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Superiority of urgent vs early endoscopic hemostasis in patients with upper gastrointestinal bleeding with high-risk stigmata

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Gastroenterology Report 2021年第6期9卷 543-551页

作者： Masayasu Horibe Eisuke Iwasaki Juntaro Matsuzaki Fateh Bazerbachi Tetsuji Kaneko Kazuhiro Minami seiichiro fukuhara Tatsuhiro Masaoka Naoki Hosoe Yuki Ogura Shin Namiki Yasuo Hosoda Haruhiko Ogata Takanori Kanai Division of Gastroenterology and Hepatology Department of Internal MedicineKeio University School of MedicineTokyoJapan Division of Gastroenterology and Hepatology Mayo ClinicMNUSA Interventional Endoscopy Program CentraCareSt Cloud HospitalMNUSA Department of Clinical Trial Tokyo Metropolitan Children’s Medical CenterTokyoJapan Teikyo Academic Research Center Teikyo UniversityTokyoJapan Center for Diagnostic and Therapeutic Endoscopy Keio University HospitalTokyoJapan Department of Gastroenterology and Hepatology Tokyo Metropolitan Tama Medical CenterTokyoJapan Division of Gastroenterology Department of Internal MedicineNational Hospital Organization Saitama National HospitalSaitamaJapan

Background Guidelines recommend that all patients with upper gastrointestinal bleeding(UGIB)undergo endoscopy within 24 *** is unclear whether a subgroup may benefit from an urgent *** aimed to evaluate the influence of endoscopic hemostasis and urgent endoscopy on mortality in UGIB patients with high-risk stigmata(HRS).Methods Consecutive patients with suspected UGIB were enrolled in three Japanese hospitals with a policy to perform endoscopy within 24 *** primary outcome was 30-day *** hemostasis and endoscopy timing(urgent,6h;early,>6h)were evaluated in a regression model adjusting for age,systolic pressure,heart rate,hemoglobin,creatinine,and variceal bleeding in multivariate analysis.A propensity score of 1:1 matched sensitivity analysis was also *** HRS were present in 886 of 1966 patients,and 35 of 886(3.95%)patients *** urgent-endoscopy time(n=769)was 3.0h(interquartile range[IQR],2.0–4.0 h)and early endoscopy(n紏117)was 12.0h(IQR,8.5–19.0 h).Successful endoscopic hemostasis and urgent endoscopy were significantly associated with reduced mortality in multivariable analysis(odds ratio[OR],0.22;95%confidence interval[CI],0.09–0.52;P=0.0006,and OR,0.37;95%CI,0.16–0.87;P=0.023,respectively).In a propensity-score-matched analysis of 115 pairs,adjusted comparisons showed significantly lower mortality of urgent vs early endoscopy(2.61%vs 7.83%,P<0.001).Conclusions A subgroup of UGIB patients,namely those harboring HRS,may benefit from endoscopic hemostasis and urgent endoscopy rather than early endoscopy in reducing *** triage scores that predict the presence of such lesions is important.

关键词： UGIB urgent endoscopy non-variceal bleeding variceal bleeding HARBINGER GBS upper gastrointestinal bleeding

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Peritoneal dissemination of pancreatic cancer caused by endoscopic ultrasound-guided fine needle aspiration:A case report and literature review

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World Journal of Gastroenterology 2021年第3期27卷 294-304页

作者： Hideaki Kojima Minoru Kitago Eisuke Iwasaki Yohei Masugi Yohji Matsusaka Hiroshi Yagi Yuta Abe Yasushi Hasegawa Shutaro Hori Masayuki Tanaka Yutaka Nakano Yusuke Takemura seiichiro fukuhara Yoshiyuki Ohara Michiie Sakamoto Shigeo Okuda Yuko Kitagawa Department of Surgery Keio University School of MedicineTokyo 160-8582Japan Division of Gastroenterology and Hepatology Department of Internal MedicineKeio University School of MedicineTokyo 160-8582Japan Department of Pathology Keio University School of MedicineTokyo 160-8582Japan Department of Radiology Keio University School of MedicineTokyo 160-8582Japan

BACKGROUND Endoscopic ultrasound-guided fine needle aspiration(EUS-FNA)is a biopsy technique widely used to diagnose pancreatic tumors because of its high sensitivity and *** needle-tract seeding caused by EUS-FNA has been recently reported,dissemination of pancreatic cancer cells is generally considered to be a rare complication that does not affect patient ***,the frequency of dissemination and needle-tract seeding appears to have been *** present a case of peritoneal dissemination of pancreatic cancer due to preoperative *** SUMMARY An 81-year-old man was referred to the Department of Surgery of our hospital in Japan owing to the detection of a pancreatic mass on computed tomography during medical ***-gastric EUS-FNA revealed that the mass was an adenocarcinoma;hence laparoscopic distal pancreatectomy with lymphadenectomy was *** intraoperative peritoneal dissemination and liver metastasis were visually detected,and pelvic lavage cytology was negative for carcinoma *** postoperative surgical specimen was negative for carcinoma cells at the dissected margin and the cut end margin;however,pathological findings revealed adenocarcinoma cells on the peritoneal surface proximal to the needle puncture site,and the cells were suspected to be disseminated via ***,the patient received adjuvant therapy with S-1(tegafur,gimeracil,and oteracil potassium);however,computed tomography performed 5 mo after surgery revealed liver metastasis and cancerous *** patient received palliative therapy and died 8 mo after the *** The indications of EUS-FNA should be carefully considered to avoid iatrogenic dissemination,especially for cancers in the pancreatic body or tail.

