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Dehiscence following successful endoscopic closure of gastric perforation during endoscopic submucosal dissection

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World Journal of Gastroenterology 2012年第31期18卷 4224-4227页

作者： Masau Sekiguchi Haruhisa Suzuki Ichiro Oda Shigetaka Yoshinaga Satoru Nonaka Makoto Saka Hitoshi Katai Hirokazu Taniguchi ryoji kushima Yutaka Saito Endoscopy Division National Cancer Center HospitalTokyo 104-0045Japan Gastric Surgery Division National Cancer Center HospitalTokyo 104-0045Japan Pathology Division National Cancer Center HospitalTokyo 104-0045Japan

Gastric perforation is one of the most serious complications that can occur during endoscopic submucosal dissection(ESD).In terms of the treatment of such perforations,we previously reported that perforations immediately observed and successfully closed with endoclips during endoscopic resection could be managed conservatively.We now report the first case in our medical facility of a gastric perforation during ESD that was ineffectively treated conservatively even after successful endoscopic closure.In December 2006,we performed ESD on a recurrent early gastric cancer in an 81-year-old man with a medical history of laparotomy for cholelithiasis.A perforation occurred during ESD that was immediately observed and successfully closed with endoclips so that ESD could be continued resulting in an en-bloc resection.Intensive conservative management was conducted following ESD,however,an endoscopic examination five days after ESD revealed dehiscence of the perforation requiring an emergency laparotomy.

关键词：胃穿孔层剥离内镜关闭膜下保守治疗 ESD 医疗机构

Application of novel magnified single balloon enteroscopy for a patient with Cronkhite-Canada syndrome

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World Journal of Gastroenterology 2017年第22期23卷 4121-4126页

作者： Masaki Murata Shigeki Bamba Kenichiro Takahashi Hirotsugu Imaeda Atsushi Nishida Osamu Inatomi Tomoyuki Tsujikawa ryoji kushima Mitsushige Sugimoto Akira Andoh Department of Medicine Shiga University of Medical Science Comprehensive Internal Medicine Shiga University of Medical ScienceSeta-Tsukinowa Department of Clinical Laboratory Medicine Shiga University of Medical Science Division of Digestive endoscopy Shiga University of Medical Science

We present a case of Cronkhite-Canada syndrome(CCS) in which the entire intestine was observed using a prototype of magnifying single-balloon enteroscope(SIF Y-0007, Olympus). CCS is a rare, non-familial gastrointestinal polyposis with ectodermal abnormalities. To our knowledge, this is the first report showing magnified intestinal lesions of CCS. A 73-year-old female visited our hospital with complaints of diarrhea and dysgeusia. The blood test showed mild anemia and hypoalbuminemia. The esophagogastroduodenoscopy and colonoscopy revealed diffuse and reddened sessile to semi-pedunculated polyps, resulting in the diagnosis of CCS. In addition to the findings of conventional balloon-assisted enteroscopy or capsule endoscopy, magnifying observation revealed tiny granular structures, non-uniformity of the villus, irregular caliber of the loop-like capillaries, scattered white spots in the villous tip, and patchy redness of the villus. Histologically, the scattered white spots and patchy redness of the villus reflect lymphangiectasia and bleeding to interstitium, respectively.

关键词：帮助汽球的 enteroscopy 放大内视镜检查法缩小乐队成像小肠

ARID1A expression in gastric adenocarcinoma:Clinicopathological significance and correlation with DNA mismatch repair status

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World Journal of Gastroenterology 2015年第7期21卷 2159-2168页

作者： Ryo Inada Shigeki Sekine Hirokazu Taniguchi Hitoshi Tsuda Hitoshi Katai Toshiyoshi Fujiwara ryoji kushima Pathology and Clinical Laboratory Division National Cancer Center Hospital Department of Gastroenterological Surgery Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences Molecular Pathology Division National Cancer Center Research Institute Gastric Surgery Division National Cancer Center Hospital

