka Department of Pediatrics Faculty of MedicineKagawa University Department of Gastroenterology and Neurology Faculty of MedicineKagawa University Department of Pediatric Surgery Faculty of MedicineKagawa University

Traditional serrated adenoma(TSA)is a type of serrated polyp of the colorectum and is thought to be a precancerous *** are three types of serrated polyps,namely,hyperplastic polyps,sessile serrated adenomas/polyps,and *** is the least common of the three types and accounts for about 5% of serrated *** we report a pediatric case of TSA that was successfully resected by endoscopic submucosal dissection(ESD).This rare case report describes a pediatric patient with no family history of colonic polyp who was admitted to our hospital with *** colonoscopy,we found a polypoid lesion measuring 10 mm in diameter in the lower *** selected ESD as a surgical option for en bloc resection,and histopathological examination revealed *** findings in this case suggest that TSA with precancerous potential can occur in children,and that ESD is useful for treating this lesion.

关键词： Pediatric colonic polyp Hematochezia Colorectal serrated lesions Traditional serrated adenoma Endoscopic mucosal resection Endoscopic submucosal dissection

Management of a large mucosal defect after duodenal endoscopic resection

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World Journal of Gastroenterology 2016年第29期22卷 6595-6609页

作者： Shintaro Fujihara Hirohito Mori Hideki Kobara noriko nishiyama Tae Matsunaga Maki Ayaki Tatsuo Yachida Tsutomu Masaki Departments of Gastroenterology and Neurology Kagawa University Faculty of Medicine

Duodenal endoscopic resection is the most difficult type of endoscopic treatment in the gastrointestinal tract(GI) and is technically challenging because of anatomical specificities. In addition to these technical difficulties, this procedure is associated with a significantly higher rate of complication than endoscopic treatment in other parts of the GI tract. Postoperative delayed perforation and bleeding are hazardous complications, and emergency surgical intervention is sometimes required. Therefore, it is urgently necessary to establish a management protocol for preventing serious complications. For instance, the prophylactic closure of large mucosal defects after endoscopic resection may reduce the risk of hazardous complications. However, the size of mucosal defects after endoscopic submucosal dissection(ESD) is relatively large compared with the size after endoscopic mucosal resection, making it impossible to achieve complete closure using only conventional clips. The over-the-scope clip and polyglycolic acid sheets with fibrin gel make it possible to close large mucosal defects after duodenal ESD. In addition to the combination of laparoscopic surgery and endoscopic resection, endoscopic full-thickness resection holds therapeutic potential for difficult duodenal lesions and may overcome the disadvantages of endoscopic resection in the near future. This review aims to summarize the complications and closure techniques of large mucosal defects and to highlight some directions for management after duodenal endoscopic treatment.

关键词： Endoscopic mucosal resection Endoscopic submucosal dissection Duodenum Complication Bleeding Perforation Over-the-scope clip Clip Closure Endoscopic full-thickness resection

Efficacy and safety of over-the-scope clip: Including complications after endoscopic submucosal dissection

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World Journal of Gastroenterology 2013年第18期19卷 2752-2760页

作者： noriko nishiyama Hirohito Mori Hideki Kobara Kazi Rafiq Shintarou Fujihara Mitsuyoshi Kobayashi Makoto Oryu Tsutomu Masaki Department of Gastroenterology and Neurology Faculty of Medicine Kagawa University Kagawa 761-0796 Japan Department of Pharmacology Faculty of Medicine Kagawa University Kagawa 761-0796 Japan

