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Irritable bowel syndrome evaluation using computed tomography colonography

World Journal of Gastroenterology 2016年第42期22卷 9394-9399页

作者： Hideki Ohgo Hiroyuki Imaeda Minoru Yamaoka Kazuaki Yoneno Naoki Hosoe takeshi mizukami Hidetomo Nakamoto Department of Gastroenterology Saitama Medical University Department of General Internal Medicine Saitama Medical University Center for Diagnostic and Therapeutic Endoscopy School of Medicine Keio University Endoscopy Center NHO Kurihama Medical and Addiction Center

AIM To evaluate the morphology of the colon in patients with irritable bowel syndrome(IBS) by using computed tomography colonography(CTC).METHODS Twelve patients with diarrhea type IBS(IBS-D), 13 patients with constipation type IBS(IBS-C), 12 patients with functional constipation(FC) and 14 control patients underwent colonoscopy following CTC. The lengths of the rectosigmoid colon, transverse colon and the total colon were measured. The diameters of the rectum, sigmoid colon, descending colon, transverse colon, and ascending colon were *** The mean length of the total colon was 156.5 cm in group C, 158.9 cm in group IBS-D, 172.0 cm in group IBS-C, and 188.8 cm in group FC. The total colon in group FC was significantly longer than that in group C(P < 0.05). The mean length of the rectosigmoid colon was 56.2 cm, 55.9 cm, 63.6cm, and 77.4 cm(NS). The mean length of the transverse colon was 49.9 cm, 43.1 cm, 57.0 cm, and 55.0 cm. The transverse colonin group IBS-D was significantly shorter than that in group IBS-C(P < 0.01) and that in group FC(P = 0.02). The mean diameter of the sigmoid colon was 4.0 cm, 3.3 cm, 4.2 cm, and 4.3 cm(NS). The mean diameter of the descending colon was 3.6 cm, 3.1 cm, 3.8 cm, and 4.3 cm. The descending colon diameter in group IBS-D was significantly less than that in group IBS-C(P = 0.03) and that in group FC(P < 0.001). The descending colon diameter in group FC was significantly greater than that in group C(P = 0.04). The mean diameter of the transverse colon was 4.4 cm, 3.3 cm, 4.2 cm, and 5.0 cm(NS).CONCLUSION CT colonography might contribute the clarification of subtypes of IBS.

关键词： Constipation Irritable bowel syndrome Computed tomography colonography

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Diagnostic and therapeutic applications of water-immersion colonoscopy

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World Journal of Gastroenterology 2015年第21期21卷 6451-6459页

作者： Shinya Sugimoto takeshi mizukami Division of Gastroenterology and Hepatology Department of Internal MedicineKeio University School of Medicine Endoscopy Center NHO Kurihama Medical and Addiction Center

Colonoscopy techniques combining or replacing air insufflation with water infusion are becoming *** were originally designed to reduce colonic spasms,facilitate cecal intubation,and lower patient discomfort and the need for *** maneuvers straighten the rectosigmoid colon and enable the colonoscope to be inserted deeply without causing looping of the ***-immersion colonoscopy minimizes colonic distension and improves visibility by introducing a small amount of *** addition,since pain during colonoscopy indicates risk of bowel perforation and sedation masks this important warning,this method has the potential to be the favored insertion technique because it promotes patient safety without ***,this water-immersion method has not only been used for colonoscope insertion,but has also been applied to therapy for sigmoid volvulus,removal of lesions,lower gastrointestinal bleeding,and therapeutic diagnosis of abnormal bowel morphology and irritable bowel *** a larger sample size and prospective head-to-head-designed studies will be needed,this review focuses on the usefulness of waterimmersion colonoscopy for diagnostic and therapeutic applications.

关键词： Colonoscopy Water immersion Waterexchange Underwater Unsedated Sigmoid volvulus Detorsion Polypectomy Gastrointestinal bleeding Irritable bowel syndrome

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Presence of columnar-lined esophagus is negatively associated with the presence of esophageal varices in Japanese alcoholic men

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World Journal of Gastroenterology 2017年第39期23卷 7150-7159页

作者： Akira Yokoyama Kenro Hirata Rieko Nakamura Tai Omori takeshi mizukami Junko Aida Katsuya Maruyama Tetsuji Yokoyama National Hospital Organization Kurihama Medical and Addiction Center Division of Gastroenterology and Hepatology Department of Internal Medicine School of Medicine Keio University Department of Health Promotion National Institute of Public HealthSaitama Endoscopy Center Kawasaki Municipal Ida Hospital Research Team for Geriatric Pathology Tokyo Metropolitan Institute of Gerontology

