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Topic highlight on texture and color enhancement imaging in gastrointestinal diseases

World Journal of Gastroenterology 2024年第14期30卷 1934-1940页

作者： Osamu Toyoshima toshihiro nishizawa Keisuke Hata Department of Gastroenterology Toyoshima Endoscopy ClinicTokyo 157-0066Japan Department of Gastroenterology and Hepatology International University of Health and WelfareNarita HospitalNarita 286-8520Japan Department of Gastroenterology Nihonbashi Muromachi Mitsui Tower Midtown ClinicTokyo 103-0022Japan

Olympus Corporation developed texture and color enhancement imaging(TXI)as a novel image-enhancing endoscopic technique.This topic highlights a series of hot-topic articles that investigated the efficacy of TXI for gastrointestinal disease identification in the clinical setting.A randomized controlled trial demonstrated improvements in the colorectal adenoma detection rate(ADR)and the mean number of adenomas per procedure(MAP)of TXI compared with those of white-light imaging(WLI)observation(58.7%vs 42.7%,adjusted relative risk 1.35,95%CI:1.17-1.56;1.36 vs 0.89,adjusted incident risk ratio 1.48,95%CI:1.22-1.80,respectively).A cross-over study also showed that the colorectal MAP and ADR in TXI were higher than those in WLI(1.5 vs 1.0,adjusted odds ratio 1.4,95%CI:1.2-1.6;58.2%vs 46.8%,1.5,1.0-2.3,respectively).A randomized controlled trial demonstrated non-inferiority of TXI to narrow-band imaging in the colorectal mean number of adenomas and sessile serrated lesions per procedure(0.29 vs 0.30,difference for non-inferiority-0.01,95%CI:-0.10 to 0.08).A cohort study found that scoring for ulcerative colitis severity using TXI could predict relapse of ulcerative colitis.A cross-sectional study found that TXI improved the gastric cancer detection rate compared to WLI(0.71%vs 0.29%).A cross-sectional study revealed that the sensitivity and accuracy for active Helicobacter pylori gastritis in TXI were higher than those of WLI(69.2%vs 52.5%and 85.3%vs 78.7%,res-pectively).In conclusion,TXI can improve gastrointestinal lesion detection and qualitative diagnosis.Therefore,further studies on the efficacy of TXI in clinical practice are required.

关键词： Endoscopy Texture and color enhancement imaging White-light imaging Narrow-band imaging Colorectal neoplasm Gastric cancer Adenoma Ulcerative colitis Helicobacter infections Colonoscopy

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Kyoto classification of gastritis:Advances and future perspectives in endoscopic diagnosis of gastritis

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World Journal of Gastroenterology 2022年第43期28卷 6078-6089页

作者： Osamu Toyoshima toshihiro nishizawa Department of Gastroenterology Toyoshima Endoscopy ClinicTokyo 157-0066Japan Department of Gastroenterology and Hepatology International University of Medicine and WelfareNarita 286-8520Japan

This editorial provides an update of the recent evidence on the endoscopy-based Kyoto classification of gastritis,clarifying the shortcomings of the Kyoto classification,and providing prospects for future research,with particular focus on the histological subtypes of gastric cancer(GC)and Helicobacter pylori(H.pylori)infection status.The total Kyoto score is designed to express GC risk on a score ranging from 0 to 8,based on the following five endoscopic findings:Atrophy,intestinal metaplasia(IM),enlarged folds(EF),nodularity,and diffuse redness(DR).The total Kyoto score reflects H.pylori status as follows:0,≥2,and≥4 indicate a normal stomach,H.pylori-infected gastritis,and gastritis at risk for GC,respectively.Regular arrangement of collecting venules(RAC)predicts noninfection;EF,nodularity,and DR predict current infection;map-like redness(MLR)predicts past infection;and atrophy and IM predict current or past infection.Atrophy,IM,and EF all increase the incidence of H.pylori-infected GC.MLR is a specific risk factor for H.pylori-eradicated GC,while RAC results in less GC.Diffuse-type GC can be induced by active inflammation,which presents as EF,nodularity,and atrophy on endoscopy,as well as neutrophil and mononuclear cell infiltration on histology.In contrast,intestinal-type GC develops via atrophy and IM,and is consistent between endoscopy and histology.However,this GC risk-scoring design needs to be improved.

