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Endoscopic Kyoto classification of Helicobacter pylori infection and gastric cancer risk diagnosis

World Journal of Gastroenterology 2020年第5期26卷 466-477页

作者： Osamu Toyoshima Toshihiro Nishizawa Kazuhiko Koike Department of Gastroenterology Toyoshima Endoscopy ClinicTokyo 157-0066Japan Department of Gastroenterology Graduate School of MedicineThe University of TokyoTokyo 113-8655Japan Department of Gastroenterology and Hepatology International University of Health and WelfareMita HospitalTokyo 108-8329Japan

Recent advances in endoscopic technology allow detailed observation of the gastric mucosa.Today,endoscopy is used in the diagnosis of gastritis to determine the presence/absence of Helicobacter pylori(H.pylori)infection and evaluate gastric cancer risk.In 2013,the Japan Gastroenterological Endoscopy Society advocated the Kyoto classification,a new grading system for endoscopic gastritis.The Kyoto classification organized endoscopic findings related to H.pylori infection.The Kyoto classification score is the sum of scores for five endoscopic findings(atrophy,intestinal metaplasia,enlarged folds,nodularity,and diffuse redness with or without regular arrangement of collecting venules)and ranges from 0 to 8.Atrophy,intestinal metaplasia,enlarged folds,and nodularity contribute to gastric cancer risk.Diffuse redness and regular arrangement of collecting venules are related to H.pylori infection status.In subjects without a history of H.pylori eradication,the infection rates in those with Kyoto scores of 0,1,and≥2 were 1.5%,45%,and 82%,respectively.A Kyoto classification score of 0 indicates no H.pylori infection.A Kyoto classification score of 2 or more indicates H.pylori infection.Kyoto classification scores of patients with and without gastric cancer were 4.8 and 3.8,respectively.A Kyoto classification score of 4 or more might indicate gastric cancer risk.

关键词： Gastric cancer Helicobacter pylori Endoscopy Kyoto classification Atrophy Intestinal metaplasia Enlarged fold Nodularity Diffuse redness Regular arrangement of collecting venules

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Kyoto classification of gastritis:Advances and future perspectives in endoscopic diagnosis of gastritis

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World Journal of Gastroenterology 2022年第43期28卷 6078-6089页

作者： Osamu Toyoshima Toshihiro Nishizawa Department of Gastroenterology Toyoshima Endoscopy ClinicTokyo 157-0066Japan Department of Gastroenterology and Hepatology International University of Medicine and WelfareNarita 286-8520Japan

This editorial provides an update of the recent evidence on the endoscopy-based Kyoto classification of gastritis,clarifying the shortcomings of the Kyoto classification,and providing prospects for future research,with particular focus on the histological subtypes of gastric cancer(GC)and Helicobacter pylori(H.pylori)infection status.The total Kyoto score is designed to express GC risk on a score ranging from 0 to 8,based on the following five endoscopic findings:Atrophy,intestinal metaplasia(IM),enlarged folds(EF),nodularity,and diffuse redness(DR).The total Kyoto score reflects H.pylori status as follows:0,≥2,and≥4 indicate a normal stomach,H.pylori-infected gastritis,and gastritis at risk for GC,respectively.Regular arrangement of collecting venules(RAC)predicts noninfection;EF,nodularity,and DR predict current infection;map-like redness(MLR)predicts past infection;and atrophy and IM predict current or past infection.Atrophy,IM,and EF all increase the incidence of H.pylori-infected GC.MLR is a specific risk factor for H.pylori-eradicated GC,while RAC results in less GC.Diffuse-type GC can be induced by active inflammation,which presents as EF,nodularity,and atrophy on endoscopy,as well as neutrophil and mononuclear cell infiltration on histology.In contrast,intestinal-type GC develops via atrophy and IM,and is consistent between endoscopy and histology.However,this GC risk-scoring design needs to be improved.

关键词： Kyoto classification Gastritis Endoscopy Gastric cancer Histology Helicobacter pylori

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Topic highlight on texture and color enhancement imaging in gastrointestinal diseases

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World Journal of Gastroenterology 2024年第14期30卷 1934-1940页

作者： Osamu Toyoshima Toshihiro Nishizawa Keisuke Hata Department of Gastroenterology Toyoshima Endoscopy ClinicTokyo 157-0066Japan Department of Gastroenterology and Hepatology International University of Health and WelfareNarita HospitalNarita 286-8520Japan Department of Gastroenterology Nihonbashi Muromachi Mitsui Tower Midtown ClinicTokyo 103-0022Japan