AIM To determine whether the presence of columnar-lined esophagus(CLE) is associated with the presence of esophageal varices(EVs) in male Japanese alcoholics. METHODS The subjects were 1614 Japanese alcohol-dependent men(≥ 40 years of age) who had undergone upper gastrointestinal endoscopic screening. Digitalized records of high-quality endoscopic images that included the squamocolumnar junction and esophagogastric junction were retrospectively jointly reviewed by four expert endoscopists for the purpose of diagnosing CLE. The authors investigated whether and to what extent there were associations between the presence of CLE and the presence of EVs, especially in the group with liver cirrhosis(LC).RESULTS CLE ≥ 5 mm in length was found in 355 subjects(≥ 30 mm in 6 of them), LC without EVs in 152 subjects, LC with EVs in 174 subjects, and EVs without LC in 6 subjects. Advanced EVs, i.e., nodular, large or coiled forms, red color sign, or post-treatment, were found in 88 subjects. The incidence of CLE ≥ 5 mm decreased in the following order(P < 0.0001): 23.3% in the group without EVs, 17.4% in the group with small and straight EVs, and 5.7% in the group with advanced EVs. The multivariate ORs(95%CI) for EVs and advanced EVs in the group with LC were lower when CLE ≥ 5 mm was present [0.46(0.23-0.93) and 0.24(0.08-0.74), respectively, vs 0-4 mm CLE]. CONCLUSION The presence of CLE in male Japanese alcoholics was negatively associated with the presence of EVs.

关键词： Alcohol Columnar-lined esophagus Hiatal hernia Liver cirrhosis Portal hypertension Esophageal varices

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“Passive-bending colonoscope”significantly improves cecal intubation in difficult cases

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World Journal of Gastroenterology 2012年第32期18卷 4454-4456页

作者： takeshi mizukami Haruhiko Ogata Toshihumi Hibi Endoscopy Center NHO Kurihama Medical and Addiction CenterKanagawa 239-0841Japan Endoscopy Center Keio UniversityTokyo 160-0016Japan Department of Gastroenterology Keio UniversityTokyo 160-0016Japan

Colonoscopy sometimes causes pain during insertion,especially in difficult ***-insufflation of air causes elongation or acute angulations of the colon,making passage of the scope difficult and causing *** previously reported a sedative-risk-free colonoscopy insertion technique,namely,"Water Navigation Colonoscopy".Complete air suction after water infusion not only improves the vision,but also makes water flow down to the descending colon,while the sigmoid colon collapses and *** non-sedative colonoscopy can be carried out without pain in most cases,some patients do complain of *** of these patients have abnormal colon morphology,and the pain is caused while negotiating the "hairpin" bends of the *** "hairpin" bends of the colon should be negotiated by gently pushing the full-angled *** proximal 10-20 cm from the angulated part of the conventional colonoscope is stiff,with a wide turning radius,therefore,a conventional colonoscope cannot be negotiated through the "hairpin" bends of the colon without stretching them and causing *** "passive-bending colonoscope" has a flexible tip with a narrow turning radius,so that the scope can be negotiated through the "hairpin" bends of the colon with a minimum turning radius and minimal ***,the intubation and pain-reducing performance of the "passive-bending colonoscope" was assessed in difficult cases.

关键词： Computed tomographic colonography Water navigation colonoscopy Passive-bending colonoscope Cecal intubation

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Sedation-risk-free colonoscopy for minimizing the burden of colorectal cancer screening

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World Journal of Gastrointestinal Endoscopy 2010年第3期2卷 81-89页

作者： Felix W Leung Abdulrahman M Aljebreen Emilio Brocchi Eugene B Chang Wei-Chih Liao takeshi mizukami Melvin Schapiro Konstantinos Triantafyllou Research and Medical Services Sepulveda Ambulatory Care CenterVeterans Affairs Greater Los Angeles Healthcare SystemNorth Hills David Geffen School of Medicine University of CaliforniaLos Angeles King Khalid University Hospital Department of Internal Medicine and Gastro-enterology University of Bologna Department of Medicine University of Chicago School of MedicineChicago Department of Internal Medicine National Taiwan University Hospital Endoscopy Center Yokohama Municipal Citizen's Hospital Hepatogastroenterology Unit 2nd Dep artment of Internal Medicine-PropaedeuticAttikon Univer-sity General HospitalMedical SchoolAthens University

Unsedated colonoscopy is available worldwide,but is not a routine option in the United States(US).We conducted a literature review supplemented by our experience and expert commentaries to provide data to support the use of unsedated colonoscopy for colorectal cancer *** data from 1966 to 2009 were searched to identify relevant articles on the *** were summarized and co-authors provided critiques as well as accounts of unsedated colonoscopy for screening and *** colonoscopy was initially dev eloped as an unsedated ***-re lated discomfort led to wide adoption of sedation in the US,although unsedated colonoscopy remains the usual practice *** increased use of colonoscopy for colorectal cancer screening in healthy,asymptomatic individuals suggests a reass-essment of the burden of sedation in colonoscopy for screening is appropriate in the US for lowering costs and minimizing complications for patients.A water method developed to minimize discomfort has shown promise to enhance outcomes of unsedated *** use of scheduled,unsedated colono scopy in the US appears to be feasible for colorectal cancer *** to assess its applicability in diverse practice settings deserve to be conducted and supported.

关键词： Unsedated colonoscopy Sedation-risk-free colonoscopy Colon cancer screening

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