关键词： Kyoto classification Gastritis Endoscopy Gastric cancer Histology Helicobacter pylori

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Gastric cancer incidence based on endoscopic Kyoto classification of gastritis

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世界胃肠病学杂志:英文版 2023年第31期29卷 4763-4773页

作者： Osamu Toyoshima toshihiro nishizawa Shuntaro Yoshida Tatsuya Matsuno Gota Fujisawa Akira Toyoshima Hirotoshi Ebinuma Mitsuhiro Fujishiro Yutaka Saito Hidekazu Suzuki Department of Gastroenterology Toyoshima Endoscopy ClinicTokyo 157-0066Japan Department of Gastroenterology and Hepatology International University of Health and WelfareNarita HospitalNarita 286-8520Japan Department of Colorectal Surgery Japanese Red Cross Medical CenterTokyo 150-8935Japan Department of Gastroenterology Graduate School of MedicineThe University of TokyoTokyo 113-8655Japan Division of Endoscopy National Cancer Center HospitalTokyo 104-0045Japan Division of Gastroenterology and Hepatology Department of Internal MedicineTokai University School of MedicineIsehara 259-1193Japan

BACKGROUND Gastric cancer(GC)incidence based on the endoscopic Kyoto classification of gastritis has not been systematically investigated using time-to-event analysis.AIM To examine GC incidence in an endoscopic surveillance cohort.METHODS This study was retrospectively conducted at the Toyoshima Endoscopy Clinic.Patients who underwent two or more esophagogastroduodenoscopies were enrolled.GC incidence was based on Kyoto classification scores,such as atrophy,intestinal metaplasia(IM),enlarged folds(EFs),nodularity,diffuse redness(DR),and total Kyoto scores.Hazard ratios(HRs)adjusted for age and sex were calculated using a Cox hazard model.RESULTS A total of 6718 patients were enrolled(median age 54.0 years;men 44.2%).During the follow-up period(max 5.02 years;median 2.56 years),GC developed in 34 patients.The average frequency of GCs per year was 0.19%.Kyoto atrophy scores 1[HR with score 0 as reference:3.66,95%confidence interval(CI):1.06 to 12.61],2(11.60,3.82-35.27),IM score 2(9.92,4.37-22.54),EF score 1(4.03,1.63-9.96),DR scores 1(6.22,2.65-14.56),and 2(10.01,3.73-26.86)were associated with GC incidence,whereas nodularity scores were not.The total Kyoto scores of 4(HR with total Kyoto scores 0-1 as reference:6.23,95%CI:1.93 to 20.13,P=0.002)and 5-8(16.45,6.29-43.03,P<0.001)were more likely to develop GC,whereas the total Kyoto scores 2-3 were not.The HR of the total Kyoto score for developing GC per 1 rank was 1.75(95%CI:1.46 to 2.09,P<0.001).CONCLUSION A high total Kyoto score(≥4)was associated with GC incidence.The endoscopy-based diagnosis of gastritis can stratify GC risk.

关键词： Gastric cancer Gastritis Endoscopy Atrophy Intestinal metaplasia Kyoto classification

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Brown slits for colorectal adenoma crypts on conventional magnifying endoscopy with narrow band imaging using the X1 system

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World Journal of Gastroenterology 2022年第24期28卷 2748-2757页

作者： Osamu Toyoshima toshihiro nishizawa Shuntaro Yoshida Hidenobu Watanabe Nariaki Odawara Kosuke Sakitani Toru Arano Hirotoshi Takiyama Hideyuki Kobayashi Hirofumi Kogure Mitsuhiro Fujishiro Department of Gastroenterology Toyoshima Endoscopy ClinicTokyo 157-0066Japan Department of Gastroenterology and Hepatology International University of Health and WelfareNarita HospitalChiba 286-8520Japan Department of Pathology Pathology and Cytology Laboratory JapanTokyo 166-0003Japan Department of Gastroenterology Graduate School of MedicineThe University of TokyoTokyo 113-8655Japan Department of Gastroenterology Sakitani Endoscopy ClinicChiba 275-0026Japan Department of Gastroenterology The Fraternity Memorial HospitalTokyo 130-8587Japan Department of Surgical Oncology The University of TokyoTokyo 113-8655Japan Department of Internal Medicine Umegaoka Ekimae ClinicTokyo 154-0022Japan

