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World Journal of Gastrointestinal Endoscopy 2019年第4期11卷 262-270页

作者： Uayporn Kaosombatwattana takeshi yamamura Masanao Nakamura Yoshiki Hirooka Hidemi Goto Department of Gastroenterology and Hepatology Nagoya University Graduate School of Medicine Division of Gastroenterology Department of Medicine Faculty of Medicine Siriraj Hospital Mahidol University Department of Endoscopy Nagoya University Hospital

Colorectal endoscopic submucosal dissection(ESD) is considered one of the most challenging endoscopic procedures for novice endoscopists. When compared with the stomach, the colon and rectum have a narrower tubular lumen, greater angulation at the flexures, and a thinner muscle layer. These factors make endoscopic control and maneuverability difficult. ESD of the colorectum was considered more difficult than gastric and esophageal ESD. However, with learning from the experts, practicing, and selecting an appropriate technique,most of colorectal ESD could be performed successfully. Nevertheless, some colorectal locations are extremely specialized either from unique anatomy or given unstable scope position. Accordingly, the objective of this review was to provide endoscopists with an overview of the techniques and outcomes associated with ESD at these special colorectal locations. ESD at the discussed special locations of the ileo-colo-rectum was found to be feasible, and outcomes were comparable to those of ESD performed in non-special locations of the ileocolo-rectum. Practice for skill improvement and awareness of the unique characteristics of each special location is the key to performing successful ESD.

关键词： Colorectal endoscopic submucosal dissection Endoscopic submucosal dissection Special locations

Real-world local recurrence rate after cold polypectomy in colorectal polyps less than 10 mm using propensity score matching

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World Journal of Gastroenterology 2021年第47期27卷 8182-8193页

作者： Masashi Saito takeshi yamamura Masanao Nakamura Keiko Maeda Tsunaki Sawada Eri Ishikawa Yasuyuki Mizutani Takuya Ishikawa Naomi Kakushima Kazuhiro Furukawa Eizaburo Ohno Hiroki Kawashima Masatoshi Ishigami Mitsuhiro Fujishiro Department of Gastroenterology and Hepatology Nagoya University Graduate School of MedicineNagoya 4668550Japan Department of Endoscopy Nagoya University HospitalNagoya 4668550Japan

BACKGROUND Cold polypectomy(CP)is a simple and safe procedure for polyps less than 10 mm in size;however,there is concern about local recurrence following CP because of unidentified margins of excised specimens and the lack of tumor suppression effect by *** clinical trials have evaluated local persistent recurrence;their results suggest that a higher rate of local recurrence has not been documented so *** were few reports that observed the course over long periods of time after CP in clinical *** To evaluate the presence of local recurrence following CP and hot polypectomy(HP)using propensity score *** We analyzed 275 patients who underwent polypectomy for non-pedunculated colorectal polyps less than 10 mm(959 Lesions)between October 2016 and 2017 and underwent follow-up endoscopy *** divided them into the CP group(706 Lesions),wherein CP was performed,and the HP group(253 Lesions),wherein HP was *** propensity score matching,we extracted 215 Lesions in each group and evaluated the local recurrence and content of CP in the real clinic and adverse events using medical *** After propensity score matching,there were no significant differences in the patients’and their endoscopic background(age,use of antithrombotics,indications,size,morphology,location of polyps,and polypectomy device)between the *** mean duration between colorectal polypectomy and the next follow-up colonoscopy was 17.5±7.1(range,6-39)mo in the CP group and 15.7±6.0(range,6-35)mo in the HP group,which was significantly longer in the CP group(P=0.005).The local recurrence rate was 0.93%in the CP group and 0.93%in the HP group,without a significant difference(P=0.688).Additionally,no differences were observed in the macroscopic en bloc resection rate,histopathological complete resection rate,and pathological results between the *** events did not occur in either *** Local recurrence after CP was

关键词： Cold polypectomy Colorectal polyp Hot polypectomy Local recurrence Safety Propensity score matching

Double-balloon endoscopic retrograde cholangiopancreatography for patients who underwent liver operation: A retrospective study

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World Journal of Gastroenterology 2020年第10期26卷 1056-1066页

