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Risk factors for bleeding after endoscopic submucosal dissection for gastric lesions

World Journal of Gastroenterology 2010年第23期16卷 2913-2917页

作者： Yosuke Tsuji Ken Ohata Takafumi Ito Hideyuki Chiba Tomohiko Ohya Toshiaki Gunji Nobuyuki Matsuhashi Department of Gastroenterology Kanto Medical CenterNTT EC Department of Endoscopy The Jikei University School of Medicine Center for Preventive Medicine Kanto Medical CenterNTT EC

AIM:To assess risk factors for bleeding after gastric endoscopic submucosal dissection(ESD) and to develop preventive measures.METHODS:This retrospective study was performed in a tertiary referral center.A total of 328 patients underwent ESD for 398 gastric neoplasms between July 2007 and June 2009.The main outcome was association between post-ESD bleeding and the following:age;sex;comorbidities;daily use of medicine potentially related to gastric injury/bleeding;location,size,and histological depth of lesions;ulceration;experience of operator coagulating the ulcer floor,and duration of operation.We also determined the relationship between the location of post-ESD bleeding and risk factors for hemorrhage.RESULTS:Univariate analysis revealed significant risk factors:tumor location [odds ratio(OR),2.86;95% CI:1.21-6.79,P=0.024],coagulator experience(OR,4.29;95% CI:1.43-12.86,P=0.009),and medicine potentially related to gastric injury/bleeding(OR,2.80;95% CI:1.14-6.90,P=0.039).Multivariate logistic regression analysis confirmed significant,independent risk factors:tumor in lower third of stomach(OR,2.47;95% CI:1.02-5.96,P=0.044),beginner coagulator(OR,3.93;95% CI:1.29-11.9,P=0.016),and medicine(OR,2.76;95% CI:1.09-6.98,P=0.032).We classif ied cases of post-ESD bleeding into two groups(bleeding at the ulcer margin vs bleeding at the center) and found that bleeding at the margin occurred more frequently with beginner coagulators compared with experts(OR,16.00;95% CI:1.22-210.59,P=0.040).CONCLUSION:Beginner coagulators,tumor in the antrum,and medicines were significant risk factors for post-ESD bleeding.Bleeding at the ulcer margin frequently occurred with beginner operators.

关键词： Bleeding Endoscopic submucosal dissection Ulcer floor Anti-thrombotic drugs Coagulation

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Prospective controlled study on the effects of polyethylene glycol in capsule endoscopy

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World Journal of Gastroenterology 2012年第15期18卷 1789-1792页

作者： Takafumi Ito Ken Ohata Akiko Ono Hideyuki Chiba Yosuke Tsuji Hajime Sato Nobuyuki Matsuhashi Department of Gastroenterology Kanto Medical CenterNTT EastTokyo 1418625Japan Department of Health Policy and Technology Assessment National Institute of Public Health2-3-6 MinamiWako-shi 3293147Japan

AIM:To prospectively confirm whether a small amount of polyethylene glycol(PEG)ingested after swallowing endoscopy capsule improves image quality and completion rate.METHODS:Forty-four consecutive patients referred to us for capsule endoscopy(CE)were randomized to two groups.All patients were restricted to clear fluids for 12 h before the examination.Patients in group A(22 cases)received no additional preparation,while those in group B(20 cases)ingested 500 mL of PEG within a 2 h period starting 30 min after swallowing the capsule.Clear fluids and meals were allowed 2 h and 4 h after capsule ingestion,respectively.Image quality was assessed as the percentage of visualized bowel surface area as follows:1:90%.The small bowel record was divided into five segments by time,and the score for each segment was evaluated.All CE examinations were performed with the Pillcam SB capsule endoscopy sys-tem(Given Imaging Co.Ltd.,Yoqnem).RESULTS:This study ended in December 2009,because sample size was considered large enough.A total of 44 patients were enrolled.Two patients in group B were excluded from the analysis because small bowel images could not be obtained from these patients;one had a full stomach,while the other presented with a massive gastric bleed.Thus,22 patients from group A and 20 patients from group B completed the study.There was no significant difference in age(P=0.22),sex(P=0.31),and indication for CE.No significant adverse events occurred in any of the study patients.In group A,image quality deteriorated as the capsule progressed distally.However,in group B,image quality was maintained to the distal small bowel.In each of the five segments,the visibility score was significantly higher in group B than in group A(segment 1:4.3± 0.7vs 4.7±0.5,P=0.03;segment 2:4.2±0.9vs 4.8 ±0.4,P=0.01;segment 3:4.0±1.0 vs 4.6±0.7,P =0.04;segment 4:3.6±1.1 vs 4.5±0.6,P=0.003;segment 5:2.7±1.0vs 4.4±0.8,P=0.00004).Thus,the use of PEG during CE examination significantly improved image quality

