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Management and associated factors of delayed perforation after gastric endoscopic submucosal dissection

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World Journal of Gastroenterology 2015年第44期21卷 12635-12643页

作者： Haruhisa Suzuki Ichiro Oda Masau Sekiguchi Seiichiro Abe Satoru Nonaka shigetaka yoshinaga Takeshi Nakajima Yutaka Saito Endoscopy Division National Cancer Center Hospital

AIM: To identify the actual clinical management and associated factors of delayed perforation after gastric endoscopic submucosal dissection(ESD).METHODS: A total of 4943 early gastric cancer(EGC) patients underwent ESD at our hospital between January 1999 and June 2012. We retrospectively assessed the actual management of delayed perforation. In addition, to determine the factors associated with delayed perforation, after excluding 123 EGC patients with perforations that occurred during the ESD procedure, we analyzed the following clinicopathological factors among the remaining 4820 EGC patients by comparing the ESD cases with delayed perforation and the ESD cases without perforation: age, sex, chronological periods, clinical indications for ESD, status of the stomach, location, gastric circumference, tumor size, invasion depth, presence/absence of ulceration, histological type, type of resection, and procedure time.RESULTS: Delayed perforation occurred in 7(0.1%) cases. The median time until the occurrence of delayed perforation was 11 h(range, 6-172 h). Three(43%) of the 7 cases required emergency surgery, while four were conservatively managed without surgical intervention. Among the 4 cases with conservative management, 2 were successfully managed endoscopically using the endoloop-endoclip technique. The median hospital stay was 18 d(range, 15-45 d). There were no delayed perforation-related deaths. Based on a multivariate analysis, gastric tube cases(OR = 11.0; 95%CI: 1.7-73.3; P = 0.013) were significantly associated with delayed perforation.CONCLUSION: Endoscopists must be aware of not only the identified factors associated with delayed perforation, but also how to treat this complicationeffectively and promptly.

关键词： Early gastric cancer Endoscopic submucosal dissect

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

Acute pancreatitis associated with peroral double-balloon enteroscopy: A case report

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World Journal of Gastroenterology 2006年第11期12卷 1802-1804页

作者： Kuniomi Honda Takahiro Mizutani Kazuhiko Nakamura Naomi Higuchi Kenji Kanayama Yorinobu Sumida shigetaka yoshinaga Soichi Itaba Hirotada Akiho Ken Kawabe Yoshiyuki Arita Tetsuhide Ito Department of Medicine and Bioregulatory Science Graduate School of Medical Sciences Kyushu UniversityFukuokaJapan

人有的一个 58 岁的日本人逗留凳子和严重贫血症。既不上面也不更低胃肠(官方补给) 内视镜检查法显示出任何局部性的损害。因此，他的官方补给的流血的来源被怀疑在小肠，并且他用 EN-450T5 每口头的双汽球肠寄生物(DBE ) 经历了(Fujin... 详细信息

人有的一个 58 岁的日本人逗留凳子和严重贫血症。既不上面也不更低胃肠(官方补给) 内视镜检查法显示出任何局部性的损害。因此，他的官方补给的流血的来源被怀疑在小肠，并且他用 EN-450T5 每口头的双汽球肠寄生物(DBE ) 经历了(Fujinon 东芝 ES 系统公司，东京，日本) 。没有损害，考虑是官方补给的流血的来源。在过程以后，病人开始经历了腹的疼痛。实验室测试揭示了血淀粉酶过多，腹的计算断层摄影术揭示了胰和仙子胰的发炎。他因此被诊断有尖锐胰腺炎。保守疗法导致了临床并且实验室改善。他没有白酒摄取，胆石疾病或胰腺炎的历史。磁性的回声 cholangiopancreatography 没在 pancreatobiliary 管的系统表明结构的改变和没有石头。当他的腹的疼痛在过程以后开始了，他的尖锐胰腺炎因此被认为与 per 有关是口头的 DBE。这是可能与联系的尖锐胰腺炎的首先报导的案例每口头的 DBE。

关键词：急性胰腺炎双球肠镜病理报告治疗

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

Evaluation of the margins of differentiated early gastric cancer by using conventional endoscopy

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World Journal of Gastrointestinal Endoscopy 2015年第6期7卷 659-664页

作者： shigetaka yoshinaga Ichiro Oda Seiichiro Abe Satoru Nonaka Haruhisa Suzuki Hajime Takisawa Hirokazu Taniguchi Yutaka Saito Endoscopy Division National Cancer Center Hospital Pathology Division National Cancer Center Hospital

AIM: To evaluate the determination of the margin of differentiated-type early gastric cancers by using conventional endoscopy.METHODS: We retrospectively evaluated 364 differentiated early gastric cancers that were endoscopically resected as en-bloc specimens and diagnosed pathologically in detail between November 2007 and October 2008. All procedures were done with conventional endoscopes and all endoscopic samples, before and after indigo carmine dye, were re-evaluated using a digital filing system by one endoscopist. We analyzed the incidence of lesions with unclear margins and the relationship between unclear margins and relevant clinicopathological findings. RESULTS: The rate of lesions with unclear margins was 20.6%(75/364). Multivariate regression analysis suggested that the factors that make the determination of the margin difficult were normal color, presence of components of flat area(0-IIb), a diameter ≥ 21 mm, ulceration, and components of poorly differentiated adenocarcinoma in the mucosal surface.CONCLUSION: As many as 20% of differentiated early gastric cancers show unclear margins. Consideration of the factors associated with unclear margins may help endoscopists to accurately determine the margins of the lesion.

关键词： Early gastric cancer Conventional endoscopy Determination of the margin

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