作者： Ryo Nishio Hiroki Kawashima Masanao Nakamura Eizaburo Ohno Takuya Ishikawa takeshi yamamura Keiko Maeda Tsunaki Sawada Hiroyuki Tanaka Daisuke Sakai Ryoji Miyahara Masatoshi Ishigami Yoshiki Hirooka Mitsuhiro Fujishiro Department of Gastroenterology and Hepatology Nagoya University Graduate School of MedicineAichi PrefectureNagoya 4668550Japan Department of Endoscopy Nagoya University HospitalAichi PrefectureNagoya 4668550Japan Department of Liver Biliary Tract and Pancreas DiseasesFujita Health University HospitalAichi PrefectureToyoake 4701192Japan

BACKGROUND Double-balloon endoscopic retrograde cholangiography (DB-ERC) is widely performed for biliary diseases after reconstruction in gastrointestinal surgery,but there are few reports on DB-ERC after hepatectomy or living donor liver transplantation (LDLT).AIM To examine the success rates and safety of DB-ERC after hepatectomy or LDLT METHODS The study was performed retrospectively in 26 patients (45 procedures) who underwent hepatectomy or LDLT (liver operation:LO group) and 40 control patients (59 procedures) who underwent pancreatoduodenectomy (control group).The technical success (endoscope reaching the choledochojejunostomy site),diagnostic success (performance of cholangiography),therapeutic success(completed interventions) and overall success rates,insertion and procedure(completion of DB-ERC) time,and adverse events were compared between these *** There were no significant differences between LO and control groups in the technical [93.3%(42/45) vs 96.6%(57/59),P=0.439],diagnostic [83.3%(35/42) vs83.6%(46/55),P=0.968],therapeutic [97.0%(32/33) vs 97.7%(43/44),P=0.836],and overall [75.6%(34/45) vs 79.7%(47/59),P=0.617] success *** median insertion time (22 vs 14 min,P <0.001) and procedure time (43.5 vs 30 min,P=0.033) were significantly longer in the LO *** incidence of adverse events showed no significant difference [11.1%(5/45) vs 6.8%(4/59),P=0.670].CONCLUSION DB-ERC after liver operation is safe and useful but longer time is required,so should be performed with particular care.

关键词： Biliary tract diseases Double-balloon enteroscopy Endoscopic retrograde cholangiopancreatography Hepatectomy Liver transplantation Risk management

Diagnostic performance of endoscopic classifications for neoplastic lesions in patients with ulcerative colitis:A retrospective casecontrol study

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World Journal of Gastroenterology 2022年第10期28卷 1055-1066页

作者： Yuichi Kida takeshi yamamura Keiko Maeda Tsunaki Sawada Eri Ishikawa Yasuyuki Mizutani Naomi Kakushima Kazuhiro Furukawa Takuya Ishikawa Eizaburo Ohno Hiroki Kawashima Masanao Nakamura Masatoshi Ishigami Mitsuhiro Fujishiro Department of Gastroenterology and Hepatology Nagoya University Graduate School of MedicineNagoya 466-8550AichiJapan Department of Endoscopy Nagoya University HospitalNagoya 466-8560AichiJapan Department of Gastroenterology Graduate School of MedicineThe University of TokyoTokyo 113-8655Japan

BACKGROUND It is unclear whether the Japan Narrow-Band Imaging Expert Team(JNET)classification and pit pattern classification are applicable for diagnosing neoplastic lesions in patients with ulcerative colitis(UC).AIM To clarify the diagnostic performance of these classifications for neoplastic lesions in patients with *** This study was conducted as a single-center,retrospective case-control ***-one lesions in 19 patients with UC-associated neoplasms(UCAN)and 23 lesions in 22 UC patients with sporadic neoplasms(SN),evaluated by magnifying image-enhanced endoscopy,were retrospectively and separately assessed by six endoscopists(three experts,three non-experts),using the JNET and pit pattern *** results were compared with the pathological diagnoses to evaluate the diagnostic ***-and intra-observer agreements were *** In this study,JNET type 2 A and pit pattern typeⅢ/Ⅳwere used as indicators of low-grade dysplasia,JNET type 2 B and pit pattern typeⅥlow irregularity were used as indicators of highgrade dysplasia to shallow submucosal invasive carcinoma,JNET type 3 and pit pattern typeⅥhigh irregularity/VN were used as indicators of deep submucosal invasive *** the UCAN group,JNET type 2 A and pit pattern typeⅢ/Ⅳhad a low positive predictive value(PPV;50.0%and 40.0%,respectively);however,they had a high negative predictive value(NPV;94.7%and 100%,respectively).Conversely,in the SN group,JNET type 2 A and pit pattern typeⅢ/Ⅳhad a high PPV(100%for both)but a low NPV(63.6%and 77.8%,respectively).In both groups,JNET type 3 and pit pattern typeⅥ-high irregularity/VN showed high *** interobserver agreement of JNET classification and pit pattern classification for UCAN among experts were 0.401 and 0.364,in the same manner for SN,0.666 and 0.597,*** intra-observer agreements of JNET classification and pit pattern classification for UCAN among experts were 0.387,0.454,for SN,0.803 and