BACKGROUND Accurate diagnosis of colorectal premalignant polyps,including adenomas,is vital in clinical practice.AIM To investigate the diagnostic yields of novel findings of brown slits for adenomas.METHODS Patients who underwent colonoscopy at the Toyoshima Endoscopy Clinic were enrolled.Polyps sized≥5 mm suspected of adenomas or clinically significant serrated polyps were included in the study.We defined the surface structures of colorectal polyps,which were brown curves inside and along the tubular glands identified using a combination of a new X1 system(Olympus Corporation)and a conventional magnifying colonoscope with non-staining narrow band imaging(NBI),as brown slits.The brown slits corresponded to slit-like lumens on endocytoscopy and histological crypt openings of an adenoma.We evaluated the diagnostic performance of brown slits for adenoma.RESULTS A total of 108 Lesions from 62 patients were eligible.The average age was 60.4 years and 41.9%were male.The mean polyp size was 7.45±2.83 mm.Fifty-seven lesions were positive for brown slits.Histopathological diagnosis comprised 59 low-grade tubular adenomas,16 sessile serrated lesions,and 33 hyperplastic polyps.Among 59 adenomas,56(94.9%)were positive for brown slits.Among 16 sessile serrated lesions,0(0%)was positive for brown slits.Among 33 hyperplastic polyps,1(3.0%)was positive for brown slits.The sensitivity,specificity,and accuracy of brown slits for adenoma were 94.9%,98.0%,and 96.3%,respectively.The positive predictive value and negative predictive value of brown slits for adenoma were also excellent for 98.2%,and 94.1%,respectively.CONCLUSION Brown slits on conventional magnifying endoscopy with non-staining NBI using the X1 system were useful for diagnosing colorectal adenoma.The new endoscopy system could be examined using new standards.

关键词： Adenoma Colonoscopy Narrow band imaging Magnifying endoscopy X1 Serrated polyp Colorectal neoplasm Endocytoscopy

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Endoscopic Kyoto classification of Helicobacter pylori infection and gastric cancer risk diagnosis

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World Journal of Gastroenterology 2020年第5期26卷 466-477页

作者： Osamu Toyoshima toshihiro nishizawa Kazuhiko Koike Department of Gastroenterology Toyoshima Endoscopy ClinicTokyo 157-0066Japan Department of Gastroenterology Graduate School of MedicineThe University of TokyoTokyo 113-8655Japan Department of Gastroenterology and Hepatology International University of Health and WelfareMita HospitalTokyo 108-8329Japan

Recent advances in endoscopic technology allow detailed observation of the gastric mucosa.Today,endoscopy is used in the diagnosis of gastritis to determine the presence/absence of Helicobacter pylori(H.pylori)infection and evaluate gastric cancer risk.In 2013,the Japan Gastroenterological Endoscopy Society advocated the Kyoto classification,a new grading system for endoscopic gastritis.The Kyoto classification organized endoscopic findings related to H.pylori infection.The Kyoto classification score is the sum of scores for five endoscopic findings(atrophy,intestinal metaplasia,enlarged folds,nodularity,and diffuse redness with or without regular arrangement of collecting venules)and ranges from 0 to 8.Atrophy,intestinal metaplasia,enlarged folds,and nodularity contribute to gastric cancer risk.Diffuse redness and regular arrangement of collecting venules are related to H.pylori infection status.In subjects without a history of H.pylori eradication,the infection rates in those with Kyoto scores of 0,1,and≥2 were 1.5%,45%,and 82%,respectively.A Kyoto classification score of 0 indicates no H.pylori infection.A Kyoto classification score of 2 or more indicates H.pylori infection.Kyoto classification scores of patients with and without gastric cancer were 4.8 and 3.8,respectively.A Kyoto classification score of 4 or more might indicate gastric cancer risk.