AIM: To retrospectively review the results of over-thescope clip (OTSC) use in our hospital and to examine the feasibility of using the OTSC to treat perforations after endoscopic submucosal dissection (ESD). METHODS: We enrolled 23 patients who presented with gastrointestinal (GI) bleeding, fistulae and perforations and were treated with OTSCs (Ovesco Endoscopy GmbH, Tuebingen, Germany) between November 2011 and September 2012. Maximum lesion size was defined as lesion diameter. The number of OTSCs to be used per patient was not decided until the lesion was completely closed. We used a twin grasper (Ovesco Endoscopy GmbH, Tuebingen, Germany) as a grasping device for all the patients. A 9 mm OTSC was chosen for use in the esophagus and colon, and a 10 mm device was used for the stomach, duodenum and rectum. The overall success rate and complications were evaluated, with a particular emphasis on patients who had undergone ESD due to adenocarcinoma. In technical successful cases we included not only complete closing by using OTSCs, but also partial closing where complete closure with OTSCs is almost difficult. In overall clinical successful cases we included only complete closing by using only OTSCs perfectly. All the OTSCs were placed by 2 experienced endoscopists. The sites closed after ESD included not only the perforation site but also all defective ulcers ***: A total of 23 patients [mean age 77 years (range 64-98 years)] underwent OTSC placement during the study period. The indications for OTSC placement were GI bleeding (n = 9), perforation (n = 10), fistula (n = 4) and the prevention of post-ESD duodenal artificial ulcer perforation (n = 1). One patient had a perforation caused by a glycerin enema, after which a fistula formed. Lesion closure using the OTSC alone was successful in 19 out of 23 patients, and overall success rate was 82.6%. A large lesion size (greater than 20 mm) and a delayed diagnosis (more than 1 wk) were the major contributing fac

关键词： Over-the-scope clip Gastrointestinal bleed-ing Endoscopic submucosal dissection complications Gastrointestinal fistulae Gastrointestinal perforation

Cytomegalovirus-associated gastric ulcer:A side effect of steroid injections for pyloric stenosis

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World Journal of Gastroenterology 2013年第7期19卷 1143-1146页

作者： Hirohito Mori Shintaro Fujihara noriko nishiyama Hideki Kobara Makoto Oryu Kiyohito Kato Kazi Rafiq Tsutomu Masaki Departments of Gastroenterology and Neurology Kagawa Medical University School of MedicineKagawa 761-0793Japan Departments of Pharmacology Kagawa Medical University School of MedicineKagawa 761-0793Japan

The local injection of triamcinolone acetonide(TA) is effective in preventing pyloric stenosis and deformity following large endoscopic submucosal dissection(ESD).However,because of its long-acting nature,TA can induce long-term local immunosuppression and subsequent adverse *** report a case of a cytomegalovirus(CMV) ulcer that formed only at the TA local injection site.A 68-year-old man underwent ESD to treat early gastric cancer that formed over the *** lesion extended to the duodenum,and an artificial ulcer covered more than two-thirds of the circumference of the *** prevent pyloric stenosis,TA was locally injected into the ulcer *** day 12,a deeper ulcer 10 mm in diameter was discovered in the center of the post-ESD *** revealed large cells with intranuclear inclusion bodies,which stained positive for the anti-CMV *** TA injections are useful,however,CMV ulcer might occur as adverse events.

关键词： Pyloric stenosis Local triamcinolone acetonide injection Local immunosuppression Cytomegalovirus-associated ulcer Adverse events

Two rare gastric hamartomatous inverted polyp cases suggest the pathogenesis of growth

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World Journal of Gastroenterology 2014年第19期20卷 5918-5923页

作者： Hirohito Mori Hideki Kobara Takaaki Tsushimi Shintaro Fujihara noriko nishiyama Tae Matsunaga Maki Ayaki Tatsuo Yachida Tsutomu Masaki Department of Gastroenterology and Neurology Kagawa University School of Medicine1750-1 IkenobeMikiKitaKagawa 761-0793Japan Department of Gastroenterological Surgery Ehime Rosai Hospital13-27MinamikomatsubaraNiihamaEhime 792-8550Japan