关键词： Diagnostic performance Japan Narrow-Band Imaging Expert Team classification Pit pattern classification Sporadic neoplasms Ulcerative colitis Ulcerative colitis-associated neoplasms

Utility of linked color imaging for endoscopic diagnosis of early gastric cancer

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World Journal of Gastroenterology 2019年第10期25卷 1248-1257页

作者： Toshihisa Fujiyoshi Ryoji Miyahara Kohei Funasaka Kazuhiro Furukawa Tsunaki Sawada Keiko Maeda takeshi yamamura Takuya Ishikawa Eizaburo Ohno Masanao Nakamura Hiroki Kawashima Masato Nakaguro Masahiro Nakatochi Yoshiki Hirooka Department of Gastroenterology and Hepatology Nagoya University Graduate School of Medicine Department of Endoscopy Nagoya University Hospital Department of Pathology and Laboratory Medicine Nagoya University Hospital Division of Data Science Data Coordinating CenterDepartment of Advanced MedicineNagoya University Hospital

BACKGROUND Linked color imaging(LCI) is a method of endoscopic imaging that emphasizes slight differences in red mucosal *** To evaluate LCI in diagnostic endoscopy of early gastric cancer and to compare LCI and pathological *** Endoscopic images were obtained for 39 patients(43 lesions) with early gastric cancer. Three endoscopists evaluated lesion recognition with white light imaging(WLI) and LCI. Color values in Commission Internationale de l'Eclairage(CIE)1976 L*a*b* color space were used to calculate the color difference(ΔE) between cancer lesions and non-cancer areas. After endoscopic submucosal dissection,blood vessel density in the surface layer of the gastric epithelium was evaluated pathologically. The identical region of interest was selected for analyses of endoscopic images(WLI and LCI) and pathological *** LCI was superior for lesion recognition(P < 0.0001), and ΔE between cancer and non-cancer areas was significantly greater with LCI than WLI(29.4 vs 18.6, P <0.0001). Blood vessel density was significantly higher in cancer lesions(5.96% vs4.15%, P = 0.0004). An a* cut-off of ≥ 24 in CIE 1976 L*a*b* color space identified a cancer lesion using LCI with sensitivity of 76.7%, specificity of 93.0%, and accuracy of 84.9%.CONCLUSION LCI is more effective for recognition of early gastric cancer compared to WLI as a result of improved visualization of changes in redness. Surface blood vessel density was significantly higher in cancer lesions, and this result is consistent with LCI image analysis.

关键词： Linked color imaging Early gastric cancer Endoscopic submucosal dissection Vessel density Color difference

Accuracy of carbon dioxide insufflation for endoscopic retrograde cholangiopancreatography using double-balloon endoscopy

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World Journal of Gastroenterology 2020年第42期26卷 6669-6678页

作者： Yoshiki Niwa Masanao Nakamura Hiroki Kawashima takeshi yamamura Keiko Maeda Tsunaki Sawada Yasuyuki Mizutani Eri Ishikawa Takuya Ishikawa Naomi Kakushima Kazuhiro Furukawa Eizaburo Ohno Takashi Honda Masatoshi Ishigami Mitsuhiro Fujishiro Department of Gastroenterology and Hepatology Nagoya University Graduate School of MedicineNagoya 466-8560Japan Department of Endoscopy Nagoya University HospitalNagoya 466-8560Japan