关键词： Gastric cancer Helicobacter pylori Endoscopy Kyoto classification Atrophy Intestinal metaplasia Enlarged fold Nodularity Diffuse redness Regular arrangement of collecting venules

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Texture and color enhancement imaging in magnifying endoscopic evaluation of colorectal adenomas

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World Journal of Gastrointestinal Endoscopy 2022年第2期14卷 96-105页

作者： Osamu Toyoshima toshihiro nishizawa Shuntaro Yoshida Tomoharu Yamada Nariaki Odawara Tatsuya Matsuno Miho Obata Ken Kurokawa Chie Uekura Mitsuhiro Fujishiro Gastroenterology Toyoshima Endoscopy ClinicTokyo 157-0066Japan Department of Gastroenterology and Hepatology International University of Health and WelfareNarita HospitalNarita 286-8520ChibaJapan Department of Gastroenterology Graduate School of MedicineThe University of TokyoTokyo 113-8655Japan

BACKGROUND Olympus Corporation has developed texture and color enhancement imaging(TXI)as a novel image-enhancing endoscopic technique.AIM To investigate the effectiveness of TXI in identifying colorectal adenomas using magnifying observation.METHODS Colorectal adenomas were observed by magnified endoscopy using white light imaging(WLI),TXI,narrow band imaging(NBI),and chromoendoscopy(CE).This study adopted mode 1 of TXI.Adenomas were confirmed by histological examination.TXI visibility was compared with the visibility of WLI,NBI,and CE for tumor margin,and vessel and surface patterns of the Japan NBI expert team(JNET)classification.Three expert endoscopists and three non-expert endoscopists evaluated the visibility scores,which were classified as 1,2,3,and 4.RESULTS Sixty-one consecutive adenomas were evaluated.The visibility score for tumor margin of TXI(3.47±0.79)was significantly higher than that of WLI(2.86±1.02,P<0.001),but lower than that of NBI(3.76±0.52,P<0.001),regardless of the endoscopist’s expertise.TXI(3.05±0.79)had a higher visibility score for the vessel pattern of JNET classification than WLI(2.17±0.90,P<0.001)and CE(2.47±0.87,P<0.001),but lower visibility score than NBI(3.79±0.47,P<0.001),regardless of the experience of endoscopists.For the visibility score for the surface pattern of JNET classification,TXI(2.89±0.85)was superior to WLI(1.95±0.79,P<0.01)and CE(2.75±0.90,P=0.002),but inferior to NBI(3.67±0.55,P<0.001).CONCLUSION TXI provided higher visibility than WLI,lower than NBI,and comparable to or higher than CE in the magnified observation of colorectal adenomas.

关键词： Texture and color enhancement imaging Adenoma Colonoscopy Narrow band imaging Japan NBI Expert Team Olympus

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Impact of looping on premalignant polyp detection during colonoscopy

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World Journal of Gastrointestinal Endoscopy 2022年第11期14卷 694-703页

作者： Osamu Toyoshima toshihiro nishizawa Shuntaro Yoshida Tatsuya Matsuno Toru Arano Ryo Kondo Kazunori Kinoshita Yuki Yasumi Yosuke Tsuji Mitsuhiro Fujishiro Department of Gastroenterology Toyoshima Endoscopy ClinicTokyo 157-0066Japan Department of Gastroenterology and Hepatology International University of Health and WelfareNarita HospitalNarita 286-8520Japan Department of Obstetrics and Gynecology Seijo Kinoshita HospitalTokyo 157-0066Japan Department of Internal Medicine Yasumi HospitalMorioka 028-4125Japan Department of Gastroenterology Graduate School of MedicineThe University of TokyoTokyo 113-8655Japan

BACKGROUND The presence of premalignant polyps on colonoscopy is an indicator of metachronous colorectal cancer.Looping during colonoscopy is associated with old age,female sex,and colonoscopy insertion time.However,the clinical significance of looping is not fully understood.We aimed to clarify the effect of looping on colorectal premalignant polyp detection.AIM To assess the effects of looping on premalignant polyp detection using logistic regression analyses.METHODS We retrospectively investigated patients who underwent colonoscopy at Toyoshima Endoscopy Clinic between May,2017 and October,2020.From the clinic’s endoscopy database,we extracted data on patient age,sex,endoscopist-assessed looping,colonoscopy duration,endoscopist experience,detection rate,and number of premalignant polyps.RESULTS We assessed 12259 patients(mean age,53.6 years;men,50.7%).Looping occurred in 54.3%of the patients.Mild and severe looping were noted in 4399 and 2253 patients,respectively.The detection rates of adenomas,advanced adenomas,high-risk adenomas,clinically significant serrated polyps(CSSPs),and sessile serrated lesions(SSLs)were 44.7%,2.0%,9.9%,8.9%and 3.5%,respectively.The mean numbers of adenomas and SSLs were 0.82 and 0.04,respectively.The detection rates of adenomas,high-risk adenomas,and CSSPs increased with looping severity(all P<0.001).The number of adenomas increased with looping severity(P<0.001).Multivariate analyses found that detection of adenomas,high-risk adenomas,and CSSPs was associated with severe looping(P<0.001,P<0.001,and P=0.007,respectively)regardless of age,sex,time required for colonoscope insertion and withdrawal,and endoscopist experience.CONCLUSION Looping severity was independently associated with high detection rates of premalignant polyps.Therefore,looping may predict the risk of metachronous colorectal cancer.Endoscopists should carefully examine the colorectum of patients with looping.