关键词：聚乙二醇胶囊内镜图像质量检查 PEG 样本大小内窥镜

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Bleeding after endoscopic submucosal dissection: Risk factors and preventive methods

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World Journal of Gastroenterology 2016年第26期22卷 5927-5935页

作者： yosuke Kataoka Yosuke Tsuji Yoshiki Sakaguchi Chihiro Minatsuki Itsuko Asada-Hirayama Keiko Niimi Satoshi Ono Shinya Kodashima Nobutake Yamamichi Mitsuhiro Fujishiro Kazuhiko Koike Department of Gastroenterology Graduate School of Medicine The University of Tokyo Center for Epidemiology and Preventive Medicine Graduate School of Medicine The University of Tokyo Department of Endoscopy and Endoscopic Surgery Graduate School of Medicine The University of Tokyo

Endoscopic submucosal dissection(ESD) has become widely accepted as a standard method of treatment for superficial gastrointestinal neoplasms because it enables en block resection even for large lesions or fibrotic lesions with minimal invasiveness, and decreases the local recurrence rate. Moreover, specimens resected in an en block fashion enable accurate histological assessment. Taking these factors into consideration, ESD seems to be more advantageous than conventional endoscopic mucosal resection(EMR), but the associated risks of perioperative adverse events are higher than in EMR. Bleeding after ESD is the most frequent among these adverse events. Although post-ESD bleeding can be controlled by endoscopic hemostasis in most cases, it may lead to serious conditions including hemorrhagic shock. Even with preventive methods including administration of acid secretion inhibitors and preventive hemostasis, post-ESD bleeding cannot be completely prevented. In addition high-risk cases for post-ESD bleeding, which include cases with the use of antithrombotic agents or which require large resection, are increasing. Although there have been many reports about associated risk factors and methods of preventing post-ESD bleeding, many issues remain unsolved. Therefore, in this review, we have overviewed risk factors and methods of preventing post-ESD bleeding from previous studies. Endoscopists should have sufficient knowledge of these risk factors and preventive methods when performing ESD.

关键词： Endoscopic submucosal dissection Risk factor Bleeding Prevention Antithrombotic agents

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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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Sessile serrated adenoma detection rate is correlated with adenoma detection rate

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World Journal of Gastrointestinal Oncology 2018年第3期10卷 82-90页

作者： Daisuke Ohki Yosuke Tsuji Tomohiro Shinozaki Yoshiki Sakaguchi Chihiro Minatsuki Hiroto Kinoshita Keiko Niimi Satoshi Ono Yoku Hayakawa Shuntaro Yoshida Atsuo Yamada Shinya Kodashima Nobutake Yamamichi Yoshihiro Hirata Tetsuo Ushiku Mitsuhiro Fujishiro Masashi Fukayama Kazuhiko Koike Department of Gastroenterology Graduate School of Medicinethe University of Tokyo Department of Biostatistics School of Public Healththe University of Tokyo Center for Epidemiology and Preventive Medicine Graduate School of Medicinethe University of Tokyo Department of Endoscopy and Endoscopic Surgery Graduate School of Medicinethe University of Tokyo Department of Pathology Graduate School of Medicine the University of Tokyo