AIM:To analyze the mismatch repair(MMR)status and the ARID1A expression as well as their clinicopathological significance in gastric adenocarcinomas.METHODS:We examined the expressions of MMR proteins and ARID1A by immunohistochemistry in consecutive 489 primary gastric adenocarcinomas.The results were further correlated with clinicopathological variables.RESULTS:The loss of any MMR protein expression,indicative of MMR deficiency,was observed in 38cases(7.8%)and was significantly associated with an older age(68.6±9.2 vs 60.4±11.7,P<0.001),a female sex(55.3%vs 31.3%,P=0.004),an antral location(44.7%vs 25.7%,P=0.021),and a differentiated histology(57.9%vs 39.7%,P=0.023).Abnormal ARID1A expression,including reduced or loss of ARID1A expression,was observed in 109 cases(22.3%)and was significantly correlated with lymphatic invasion(80.7%vs 69.5%,P=0.022)and lymph node metastasis(83.5%vs 73.7%,P=0.042).The tumors with abnormal ARID1A expression more frequently indicated MMR deficiency(47.4%vs 20.2%,P<0.001).A multivariate analysis identified abnormal ARID1A expression as an independent poor prognostic factor(HR=1.36,95%CI:1.01-1.84;P=0.040).CONCLUSION:Our observations suggest that the AIRD1A inactivation is associated with lymphatic invasion,lymph node metastasis,poor prognosis,and MMR deficiency in gastric adenocarcinomas.

关键词： Adenocarcinoma ARID1A Mismatch Repair Stomach Immu

Cap polyposis refractory to Helicobacter pylori eradication treated with endoscopic submucosal dissection

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World Journal of Gastrointestinal Endoscopy 2017年第10期9卷 529-534页

作者： Masaki Murata Mitsushige Sugimoto Hiromitsu Ban Taketo Otsuka Toshiro Nakata Masahide Fukuda Osamu Inatomi Shigeki Bamba ryoji kushima Akira Andoh Department of Gastroenterology Shiga University of Medical Science Hospital Division of Digestive Endoscopy Shiga University of Medical Science Hospital Department of Clinical Laboratory Medicine Shiga University of Medical Science Hospital

Cap polyposis is a rare intestinal disorder. Characteristic endoscopic findings are multiple inflammatory polypoid lesions covered by caps of fibrous purulent exudate. Although a specific treatment has not been established, some studies have suggested that eradication therapy for Helicobacter pylori(H. pylori) is effective. We report a case of a 20-year-old man with cap polyposis presenting with hematochezia. Colonoscopy showed the erythematous polyps with white caps from the sigmoid colon to rectum. Histopathological findings revealed elongated, tortuous, branched crypts lined by hyperplastic epithelium with a mild degree of fibromusculosis in the lamina propria. Although H. pylori eradication was instituted, there was no improvement over six months. We then performed en bloc excision of the polyps by endoscopic submucosal dissection(ESD), which resulted in complete resolution of symptoms. ESD may be a treatment option for cap polyposis refractory to conservative treatments. We review the literature concerning treatment for cap polyposis and clinical outcomes.

关键词： Endoscopic submucosal dissection Cap polyposis Eradication therapy Helicobacter pylori

Small undifferentiated intramucosal gastric cancer with lymph-node metastasis:Case report

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World Journal of Gastroenterology 2013年第20期19卷 3157-3160页

作者： Tomoyuki Odagaki Haruhisa Suzuki Ichiro Oda Shigetaka Yoshinaga Satoru Nonaka Hitoshi Katai Hirokazu Taniguchi ryoji kushima Yutaka Saito Endoscopy Division National Cancer Center HospitalTokyo 104-0045Japan Gastric Surgery Division National Cancer Center HospitalTokyo 104-0045Japan Pathology Division National Cancer Center HospitalTokyo 104-0045Japan

It has been reported recently that small undifferentiated intramucosal early gastric cancer(EGC) < 20 mm in size without any lymphovascular involvement or ulcerative findings had virtually no risk of lymph-node(LN) metastasis.Consequently,the indications for endoscopic resection were expanded to include such undifferentiated EGC lesions.We describe herein a case of a small undifferentiated intramucosal EGC < 20 mm in size without lymphovascular involvement or ulcerative findings that involved lymph-node metastasis.A 57-year-old female underwent pylorus preserving gastrectomy as standard treatment for an undifferentiated EGC 15 mm in size without any ulcerative finding.The surgical specimen revealed a signet-ring cell carcinoma with a moderately to poorly differentiated adenocarcinoma limited to the mucosa that was 15 mm in size with no lymphovascular involvement or ulcerative findings.This case involved LN metastasis,however,and the lesion was diagnosed as pathological stage ⅡA(T1N2M0) according to the Japanese Classification of Gastric Carcinoma.