Olympus Corporation developed texture and color enhancement imaging(TXI)as a novel image-enhancing endoscopic technique.This topic highlights a series of hot-topic articles that investigated the efficacy of TXI for gastrointestinal disease identification in the clinical setting.A randomized controlled trial demonstrated improvements in the colorectal adenoma detection rate(ADR)and the mean number of adenomas per procedure(MAP)of TXI compared with those of white-light imaging(WLI)observation(58.7%vs 42.7%,adjusted relative risk 1.35,95%CI:1.17-1.56;1.36 vs 0.89,adjusted incident risk ratio 1.48,95%CI:1.22-1.80,respectively).A cross-over study also showed that the colorectal MAP and ADR in TXI were higher than those in WLI(1.5 vs 1.0,adjusted odds ratio 1.4,95%CI:1.2-1.6;58.2%vs 46.8%,1.5,1.0-2.3,respectively).A randomized controlled trial demonstrated non-inferiority of TXI to narrow-band imaging in the colorectal mean number of adenomas and sessile serrated lesions per procedure(0.29 vs 0.30,difference for non-inferiority-0.01,95%CI:-0.10 to 0.08).A cohort study found that scoring for ulcerative colitis severity using TXI could predict relapse of ulcerative colitis.A cross-sectional study found that TXI improved the gastric cancer detection rate compared to WLI(0.71%vs 0.29%).A cross-sectional study revealed that the sensitivity and accuracy for active Helicobacter pylori gastritis in TXI were higher than those of WLI(69.2%vs 52.5%and 85.3%vs 78.7%,res-pectively).In conclusion,TXI can improve gastrointestinal lesion detection and qualitative diagnosis.Therefore,further studies on the efficacy of TXI in clinical practice are required.

关键词： Endoscopy Texture and color enhancement imaging White-light imaging Narrow-band imaging Colorectal neoplasm Gastric cancer Adenoma Ulcerative colitis Helicobacter infections Colonoscopy

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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

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Endoscopic diagnosis for colorectal sessile serrated lesions

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World Journal of Gastroenterology 2021年第13期27卷 1321-1329页

作者： Toshihiro Nishizawa Shuntaro Yoshida Akira toyoshima Tomoharu Yamada Yoshiki Sakaguchi Taiga Irako Hirotoshi Ebinuma Takanori Kanai Kazuhiko Koike Osamu Toyoshima Department of Gastroenterology and Hepatology International University of Health and Welfare Narita HospitalNarita 2868520Japan Department of Gastroenterology Toyoshima Endoscopy ClinicTokyo 1570066Japan Department of Colorectal Surgery Japanese Red Cross Medical CenterTokyo 1508935Japan Department of Gastroenterology The University of TokyoTokyo 1138655Japan Department of Gastroenterology Graduate School of MedicineThe University of TokyoTokyo 1138655Japan Department of Internal Medicine Irako ClinicTokyo 1560052Japan Division of Gastroenterology and Hepatology Department of Internal MedicineKeio University School of MedicineShinjuku-ku 1608582TokyoJapan

BACKGROUND Hyperplastic polyps are considered non-neoplastic, whereas sessile serrated lesions(SSLs) are precursors of cancer via the ‘‘serrated neoplastic pathway’’. The clinical features of SSLs are tumor size(> 5 mm), location in the proximal colon, coverage with abundant mucus called the ‘‘mucus cap’’, indistinct borders, and a cloud-like surface. The features in magnifying narrow-band imaging are varicose microvascular vessels and expanded crypt openings. However, accurate diagnosis is often difficult.AIM To develop a diagnostic score system for SSLs.METHODS We retrospectively reviewed consecutive patients who underwent endoscopic resection during colonoscopy at the toyoshima endoscopy clinic. We collected data on serrated polyps diagnosed by endoscopic or pathological examination. The significant factors for the diagnosis of SSLs were assessed using logistic regression analysis. Each item that was significant in multivariate analysis was assigned 1 point, with the sum of these points defined as the endoscopic SSL diagnosis score. The optimal cut-off value of the endoscopic SSL diagnosis score was determined by receiver-operating characteristic curve analysis.RESULTS Among 1288 polyps that were endoscopically removed, we analyzed 232 diagnosed as serrated polyps by endoscopic or pathological examination. In the univariate analysis, the location(proximal colon), size(> 5 mm), mucus cap, indistinct borders, cloud-like surface, and varicose microvascular vessels were significantly associated with the diagnosis of SSLs. In the multivariate analysis, size(> 5 mm;P = 0.033), mucus cap(P = 0.005), and indistinct borders(P = 0.033) were independently associated with the diagnosis of SSLs. Size > 5 mm, mucus cap, and indistinct borders were assigned 1 point each and the sum of these points was defined as the endoscopic SSL diagnosis score. The receiver-operating characteristic curve analysis showed an optimal cut-off score of 3, which predicted pathological SSLs with 75% sensitivity, 80% specificity, and 78.4% accura