Gastric hamartomatous inverted polyps(GHIP)are difficult to diagnose accurately because of inversion into the submucosal *** are diagnosed using the pathological characteristics of the tumor,including the fibroblast cells,smooth muscle,nerve components,glandular hyperplasia,and cystic gland *** Peutz-Jeghers syndrome,juvenile polyposis,and Cowden disease are hereditary,it is rare to encounter 2 cases of monostotic and asymptomatic gastric *** pathogeneses of hamartomatous inverted polyps and inverted hyperplastic polyps remain controversial because of the paucity of reported *** are 3 hypotheses regarding the pathogenesis of complete gastric inverted *** on our experience with 2 successive,rare GHIP cases,we affirm the hypothesis that after a hamartomatous change occurs in the submucosal layer,some of these components are exposed to the gastric mucosa and,consequently,form a hypertrophic *** Case 1,our hypothesis explains why a tiny hypertrophic change was first detected on the top of the submucosal tumor using a detailed narrow band imaging-magnified *** was no confirmation that the milky white mucous and calcification structures were exuding directly from the biopsy site like Case 1,and in Case 2 the presence of this mucous was indirectly confirmed during an endoscopic submucosal dissection(ESD).Regarding the pathogenesis of GHIP,a submucosal hamartomatous change may occur prior to the growth of hypertrophic *** en bloc resection using ESD is recommended for treatment.

关键词： Hamartomatous inverted polyps Hypotheses of pathogenesis Milky white mucous Endoscopic submucosal dissection Pathological findings

Novel and safer endoscopic cholecystectomy using only a flexible endoscope via single port

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World Journal of Gastroenterology 2016年第13期22卷 3558-3563页

作者： Hirohito Mori Nobuya Kobayashi Hideki Kobara noriko nishiyama Shintaro Fujihara Taiga Chiyo Maki Ayaki Takashi Nagase Tsutomu Masaki Department of Gastroenterology and Neurology Kagawa University Department of Gastroenterological Surgery Ehime Rosai Hospital

AIM: To apply the laparoscopic and endoscopic cooperative surgery concept, we investigated whether endoscopic cholecystectomy could be performed more safely and rapidly via only 1 port or ***: Two dogs(11 and 13-mo-old female Beagle) were used in this study. Only 1 blunt port was created, and a flexible endoscope with a tip attachment was inserted between the fundus of gallbladder and liver. After local injection of saline to the gallbladder bed, resection of the gallbladder bed from the liver was performed. After complete resection of the gallbladder bed, the gallbladder was pulled up to resect its neck using the Ring-shaped thread technique. The neck of the gallbladder was cut using scissor forceps. Resected gallbladder was retrieved using endoscopic net forceps via a port. RESULTS: The operation times from general anesthetizing with sevoflurane to finishing the closure of the blunt port site were about 50 min and 60 min respectively. The resection times of gallbladder bed were about 15 min and 13 min respectively without liver injury and bleeding at all. Feed were given just after next day of operation, and they had a good appetite. Two dogs are in good health now and no complications for 1 mo after endoscopic cholecystectomy using only a flexible endoscope via one ***: We are sure of great feasibility of endoscopic cholecystectomy via single port for human.

关键词： Laparoscopic and endoscopic cooperative surgery Endoscopic cholecystectomy Single port Safer and complete resection Feasibility

Radical excision of Barrett's esophagus and complete recovery of normal squamous epithelium

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World Journal of Gastroenterology 2013年第31期19卷 5195-5198页

作者： Hirohito Mori Hideki Kobara Kazi Rafiq noriko nishiyama Shintaro Fujihara Maki Ayagi Tatsuo Yachida Kiyohito Kato Tsutomu Masaki Department of Gastroenterology and Neurology Kagawa University Kagawa 761-0793 Japan Department of Pharmacology Kagawa UniversityKagawa 761-0793 Japan

To treat Barrett's esophagus(BE),radiofrequency ablation or cryotherapy are effective treatments for eradicating BE with dysplasia and intestinal metaplasia,and reduce the rates of Barrett's esophageal adenocarcinoma(BAC).However,patients with BE and dysplasia or early cancer who achieved complete eradication of intestinal metaplasia,BE recurred in 5% within a year,requiring expensive endoscopic *** performed endoscopic submucosal dissection as complete radically curable treatment procedure for BE with dysplasia,intestinal metaplasia and BAC.

关键词： Barrett’s esophagus Radiofrequency ablation Cryotherapy Endoscopic submucosal dissection Radically curable treatment