关键词： Case report Pancreatic carcinoma Endoscopic ultrasound-guided fine needle aspiration Peritoneal dissemination Cancerous peritonitis Biopsy

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Endoscopic characteristics of small intestinal malignant tumors observed by balloon-assisted enteroscopy

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World Journal of Gastrointestinal Endoscopy 2019年第5期11卷 373-382页

作者： Tomofumi Horie Naoki Hosoe Kaoru Takabayashi Yukie Hayashi Kenji JL Limpias Kamiya Ryoichi Miyanaga Shinta Mizuno Kayoko fukuhara seiichiro fukuhara Makoto Naganuma Masayuki Shimoda Haruhiko Ogata Takanori Kanai Division of Gastroenterology and Hepatology Department of Internal MedicineSchool of MedicineKeio University Center for Diagnostic and Therapeutic Endoscopy School of MedicineKeio University Department of Pathology School of MedicineKeio University

BACKGROUND Capsule endoscopy and balloon-assisted enteroscopy(BAE) enable visualization of rare small bowel conditions such as small intestinal malignant ***,details of the endoscopic characteristics of small intestinal malignant tumors are still *** To elucidate the endoscopic characteristics of small intestinal malignant *** From March 2005 to February 2017,1329 BAE procedures were performed at Keio University Hospital. Of these procedures,malignant tumors were classified into three groups,Group 1: epithelial tumors including primary small intestinal cancer,metastatic small intestinal cancer,and direct small intestinal invasion by an adjacent organ cancer; Group 2: small intestinal malignant lymphoma; and Group 3,small intestinal gastrointestinal stromal tumors. We systematically collected clinical and endoscopic data from patients' medical records to determine the endoscopic characteristics for each *** The number of patients in each group was 16(Group 1),23(Group 2),and 6(Group 3),and the percentage of solitary tumors was 100%,43.5%,and 100%,respectively(P < 0.001). Patients' clinical background parameters including age,symptoms,and laboratory data were not significantly different between the groups. Seventy-five percent of epithelial tumors(Group 1) were located in the upper small intestine(duodenum and ileum),and approximately 70% of gastrointestinal stromal tumors(Group 3) were located in the jejunum. Solitary protruding or mass-type tumors were not seen in malignant lymphoma(Group2)(P < 0.001). Stenosis was seen more often in Group 1,(68.8%,27.3%,and 0%;Group 1,2,and 3,respectively; P = 0.004). Enlarged white villi inside and/or surrounding the tumor were seen in 12.5%,54.5%,and 0% in Group 1,2,and 3,respectively(P = 0.001).CONCLUSION The differential diagnosis of small intestinal malignant tumors could be tentatively made based on BAE findings.

关键词： Small intestine Malignant Tumor Double balloon enteroscopy Balloon enteroscopy Video capsule endoscopy Endoscopy

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Endoscopic removal of foreign bodies:A retrospective study in Japan

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World Journal of Gastrointestinal Endoscopy 2020年第1期12卷 33-41页

作者： Kenji JL Limpias Kamiya Naoki Hosoe Kaoru Takabayashi Yukie Hayashi Xi Sun Ryoichi Miyanaga Kayoko fukuhara seiichiro fukuhara Makoto Naganuma Atsushi Nakayama Motohiko Kato Tadateru Maehata Rieko Nakamura Koichi Ueno Junichi Sasaki Yuko Kitagawa Naohisa Yahagi Haruhiko Ogata Takanori Kanai Division of Gastroenterology and Hepatology Department of Internal MedicineKeio University School of MedicineTokyo 160-8582Japan Center for Diagnostic and Therapeutic Endoscopy Keio University School of MedicineTokyo 160-8582Japan Department of Gastroenterology and Hepatology Chinese PLA General HospitalBeijing 100853China Division of Research and Development for Minimally Invasive Treatment Cancer CenterKeio University School of MedicineTokyo 160-8582Japan Department of Surgery Keio University School of MedicineTokyo 160-8582Japan Department of Emergency and Critical Care Medicine Keio University School of MedicineTokyo 160-8582Japan

BACKGROUND The ingestion of foreign bodies(FBs)and food bolus impaction(FBI)in the digestive tract are commonly encountered clinical *** to handle such problems continue to evolve offering advantages,such as the avoidance of surgery,reduced cost,improved visualization,reduced morbidity,and high removal success ***,to date,no studies have evaluated the endoscopic management of FBs in *** To elucidate level of safety and efficacy in the endoscopic management of FBs and *** A total of 215 procedures were performed at Keio University Hospital between November 2007 and August *** were collected from medical charts,and endoscopic details were collected from an endoscopic reporting *** performed with a flexible gastrointestinal endoscope were only taken into *** who underwent a technique involving FB or FBI from the digestive tract were only *** on patient sex,patient age,outpatient,inpatient,FB type,FB location,procedure time,procedure type,removal device type,success,and technical complications were reviewed and analyzed *** Among the 215 procedures,136(63.3%)were performed in old adults(≥60 years),180(83.7%)procedures were performed in *** most common type of FBs were press-through-pack(PTP)medications[72(33.5%)cases],FBI[47(21.9%)],Anisakis parasite(AP)[41(19.1%)cases].Most FBs were located in the esophagus[130(60.5%)cases]followed by the stomach[68(31.6%)cases].AP was commonly found in the stomach[39(57.4%)cases],and it was removed using biopsy forceps in 97.5%of the *** most common FBs according to anatomical location were PTP medications(40%)and dental prostheses(DP)(40%)in the laryngopharynx,PTP(48.5%)in the esophagus,AP(57.4%)in the stomach,DP(37.5%)in the small intestine and video capsule endoscopy device(75%)in the colon.A transparent cap with grasping forceps was the most commonly used device[82(38.1%)cases].The success rate of the procedure was

关键词： Anisakis parasite Endoscopic removal Food bolus impaction Foreign body Grasping forceps

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