关键词： Sessile serrated lesion Mucus cap Indistinct borders Hyperplastic polyp Endoscopic features Size

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Real-world clinical data of endoscopy-based cancer detection during the emergency declaration for COVID-19 in Japan

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World Journal of Gastrointestinal Endoscopy 2020年第10期12卷 401-403页

作者： Shuntaro Yoshida Toshihiro Nishizawa Osamu Toyoshima Department of Gastroenterology Toyoshima Endoscopy ClinicTokyo 157-0066Japan Department of Gastroenterology International University of Health and WelfareNarita HospitalChiba 2868520Japan

The impact of the coronavirus disease 2019(COVID-19)pandemic is widespread throughout the world,causing serious damage to healthcare systems.Therefore,we examined the significance of endoscopy based on the recommendation of Asian-Pacific Society for Digestive Endoscopy and Japan Gastroenterological Endoscopy Society during the COVID-19 pandemic by evaluating the details of gastrointestinal endoscopy performed during the declaration of emergency in Japan.We have continued performing gastrointestinal endoscopy at an outpatient clinic that specialized in endoscopic medical care in Tokyo,Japan.During the emergency declaration period,544 patients underwent gastrointestinal endoscopy.As a control,we investigated 1327 patients who underwent gastrointestinal endoscopy during the same period in 2019.Although the total number of endoscopies during the emergency declaration was halved,the advanced cancer detection rate during the emergency declaration was significantly higher than that in 2019(P=0.04).Additionally,no COVID-19 infection was observed in healthcare workers,staff,or patients during this period.It is possible that an outpatient endoscopy units can contribute to the detection of advanced cancer,while the hospital in charge for patients with COVID-19 infection could not perform endoscopy during the declaration of emergency.

关键词： COVID-19 Pandemics Gastrointestinal Endoscopy Neoplasms Personal protective equipment

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Helicobacter pylori infection in subjects negative for high titer serum antibody

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World Journal of Gastroenterology 2018年第13期24卷 1419-1428页

作者： Osamu Toyoshima Toshihiro Nishizawa Masahide Arita Yosuke Kataoka Kosuke Sakitani Shuntaro Yoshida Hiroharu Yamashita Keisuke Hata Hidenobu Watanabe Hidekazu Suzuki Department of Gastroenterology Toyoshima Endoscopy Clinic Department of Pathology Pathology and Cytology Laboratory Japan Medical Education Center Keio University School of Medicine

AIM To investigate the clinicopathological features of the patients testing negative for high titer serum antiHelicobacter pylori(H. pylori) antibody.METHODS The antibody titers were measured using antigens derived from Japanese individuals. ^(13)C-urea breath test-positive individuals were defined as having H. pylori infection. We investigated the demographic characteristics, laboratory data, endoscopic findings including Kyoto classification of gastritis, and histology in negative-high titer patients without H. pylori eradication therapy. Kyoto classification consisted of scores for gastric atrophy, intestinal metaplasia, enlarged folds, nodularity, and redness.RESULTS Of the 136 subjects enrolled, 23(17%) had H. pylori infection. Kyoto classification had an excellent area under the receiver operating characteristics curve(0.886, 95% confidence interval: 0.803-0.968, P = 3.7 × 10^(-20)) for predicting H. pylori infection with a cutoff value of 2. Further, Kyoto classification, H. pylori density, and neutrophil activity had high accuracies(89.7%, 96.3%, and 94.1%, respectively). Kyoto classification was independent of the demographic and laboratory parameters in multivariate analysis.CONCLUSION Endoscopic Kyoto classification of gastritis is a useful predictor of H. pylori infection in negative-high titer antibody patients.

关键词： Kyoto classification Gastritis Helicobacter pylori Antibody Endoscopy

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Narrow pelvic inlet plane area and obesity as risk factors for anastomotic leakage after intersphincteric resection

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World Journal of Gastrointestinal Surgery 2020年第10期12卷 425-434页

作者： Akira toyoshima Toshihiro Nishizawa Eiji Sunami Ryuji Akai Takahiro Amano Akiyoshi Yamashita Shin Sasaki Takeshi Endo Yoshihiro Moriya Osamu Toyoshima Department of Colorectal Surgery Japanese Red Cross Medical CenterTokyo 150-8935Japan Department of Gastroenterology International University of Health and WelfareNarita HospitalNarita 286-8520Japan Department of Gastroenterology Toyoshima Endoscopy ClinicTokyo 157-0066Japan Department of Surgery The University of KyorinTokyo 113-8655Japan Department of Radiology Japanese Red Cross Medical CenterTokyo 150-8935Japan Tokyo Midtown Clinic Tokyo 107-6206Japan Miki Hospital Iwate 029-4201Japan