关键词： Looping Colorectal polyp Colonoscopy Adenoma Serrated polyp Colorectal neoplasm

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Improved visibility of colorectal tumor by texture and color enhancement imaging with indigo carmine

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World Journal of Gastrointestinal Endoscopy 2023年第12期15卷 690-698页

作者： Takuma Hiramatsu toshihiro nishizawa Yosuke Kataoka Shuntaro Yoshida Tatsuya Matsuno Hiroya Mizutani Hideki Nakagawa Hirotoshi Ebinuma Mitsuhiro Fujishiro Osamu Toyoshima Department of Gastroenterology Graduate School of MedicineThe University of TokyoTokyo 113-8655Japan Department of Gastroenterology and Hepatology International University of Health and WelfareNarita HospitalNarita 286-8520Japan Department of Gastroenterology Toyoshima Endoscopy ClinicTokyo 157-0066Japan

BACKGROUND Accurate diagnosis and early resection of colorectal polyps are important to prevent the occurrence of colorectal cancer.However,technical factors and morphological factors of polyps itself can lead to missed diagnoses.Imageenhanced endoscopy and chromoendoscopy(CE)have been developed to facilitate an accurate diagnosis.There have been no reports on visibility using a combination of texture and color enhancement imaging(TXI)and CE for colorectal tumors.AIM To investigate the visibility of margins and surfaces with the combination of TXI and CE for colorectal lesions.METHODS This retrospective study included patients who underwent lower gastrointestinal endoscopy at the Toyoshima Endoscopy Clinic.We extracted polyps that were resected and diagnosed as adenomas or serrated polyps(hyperplastic polyps and sessile serrated lesions)from our endoscopic database.An expert endoscopist performed the lower gastrointestinal endoscopies and observed the lesion using white light imaging(WLI),TXI,CE,and TXI+CE modalities.Indigo carmine dye was used for CE.Three expert endoscopists rated the visibility of the margin and surface patterns in four ranks,from 1 to 4.The primary outcomes were the average visibility scores for the margin and surface patterns based on the WLI,TXI,CE,and TXI+CE observations.Visibility scores between the four modalities were compared by the Kruskal-Wallis and Dunn tests.RESULTS A total of 48 patients with 81 polyps were assessed.The histological subtypes included 50 tubular adenomas,16 hyperplastic polyps,and 15 sessile serrated lesions.The visibility scores for the margins based on WLI,TXI,CE,and TXI+CE were 2.44±0.93,2.90±0.93,3.37±0.74,and 3.75±0.49,respectively.The visibility scores for the surface based on WLI,TXI,CE,and TXI+CE were 2.25±0.80,2.84±0.84,3.12±0.72,and 3.51±0.60,respectively.The visibility scores for the detection and surface on TXI were significantly lower than that on CE but higher than that on WLI(P<0.001).The visibility scores for the margin and surface on TXI+CE were si

关键词： Texture and color enhancement imaging Indigo carmine Adenoma Colonoscopy Sessile serrated lesion

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Changes of gastric ulcer bleeding in the metropolitan area of Japan

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World Journal of Gastroenterology 2019年第42期25卷 6342-6353页