AIM To investigated the association between adenoma detection rate(ADR) and sessile serrated ADR(SSADR) and significant predictors for sessile serrated adenomas(SSA) detection.METHODS This study is a retrospective, single-center analysis. Total colonoscopies performed by the gastroenterologists at the University of Tokyo Hospital between January and December 2014 were retrospectively identified. Polyps were classified as low-grade or high-grade adenoma, cancer, SSA, or SSA with cytological dysplasia, and the prevalence of each type of polyp was investigated. Predictors of adenoma and SSA detection were examined using logistic generalized estimating equation models. The association between ADR and SSADR for each gastroenterologist was investigated by calculating a correlation coefficient weighted by the number of each gastroenterologist's examination.RESULTS A total of 3691 colonoscopies performed by 35 gastroenterologists were assessed. Overall, 978 (26.5%) low-and 84 (2.2%) high-grade adenomas, 81 (2.2%) cancers, 66 (1.8%) SSAs, and 2 (0.1%) SSAs with cytological dysplasia were detected. Overall ADR was 29.5%(men 33.2%, women 23.8%) and overall SSADR was 1.8%(men 1.7%, women 2.1%). In addition, 672 low-grade adenomas (68.8% of all the detected lowgrade adenomas), 58 (69.9%) high-grade adenomas, 29 (34.5%) cancers, 52 (78.8%) SSAs, and 2 (100%) SSAs with cytological dysplasia were found in the proximal colon. Adenoma detection was the only significant predictor of SSA detection (adjusted OR: 2.53, 95%CI: 1.53-4.20; P < 0.001). The correlation coefficient between ADR and SSADR weighted by the number of each gastroenterologist's examinations was 0.606(P < 0.001).CONCLUSION Our results demonstrated that ADR is correlated to SSADR. In addition, patients with adenomas had a higher prevalence of SSAs than those without adenomas.

关键词： Sessile serrated adenoma Sessile serrated adenoma detection rate Adenoma detection rate Colonoscopy Interval colorectal cancer

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Comparison of endoscopic gastritis based on Kyoto classification between diffuse and intestinal gastric cancer

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World Journal of Gastrointestinal Endoscopy 2021年第5期13卷 125-136页

作者： Osamu Toyoshima Toshihiro Nishizawa Shuntaro Yoshida Tomonori Aoki Fumiko Nagura Kosuke Sakitani Yosuke Tsuji Hayato Nakagawa Hidekazu Suzuki Kazuhiko Koike 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 Graduate School of MedicineThe University of TokyoTokyo 113-8655Japan Internal Medicine Chitosefunabashi Ekimae ClinicTokyo 157-0054Japan Department of Gastroenterology Sakiatani Endoscopy ClinicNarashino 275-0026Japan Department of Gastroenterology and Hepatology Tokai University School of MedicineIsehara 259-1193Japan