BACKGROUND Intersphincteric resection(ISR)has been increasingly used as the ultimate sphincter-preserving procedure in extremely low rectal cancer.The most critical complication of this technique is anastomotic leakage.The incidence rate of anastomotic leakage after ISR has been reported to range from 5.1%to 20%.AIM To investigate risk factors for anastomotic leakage after ISR based on clinicopathological variables and pelvimetry.METHODS This study was conducted at Department of Colorectal Surgery,Japanese Red Cross Medical Center,Tokyo,Japan,with a total of 117 patients.We enrolled 117 patients with extremely low rectal cancer who underwent laparotomic and laparoscopic ISRs at our hospital.We conducted retrospective univariate and multivariate regression analyses on 33 items to elucidate the risk factors for anastomotic leakage after ISR.Pelvic dimensions were measured using threedimensional reconstruction of computed tomography images.The optimal cutoff value of the pelvic inlet plane area that predicts anastomotic leakage was determined using a receiver operating characteristic(ROC)curve.RESULTS We observed anastomotic leakage in 10(8.5%)of the 117 patients.In the multivariate analysis,we identified high body mass index(odds ratio 1.674;95%confidence interval:1.087-2.58;P=0.019)and smaller pelvic inlet plane area(odds ratio 0.998;95%confidence interval:0.997-0.999;P=0.012)as statistically significant risk factors for anastomotic leakage.According to the receiver operating characteristic curves,the optimal cutoff value of the pelvic inlet plane area was 10074 mm2.Narrow pelvic inlet plane area(≤10074 mm2)predicted anastomotic leakage with a sensitivity of 90%,a specificity of 85.9%,and an accuracy of 86.3%.CONCLUSION Narrow pelvic inlet and obesity were independent risk factors for anastomotic leakage after ISR.Anastomotic leakage after ISR may be predicted from a narrow pelvic inlet plane area(≤10074 mm2).

关键词： Intersphincteric resection Anastomotic leakage Pelvimetry Pelvic dimensions Pelvic inlet plane area Rectal cancer

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Serum anti-Helicobacter pylori antibody titer and its association with gastric nodularity,atrophy,and age:A cross-sectional study

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World Journal of Gastroenterology 2018年第35期24卷 4061-4068页

作者： Osamu Toyoshima Toshihiro Nishizawa Kosuke Sakitani Tadahiro Yamakawa Yoshiyuki Takahashi Nobutake Yamamichi Keisuke Hata Yasuyuki Seto Kazuhiko Koike Hidenobu Watanabe Hidekazu Suzuki Gastroenterology Toyoshima Endoscopy ClinicTokyo 157-0066Japan Department of Gastroenterology Graduate School of MedicineThe University of TokyoTokyo 113-8655Japan Department of Surgical Oncology Graduate School of MedicineThe University of TokyoTokyo 113-8655Japan Department of Gastrointestinal Surgery Graduate School of MedicineThe University of TokyoTokyo 113-8655Japan Pathology and Cytology Laboratory Japan Tokyo 166-0003Japan Medical Education Center Keio University School of MedicineTokyo 160-8582Japan

AIM To clarify the role of serum anti-Helicobacter pylori(H. pylori) antibody titers in gastric cancer.METHODS In this cross-sectional study, the effect of patients' baseline characteristics and endoscopic findings on their serum antibody titers were assessed. We evaluated consecutive patients who underwent esophagogastroduodenoscopy and their first evaluation for H. pylori infection using a serum antibody test. We excluded patients with a history of eradication therapy. The participants were divided into four groups according to their E-plate serum antibody titer. Patients with serum antibody titers < 3, 3-9.9, 10-49.9, and ≥ 50 U/m L were classified into groups A, B, C, and D, respectively. RESULTS In total, 874 participants were analyzed with 70%, 16%, 8.7%, and 5.1% of them in the groups A, B, C, and D, respectively. Patients in group C were older than patients in groups A and B. Gastric open-type atrophy, intestinal metaplasia, enlarged folds, diffuse redness, and duodenal ulcers were associated with a high titer. Regular arrangements of collecting venules, fundic gland polyps, superficial gastritis, and gastroesophageal reflux disease were related to a low titer. Multivariate analysis revealed that nodularity(P = 0.0094), atrophy(P = 0.0076), and age 40-59 years(vs age ≥ 60 years, P = 0.0090) were correlated with a high serum antibody titer in H. pylori-infected patients. Intestinal metaplasia and atrophy were related to age ≥ 60 years in group C and D.CONCLUSION Serum antibody titer changes with age, reflects gastric mucosal inflammation, and is useful in predicting the risk of gastric cancer.

关键词： Antibody Helicobacter pylori Gastritis Gastric cancer Endoscopy

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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

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