BACKGROUND Retrograde cholangiopancreatography using double-balloon endoscopic retrograde cholangiography(DBERC)is a valuable technique to treat biliary stone and jejunobiliary anastomotic stenosis in patients with altered gastrointestinal *** accurate selection of the route at the anastomosis branch is one of the most important factors in reaching the target in a timely *** To determine the accuracy of carbon dioxide insufflation enterography(CDE)at the branch for selecting the correct route during *** We enrolled 52 consecutive patients scheduled for DBERC at our institution from June 2015 to November *** selection via two methods(visual observation and CDE)was performed in each *** determined the correct rate of route selection using *** Thirty-three patients had a jejunojejunal anastomosis and 19 patients had a gastrojejunal *** therapeutic target region was reached in 50 *** mean procedure times from the teeth to the target(total insertion time),from the teeth to the branch,and from the branch to the target,and the mean total examination time were 15.2,5.0,8.2,and 60.3 min,*** rate of correct route selection using visual observation and CDE were 36/52(69.2%)and 48/52(92.3%),respectively(P=0.002).The rate of correct route selection using CDE in patients with a jejunojejunal anastomosis was 29/33(87.8%),and the rate in patients with a gastrojejunal anastomosis was 19/19(100%).CONCLUSION CDE is helpful in selecting the route at the branch in the anastomosis for more timely access to the target in patients with altered gastrointestinal anatomy undergoing DBERC.

关键词： Retrograde cholangiopancreatography Double-balloon endoscopy Carbon dioxide insufflation Anastomosis Accuracy Prospective study

In vivo histological diagnosis for gastric cancer using endocytoscopy

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World Journal of Gastroenterology 2017年第37期23卷 6894-6901页

作者： Issei Tsurudome Ryoji Miyahara Kohei Funasaka Kazuhiro Furukawa Masanobu Matsushita takeshi yamamura Takuya Ishikawa Eizaburo Ohno Masanao Nakamura Hiroki Kawashima Osamu Watanabe Masato Nakaguro Akira Satou Yoshiki Hirooka Hidemi Goto Department of Gastroenterology and Hepatology Nagoya University Graduate School of Medicine Department of Endoscopy Nagoya University Hospital Department of Pathology and Laboratory Medicine Nagoya University Hospital Department of Surgical Pathology Aichi Medical University Hospital

AIM To examine usefulness of virtual biopsy using endocytoscopy by comparing the in vivo endocytoscopic and histopathological images of gastric *** Endocytoscopy was performed in 30 patients with early gastric cancer. Of these, 26 patients showed well differentiated adenocarcinomas, while 4 patients showed poorly differentiated adenocarcinomas(including one signet ring cell carcinoma). Cancerous and non-cancerous areas were observed after double staining with 0.05% crystal violet and 0.1% methylene blue. The endocytoscopic images obtained were evaluated by an expert endoscopist and an expert pathologist without knowledge of patient clinical data, and endocytoscopic and histopathological diagnoses were *** The endocytoscopic images of the cancerous area were assessed as evaluable in 25(83.3%) and 27(90%) patients by endoscopist A and pathologist B, respectively, and those of the non-cancerous area as evaluable in 28(93.3%) and 23(76.7%) patients by the endoscopist and pathologist, respectively. The sensitivity, specificity, and diagnostic accuracy of gastric cancer diagnosis using evaluable endocytoscopic images were 88.0% and 92.9%, and 90.6% by endoscopist A, and 88.9% and 91.3%, and 90.0% by pathologist B, respectively. Evaluation of the diagnostic concordance rate between the endoscopist and the pathologist by inter-observer agreement calculation revealed no significant difference between the two observers. The inter-observer agreement(κ-value) for endocytoscopic diagnosis was 0.745. CONCLUSION Endocytoscopy is useful for the differentiation of cancerous from non-cancerous gastric mucosa, making it a promising tool for virtual biopsy.

关键词： Endocytoscopy Gastric cancer Virtual biopsy In vivo histopathology Magnifying endoscopy Double staining Crystal violet Methylene blue

Characteristic endoscopic findings and risk factors for cytomegalovirus-associated colitis in patients with active ulcerative colitis

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World Journal of Gastrointestinal Endoscopy 2016年第6期8卷 301-309页

作者： Yutaka Hirayama Takafumi Ando Yoshiki Hirooka Osamu Watanabe Ryoji Miyahara Masanao Nakamura takeshi yamamura Hidemi Goto Department of Gastroenterology and Hepatolgy Nagoya University Graduate School of Medicine Department of Endoscopy Nagoya University Hospital