BACKGROUND Gastric cancers can be categorized into diffuse-and intestinal-type cancers based on the Lauren histopathological classification.These two subtypes show distinct differences in metastasis frequency,treatment application,and prognosis.Therefore,accurately assessing the Lauren classification before treatment is crucial.However,studies on the gastritis endoscopy-based Kyoto classification have recently shown that endoscopic diagnosis has improved.AIM To investigate patient characteristics including endoscopic gastritis associated with diffuse-and intestinal-type gastric cancers in Helicobacter pylori(H.pylori)-infected patients.METHODS Patients who underwent esophagogastroduodenoscopy at the Toyoshima Endoscopy Clinic were enrolled.The Kyoto classification included atrophy,intestinal metaplasia,enlarged folds,nodularity,and diffuse redness.The effects of age,sex,and Kyoto classification score on gastric cancer according to the Lauren classification were analyzed.We developed the Lauren predictive background score based on the coefficients of a logistic regression model using variables independently associated with the Lauren classification.Area under the receiver operative characteristic curve and diagnostic accuracy of this score were examined.RESULTS A total of 499 H.pylori-infected patients(49.6%males;average age:54.9 years)were enrolled;132 patients with gastric cancer(39 diffuse-and 93 intestinal-type cancers)and 367 cancer-free controls were eligible.Gastric cancer was independently associated with age≥65 years,high atrophy score,high intestinal metaplasia score,and low nodularity score when compared to the control.Factors independently associated with intestinal-type cancer were age≥65 years(coefficient:1.98),male sex(coefficient:1.02),high intestinal metaplasia score(coefficient:0.68),and low enlarged folds score(coefficient:-1.31)when compared to diffuse-type cancer.The Lauren predictive background score was defined as the sum of+2(age≥65 years),+1(male sex),+1(endoscopic intestinal metaplasia),a

关键词： Gastric cancer Lauren classification Endoscopy Pathology Gastritis Kyoto classification

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Low-ranking female Japanese macaques make efforts for social grooming

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Current Zoology 2016年第2期62卷 99-108页

作者： yosuke KURIHARAI Primate Research Institute Kyoto University Inuyama Kanrin 41-2 Inuyama Aichi 484-8506 Japan

Grooming is essential to build social relationships in primates. Its importance is universal among animals from different ranks; however, rank-related differences in feeding patterns can lead to conflicts between feeding and grooming in low-ranking animals. Unifying the effects of dominance rank on feeding and grooming behaviors contributes to revealing the importance of grooming. Here, I tested whether the grooming behavior of low-ranking females were similar to that of high-ranking females despite differences in their feeding patterns. I followed 9 Japanese macaques adult females from the Arashiyama group, and analyzed the feeding patterns and grooming behaviors of low- and high-ranking females. Low-ranking females fed on natural foods away from the provisioning site, whereas high-ranking females obtained more provisioned food at the site. Due to these differences in feeding patterns, low-ranking females spent less time grooming than high-ranking females. However, both low- and high-ranking females performed grooming around the provisioning site, which was linked to the number of neighboring individuals for low-ranking females and feeding on provisioned foods at the site for high-ranking females. The similarity in grooming area led to a range and diversity of grooming partners that did not differ with rank. Thus, low-ranking females can obtain small amounts of provisioned foods and perform grooming with as many partners around the provisioning site as high-ranking females. These results highlight the efforts made by low-ranking females to perform grooming and suggest the importance of grooming behavior in group-living primates.

关键词：社会培训猕猴日本灵长类动物女性网站喂养方式力度雌性

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Surpassing 1,000,000 resolving points in chaotic Brillouin sensing

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先进光子学(英文) 2023年第3期5卷 25-26页

作者： yosuke Mizuno Yokohama National University YokohamaJapan

Optical fiber sensors have played a pivotal role in structural health monitoring for over half a century,owing to their inherent advantages such as lightweight design,compactness,immunity to electromagnetic interference,and their ability to enable distributed sensing.1 Within this diverse range of sensors,Brillouin scattering has emerged as a widely adopted principle for distributed measurements of strain and temperature.

关键词： scattering Brillouin chaotic

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Evaluation of preferable insertion routes for esophagogastroduodenoscopy using ultrathin endoscopes

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World Journal of Gastroenterology 2014年第17期20卷 5045-5050页

作者： Satoshi Ono Keiko Niimi Mitsuhiro Fujishiro Yu Takahashi Yoshiki Sakaguchi Chiemi Nakayama Chihiro Minatsuki Rie Matsuda Itsuko Hirayama-Asada Yosuke Tsuji Satoshi Mochizuki Shinya Kodashima Nobutake Yamamichi Atsuko Ozeki Lumine Matsumoto Yumiko Ohike Tsutomu Yamazaki Kazuhiko Koike Center for Epidemiology and Preventive Medicine Graduate School of MedicineUniversity of TokyoTokyo 113-8655Japan Department of Gastroenterology Graduate School of MedicineUniversity of TokyoTokyo 113-8655Japan Department of Endoscopy and Endoscopic Surgery Graduate School of MedicineUniversity of TokyoTokyo 113-8655Japan