关键词： Early gastric cancer Endoscopic submucosal dissection Expanded indications Lymph-node metastasis Undifferentiated type

Bone metastasis from early gastric cancer following non-curative endoscopic submucosal dissection

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World Journal of Gastroenterology 2013年第30期19卷 5016-5020页

作者： Hiroyuki Kawabata Ichiro Oda Haruhisa Suzuki Satoru Nonaka Shigetaka Yoshinaga Hitoshi Katai Hirokazu Taniguchi ryoji kushima Yutaka Saito Endoscopy Division National Cancer Center Hospital Department of Internal Medicine Saiseikai Matsusaka General Hospital Gastric Surgery Division National Cancer Center Hospital Pathology Division National Cancer Center Hospital

A 67-year-old male underwent endoscopic submucosal dissection(ESD)to treat early gastric cancer(EGC)in 2001.The lesion(50 mm × 25 mm diameter)was histologically diagnosed as poorly differentiated adenocarcinoma,with an ulcer finding.Although the tumor was confined to the mucosa with no evidence of lymphovascular involvement,the ESD was regarded as a noncurative resection due to the histological type,tumor size,and existence of an ulcer finding(as indicated by the 2010 Japanese gastric cancer treatment guidelines,ver.3).Despite strong recommendation for subsequent gastrectomy,the patient refused surgery.An alternative follow-up routine was designed,which included five years of biannual clinical examinations to detect and measure serum tumor markers and perform visual assessment of recurrence by endoscopy and computed tomography scan after which the examinations were performed annually.The patient's condition remained stable for eight years,until a complaint of back pain in 2010 prompted further clinical investigation.Bone scintigraphy indicated increased uptake.Histological examination of biopsy specimens taken from the lumbar spine revealed adenocarcinoma resembling the carcinoma cells from the EGC that had been treated previously by ESD,and which was consistent with immunohistochemical findings of gastrointestinal tract cancer.Thus,the diagnosis of bone metastasis from EGC was made.The reported rates of EGC recurrence in surgically resected cases range 1.4%-3.4%,but among these bone metastasis is very rare.To our knowledge,this is the first reported case of bone metastasis from EGC following a non-curative ESD and occurring after an eight-year disease-free interval.

关键词： Endoscopic submucosal dissection Early gastric cancer Non-curative resection Bone metastasis Late recurrence

Fatal submucosal invasive gastric adenosquamous carcinoma detected at surveillance after gastric endoscopic submucosal dissection

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World Journal of Gastroenterology 2015年第14期21卷 4385-4390页

作者： Akinori Shirahige Haruhisa Suzuki Ichiro Oda Masau Sekiguchi Genki Mori Seiichiro Abe Satoru Nonaka Shigetaka Yoshinaga Shigeki Sekine ryoji kushima Yutaka Saito Takeo Fukagawa Hitoshi Katai Endoscopy Division National Cancer Center Hospital Pathology Division National Cancer Center Hospital Department of Clinical Laboratory Medicine and Diagnostic Pathology Shiga University of Medical Science Gastric Surgery Division National Cancer Center Hospital

An 80-year-old man was under annual surveillance esophagogastroduodenoscopy after endoscopic submucosal dissection(ESD) for early gastric cancer(EGC).Two years after the initial ESD, a 0-Ⅱc type metachronous EGC lesion, 8 mm in size, without an ulcer scar, was found in the gastric antrum.The estimated tumor depth was up to the mucosa, and biopsy revealed well and poorly differentiated adenocarcinoma.ESD was performed for this lesion and en bloc resection with negative margins was achieved.Histopathological examination revealed an adenosquamous carcinoma 8 mm in size invading the deep submucosal layer(1600 μm), with lymphovascular invasion, consistent with the diagnosis of non-curative resection.Additional gastrectomy was recommended for this patient; however, two months after the ESD, preoperative computed tomography revealed multiple liver metastases, and the patient was considered as an unsuitable candidate for surgical resection.Systemic chemotherapy was therefore started; however, the patient died of gastric cancer 27 mo after the second ESD.Early gastric adenosquamous carcinoma localized to the mucosa and submucosa is extremely rare and its clinical behavior is not well known.The present report is very significant in that it underscores the distinct possibility of gastric adenosquamous carcinoma being very aggressive and fatal even when detected at an early cancer.