AIM: To identify characteristic endoscopic findings and risk factors for cytomegalovirus(CMV)-associated colitis in patients with active ulcerative colitis(UC).METHODS: A total of 149 UC patients admitted to the Department of Gastroenterology, Nagoya University Hospital, from January 2004 to December 2013 with exacerbation of UC symptoms were enrolled in this retrospective study. All medical records, including colonoscopy results, were reviewed. CMV infection was determined by the presence of CMV antigen, CMV inclusion bodies in biopsy specimens, or positive specific immunohistochemical staining for CMV. Multivariate analysis was used to identify independent risk factors for CMV ***: Multivariate analysis indicated independent associations with the extent of disease(pancolitis) anduse of > 400 mg corticosteroids for the previous 4 wk. In contrast, no association was seen with sex, age at UC diagnosis, immunomodulator use, or infliximab use. Punched-out ulceration was also significantly associated with CMV infection in patients with active UC(odds ratio = 12.672, 95%CI: 4.210-38.143).CONCLUSION: Identification of a total corticosteroid dose > 400 mg for 4 wk, extensive colitis and a specific endoscopic finding of punched-out ulcer might facilitate the more rapid diagnosis and timely initiation of antiviral therapy for CMV-associated colitis in patients with active UC.

关键词： Colonoscopy Risk factor Ulcerative colitis Antigenemia Cytomegalovirus

Clinical characteristics of gastrointestinal immune-related adverse events of immune checkpoint inhibitors and their association with survival

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World Journal of Gastroenterology 2021年第41期27卷 7190-7206页

作者： Kentaro Yamada Tsunaki Sawada Masanao Nakamura takeshi yamamura Keiko Maeda Eri Ishikawa Tadashi Iida Yasuyuki Mizutani Naomi Kakushima Takuya Ishikawa Kazuhiro Furukawa Eizaburo Ohno Takashi Honda Hiroki Kawashima Masatoshi Ishigami Satoshi Furune Tetsunari Hase Kenji Yokota Osamu Maeda Naozumi Hashimoto Masashi Akiyama Yuichi Ando Mitsuhiro Fujishiro Department of Gastroenterology and Hepatology Nagoya University Graduate School of MedicineNagoya City 4668560AichiJapan Department of Endoscopy Nagoya University HospitalNagoya City 4668560AichiJapan Department of Clinical Oncology and Chemotherapy Nagoya University HospitalNagoya City 4668560AichiJapan Department of Respiratory Medicine Nagoya University Graduate School of MedicineNagoya City 4668560AichiJapan Department of Dermatology Nagoya University Graduate School of MedicineNagoya City 4668560AichiJapan Department of Gastroenterology and Hepatology Graduate School of MedicineThe University of TokyoTokyo 1138655Japan

BACKGROUND Despite the popularity of immune checkpoint inhibitors(ICIs)in the treatment of advanced cancer,patients often develop gastrointestinal(GI)and non-GI immune-related adverse events(irAEs).The clinical characteristics and survival outcomes of GI-irAEs have not been fully elucidated in previous *** necessitates the evaluation of the impact of GI-irAEs on patients receiving ICI *** To evaluate the clinical characteristics of GI-irAEs and their impact on survival in patients treated with *** In this single-center,retrospective,observational study,we reviewed the records of 661 patients who received ICIs for various cancers at Nagoya University Hospital from September 2014 to August *** analyzed the clinical characteristics of patients who received ICI *** also evaluated the correlation between GI-irAE development and prognosis in non-small cell lung cancer(LC)and malignant melanoma(MM).Kaplan-Meier analysis was used to compare the median overall survival(OS).Multivariate Cox proportional hazards models were used to identify prognostic factors.A P value<0.05 was considered statistically *** GI-irAEs occurred in 34 of 605 patients(5.6%)treated with an anti-programmed cell death-1/programmed death-ligand 1(anti-PD-1/PD-L1)antibody alone and in nine of 56 patients(16.1%)treated with an anti-cytotoxic T-lymphocyte antigen 4(CTLA-4)antibody alone or a combination of anti-PD-1 and anti-CTLA-4 *** cumulative incidence and median daily diarrhea frequency were significantly higher in patients receiving anti-CTLA-4 antibodies(P<0.05).In 130 patients with MM,OS was significantly prolonged in the group that continued ICI treatment despite the development of GI-irAEs compared to the group that did not experience GI-irAEs(P=0.035).In contrast,in 209 patients with non-small cell LC,there was no significant difference in OS between the *** multivariate analyses showed that a performance status of 2-3(ha

关键词： Colitis Cytotoxic T-lymphocyte antigen 4 Diarrhea Drug-related side effects and adverse reactions Immune checkpoint inhibitors Prognosis