作者： Yoko Kubosawa Hideki Mori Satoshi Kinoshita Yoshihiro Nakazato Ai Fujimoto Masahiro Kikuchi toshihiro nishizawa Masayuki Suzuki Hidekazu Suzuki Department of Gastroenterology National Hospital Organization Tokyo Medical CenterMeguroTokyo 152-8902Japan Division of Gastroenterology and Hepatology Department of Internal MedicineKeio University School of MedicineShinjukuTokyo 160-0016Japan Department of Clinical and Experimental Medicine Translational Research Center for Gastrointestinal Diseases(TARGID)University of LeuvenLeuven 3000Belgium Department of Gastroenterology Digestive Disease CenterInternational University of Health and WelfareMita HospitalMinatoTokyo 108-8329Japan Division of Gastroenterology and Hepatology Department of Internal MedicineTokai University School of MedicineIseharaKanagawa 259-1193Japan

BACKGROUND The two main causes of gastric ulcer bleeding are Helicobacter pylori(H.pylori)infection and ulcerogenic medicines,although the number of cases caused by each may vary with age.In Japan,the rate of H.pylori infection has fallen over the last decade and the number of prescriptions for non-steroidal anti-inflammatory drugs(NSAIDs)and antithrombotic drugs is increasing as the population ages.Methods of treatment for gastric ulcer bleeding have advanced with the advent of hemostatic forceps and potassium-competitive acid blocker(P-CAB).Thus,causes and treatments for gastric ulcer bleeding have changed over the last decade.AIM To examine the trends of gastric ulcer bleeding over 10 years in the metropolitan area of Japan.METHODS This is a single-center retrospective study.A total of 564 patients were enrolled from inpatients admitted to our hospital with gastric ulcer bleeding between 2006 and 2016.Age,medication history,H.pylori infection,method of treatment,rate of rebleeding,and the length of hospitalization were analyzed.Factors associated with gastric ulcer bleeding were evaluated using Fisher’s exact test,Pearson’s Chi-squared test or Student’s t-test as appropriate.The Jonckheere-Terpstra test was used to evaluate trends.A per-protocol analysis was used to examine the rate of H.pylori infection.RESULTS There was a significant increase in the mean age over time(P<0.01).The rate of H.pylori infection tended to decrease over the study period(P=0.10),whereas the proportion of patients taking antithrombotic agents or NSAIDs tended to increase(P=0.07).Over time,the use of NSAIDs and antithrombotic drugs increased with age.By contrast,the rate of H.pylori infection during the study period fell with age.H.pylori-induced ulcers accounted for the majority of cases in younger patients(<70 years old);however,the rate decreased with age(P<0.01).The method of treatment trend has changed significantly over time.The main method of endoscopic hemostasis has changed from clipping and injection to forceps coagulation(P

关键词： Helicobacter pylori infection Gastric ulcer bleeding Non-steroidal antiinflammatory drugs Antithrombotic agents

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Real-world clinical data of endoscopy-based cancer detection during the emergency declaration for COVID-19 in Japan

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World Journal of Gastrointestinal Endoscopy 2020年第10期12卷 401-403页

作者： Shuntaro Yoshida toshihiro nishizawa Osamu Toyoshima Department of Gastroenterology Toyoshima Endoscopy ClinicTokyo 157-0066Japan Department of Gastroenterology International University of Health and WelfareNarita HospitalChiba 2868520Japan

The impact of the coronavirus disease 2019(COVID-19)pandemic is widespread throughout the world,causing serious damage to healthcare systems.Therefore,we examined the significance of endoscopy based on the recommendation of Asian-Pacific Society for Digestive Endoscopy and Japan Gastroenterological Endoscopy Society during the COVID-19 pandemic by evaluating the details of gastrointestinal endoscopy performed during the declaration of emergency in Japan.We have continued performing gastrointestinal endoscopy at an outpatient clinic that specialized in endoscopic medical care in Tokyo,Japan.During the emergency declaration period,544 patients underwent gastrointestinal endoscopy.As a control,we investigated 1327 patients who underwent gastrointestinal endoscopy during the same period in 2019.Although the total number of endoscopies during the emergency declaration was halved,the advanced cancer detection rate during the emergency declaration was significantly higher than that in 2019(P=0.04).Additionally,no COVID-19 infection was observed in healthcare workers,staff,or patients during this period.It is possible that an outpatient endoscopy units can contribute to the detection of advanced cancer,while the hospital in charge for patients with COVID-19 infection could not perform endoscopy during the declaration of emergency.

关键词： COVID-19 Pandemics Gastrointestinal Endoscopy Neoplasms Personal protective equipment

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