AIM:To evaluate the discomfort associated with esophagogastroduodenoscopy(EGD)using an ultrathin endoscope through different insertion routes.METHODS:This study(January 2012-March 2013)included 1971 consecutive patients[male/female(M/F),1158/813,57.5±11.9 years]who visited a single institute for annual health checkups.Transnasal EGD was performed in 1394 patients and transoral EGD in 577.EGD-associated discomfort was assessed using a visual analog scale score(VAS score:0-10).RESULTS:Multivariate analysis revealed gender(M vs F:4.02±2.15 vs 5.06±2.43)as the only independent predictor of the VAS score in 180 patients who underwent EGD for the first time;whereas it revealed gender(M vs F 3.60±2.20 vs 4.84±2.37),operator,age group(A:70 years;A/B/C/D/E:4.99±2.32/4.34±2.49/4.19±2.31/3.99±2.27/3.63±2.31),and type of insertion as independent predictors in the remaining patients.Subanalysis for gender,age group,and insertion route revealed that the VAS score decreased with age regardless of gender and insertion route,was high in female patients regardless of age and insertion route,and was low in males aged over60 years who underwent transoral insertion.CONCLUSION:Although comprehensive analysis revealed that the insertion route may not be an independent predictor of the VAS score,transoral insertion may reduce EGD-associated discomfort in elderly patients.

关键词： Esophagogastroduodenoscopy Ultrathin endoscope Vis

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Usefulness of continuous suction mouthpiece during esophagogastroduodenoscopy: A single-center, prospective,randomized study

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World Journal of Gastrointestinal Endoscopy 2013年第10期5卷 508-513页

作者： Takao Maekita Jun Kato Yukihiko Nakatani Shotaro Enomoto Ema Takano Masahiro tsuji Tsuyoshi Nakaya Kosaku Moribata yosuke Muraki Naoki Shingaki Toru Niwa Hisanobu Deguchi Kazuki Ueda Izumi Inoue Mikitaka Iguchi Hideyuki Tamai Masao Ichinose Department of Gastroen-terology School of Medicine Wakayama Medical UniversityWakayama Department of Internal Medicine Nakaya HospitalWakayama

AIM: To develop a new continuous suction mouthpiece(CSM) and evaluate its usefulness for screening esophagogastroduodenoscopy(EGD).METHODS: A total of 196 patients who were scheduled to undergo screening EGD were assigned to one of two groups: a group using the CSM and a group using a conventional mouthpiece. Extent of salivary flow,frequency of saliva suction, number of choking episodesduring the examination, and incidence of aspiration pneumonia after the examination were evaluated and compared between the two groups. Adverse events during and after EGD were also examined. In addition, the oral cavity was meticulously examined after the EGD.RESULTS: The same number of patients was randomly allocated to each group. There were no significant differences between the two groups in sex, age,biopsy procedure, duration of procedure and depth of sedation. Aspiration pneumonia and other significant adverse events were not observed in either group. The grade of extent of salivary flow was significantly lower in patients with the CSM than in patients with the conventional mouthpiece(P < 0.001). Although there was no significant difference, less frequent suctioning and fewer choking episodes were observed in patients with the CSM than in patients with the conventional mouthpiece(P = 0.082 and P = 0.084, respectively). In addition, there were no patients in the CSM group who required saliva suctioning during the procedure.CONCLUSION: Use of the CSM during screening EGD can reduce the extent of salivary flow. The device is expected to reduce complications and contamination with saliva.

关键词： Mouthpiece Esophagogastroduodenoscopy Aspiration Saliva Suction

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