关键词： Early gastric cancer Endoscopic submucosal dissect

为早食道、胃的癌症的诊断的内视镜的超声使用超声探针

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World Journal of Gastrointestinal Endoscopy 2012年第6期4卷 218-226页

作者： Shigetaka Yoshinaga Ichiro Oda Satoru Nonaka ryoji kushima Yutaka Saito Endoscopy Division National Cancer Center Hospital5-1-1 TsukijiChuo-kuTokyo 104-0045Japan Pathology Division National Cancer Center Hospital5-1-1 TsukijiChuo-kuTokyo 104-0045Japan

Endoscopic ultrasound(EUS) devices were first designed and manufactured more than 30 years ago,and since then investigators have reported EUS is effective for determining both the staging and the depth of invasion of esophageal and gastric cancers.We review the present status,the methods,and the findings of EUS when used to diagnose and stage early esophageal and gastric cancer.EUS using high-frequency ultrasound probes is more accurate than conventional EUS for the evaluation of the depth of invasion of superficial esophageal carcinoma.The rates of accurate evaluation of the depth of invasion by EUS using high-frequency ultrasound probes were 70%-88% for intramucosal cancer,and 83%-94% for submucosal invasive cancer.But the sensitivity of EUS using high-frequency ultrasound probes for the diagnosis of submucosal invasive cancer was relatively low,making it difficult to confirm minute submucosal invasion.The accuracy of EUS using highfrequency ultrasound probes for early gastric tumor classification can be up to 80% compared with 63% for conventional EUS,although the accuracy of EUS using high-frequency ultrasound probes relatively decreases for those patients with depressed-type lesions,undifferentiated cancer,concomitant ulceration,expanded indications,type 0-Ⅰ lesions,and lesions located in the upper-third of the stomach.A 92% overall accuracy rate was achieved when both the endoscopic appearance and the findings from EUS using high-frequency ultrasound probes were considered together for tumor classification.Although EUS using high-frequency ultrasound probes has limitations,it has a high depth of invasion accuracy and is a useful procedure to distinguish lesions in the esophagus and stomach that are indicated for endoscopic resection.

关键词： Endoscopic ultrasound High-frequency ultrasound probe Esophageal cancer Gastric cancer Depth diagnosis

Expression levels of K_(ATP)channel subunits and morphological changes in the mouse liver after exposure to radiation

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World Journal of Experimental Medicine 2024年第2期14卷 103-113页

作者： Ming Zhou Tao-Sheng Li Hiroshi Abe Hideo Akashi ryoji Suzuki Yoshio Bando Department of Anatomy Akita University Graduate School of MedicineAkita 010-8543Japan Department of Stem Cell Biology Atomic Bomb Disease InstituteNagasaki UniversityNagasaki 852-8523Japan Sendai Old Age Refresh Station A Long-term Care Health FacilitySendai 981-1105Japan

BACKGROUND ATP sensitive K+(K_(ATP))channels are ubiquitously distributed in various of cells and tissues,including the liver.They play a role in the pathogenesis of myocardial and liver ischemia.AIM To evaluate the radiation-induced changes in the expression of K_(ATP)channel subunits in the mouse liver to understand the potential role of K_(ATP)channels in radiation injury.METHODS Adult C57BL/6 mice were randomly exposed toγ-rays at 0 Gy(control,n=2),0.2 Gy(n=6),1 Gy(n=6),or 5 Gy(n=6).The livers were removed 3 and 24 h after radiation exposure.Hematoxylin and eosin staining was used for morphological observation;immunohistochemical staining was applied to determine the expression of K_(ATP)channel subunits in the liver tissue.RESULTS Compared with the control group,the livers exposed to 0.2 Gyγ-ray showed an initial increase in the expression of Kir6.1 at 3 h,followed by recovery at 24 h after exposure.Exposure to a high dose of 5.0 Gy resulted in decreased expression of Kir6.1 and increased expression of SUR2B at 24 h.However,the expression of Kir6.2,SUR1,or SUR2A had no remarkable changes at 3 and 24 h after exposure to any of these doses.CONCLUSION The expression levels of Kir6.1 and SUR2B in mouse liver changed differently in response to different radiation doses,suggesting a potential role for them in radiation-induced liver injury.

关键词： Radiation exposure ATP-sensitive K^(+)channel Mouse Liver