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Current clinical management of gastrointestinal stromal tumor

World Journal of Gastroenterology 2018年第26期24卷 2806-2817页

作者： Kazuya Akahoshi Masafumi Oya Tadashi Koga yuki shiratsuchi Department of Gastroenterology Aso Iizuka Hospital Department of Pathology Aso Iizuka Hospital Department of Surgery Aso Iizuka Hospital

Gastrointestinal stromal tumors(GISTs) are the most common malignant subepithelial lesions(SELs) of the gastrointestinal tract. They originate from the interstitial cells of Cajal located within the muscle layer and are characterized by over-expression of the tyrosine kinase receptor KIT. Pathologically, diagnosis of a GIST relies on morphology and immunohistochemistry [KIT and/or discovered on gastrointestinal stromal tumor 1(DOG1) is generally positive]. The prognosis of this disease is associated with the tumor size and mitotic index. The standard treatment of a GIST without metastasis is surgical resection. A GIST with metastasis is usually only treated by tyrosine kinase inhibitors without radical cure; thus, early diagnosis is the only way to improve its prognosis. However, a GIST is usually detected as a SEL during endoscopy, and many benign and malignant conditions may manifest as SELs. Conventional endoscopic biopsy is difficult for tumors without ulceration. Most SELs have therefore been managed without a histological diagnosis. However, a favorable prognosis of a GIST is associated with early histological diagnosis and R0 resection. Endoscopic ultrasonography(EUS) and EUS-guided fine needle aspiration(EUSFNA) are critical for an accurate diagnosis of SELs. EUSFNA is safe and effective in enabling an early histological diagnosis and adequate treatment. This review outlines the current evidence for the diagnosis and management of GISTs, with an emphasis on early management of small SELs.

关键词： Gastrointestinal stromal tumor Endoscopic ultrasonography-guided fine needle aspiration Endoscopic ultrasonography Diagnosis Therapy

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Advances in endoscopic therapy using grasping-type scissors forceps(with video)

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World Journal of Gastrointestinal Surgery 2021年第8期13卷 772-787页

作者： Kazuya Akahoshi Keishi Komori Kazuaki Akahoshi Shinichi Tamura Shigeki Osada yuki shiratsuchi Masaru Kubokawa Endoscopy Center Aso Iizuka HospitalIizuka 820-8505Japan Department of Gastroenterology Aso Iizuka HospitalIizuka 820-8505Japan

Endoscopic submucosal dissection(ESD)is a globally accepted minimally invasive therapy for early-stage gastrointestinal tract tumors.Although numerous electrosurgical knives have been developed for ESD,technical difficulties and high complication rates(bleeding and perforation)have limited their use worldwide.The grasping-type scissors forceps[clutch cutter(CC)]is the first forceps-type resection device developed with reference to hemostatic forceps.The aim was to allow easy and safe ESD throughout the gastro-intestinal tract,as a biopsy technique,using one device.The CC can grasp the target tissue accurately and pull it away from the underlying muscle layer prior to energizing the tissue,for safe and effective incision and hemostasis during ESD.Reported clinical studies showed that ESD using the CC(ESD-CC)is a safe(perforation rate:0%-3.6%;delayed bleeding rate:0%-4.2%),technically efficient(en-bloc resection rate:88.9%-100%),and single-device method for dissecting early-stage gastrointestinal tract tumors.The ESD-CC technique is simple and easy to learn because it can be completed simply by repeating the grasp,pull,and coagulate and/or incise actions using an electrosurgical current.The reported self-completion rate by nonexperts was significantly better with the CC than with conventional knives(61.7%vs 24.5%,respectively;P<0.001).Furthermore,the CC is used for other endoscopic therapies,such as endoscopic polypectomy for large pedunculated polyps,endoscopic myotomy for Zenker’s diverticulum,endoscopic treatment of buried bumper syndrome,and endoscopic necrosectomy for wall-off pancreatic necrosis.The initial reports using CC for these therapies have shown favorable results.In this review,we describe the structural features of the CC,how to use the instrument,efficacies of ESD-CC,and other unique endoscopic therapies using the CC.

关键词： Grasping-type scissors forceps Clutch cutter Endoscopic submucosal dissection Endoscopic polypectomy Zenker’s diverticulum Buried bumper syndrome

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Clinical outcomes of Clutch Cutter endoscopic submucosal dissection for older patients with early gastric cancer

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World Journal of Gastrointestinal Oncology 2017年第10期9卷 416-422页

作者： Yoshihiro Otsuka Kazuya Akahoshi Kayoko Yasunaga Masaru Kubokawa Junya Gibo Shigeki Osada Kayo Tokumaru Kazuaki Miyamoto Takao Sato yuki shiratsuchi Masafumi Oya Hidenobu Koga Eikichi Ihara Kazuhiko Nakamura Department of Gastroenterology Aso Iizuka Hospital Diagnosis Procedure Combination Coding Management Office Aso Iizuka Hospital Department of Pathology Aso Iizuka Hospital Clinical Research Supportive Office Aso Iizuka Hospital Department of Medicine and Bioregulatory Science Graduate School of Medical SciencesKyushu University

AIM To evaluate the clinical outcome of endoscopic submucosal dissection using the Clutch Cutter(ESDCC) in older patients. METHODS We reviewed 232 consecutive patients with early gastric cancer who underwent ESDCC between June 2010 and February 2014 at Aso Iizuka Hospital. We divided patients into two groups according to age: Older patients(> 80 years, n = 64) and non-older patients(≤ 80 years, n = 168). We retrospectively compared the prevalence rates of pre-existing comorbidities, anticoagulant therapy, en bloc resection, mean duration of hospitalization, incidence of ESDCC-related complications, change in performance status(PS) before and after ESDCC, and financial cost of admission. RESULTS The older group comprised 64 patients with a mean age of 84.1 years, and the non-older group comprised 168 patients with a mean age of 69.5 years. Older patients had significantly more pre-existing comorbidities than did non-older patients, specifically heart disease(P < 0.05). The en bloc resection rate in non-older patients was significantly higher than that in older patients(100% vs 95.3%, P = 0.02). There were no significant differences between the older and non-older groups in the incidence of ESDCC-related complications(i.e., postoperative bleeding and perforation) and the post-ESDCC change in PS. There were also no significant differences between the older and non-older groups in the mean duration of hospitalization(11.4 and 10.7 d, respectively) and financial cost of admission(657040 JPY and 574890 JPY, respectively).CONCLUSION ESDCC has a good clinical outcome in older patients.

关键词： Older patients Clutch Cutter Endoscopic submucosal dissection Early gastric cancer Financial cost Duration of hospitalization

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Endoscopic submucosal dissection of gastric adenomas using the clutch cutter

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World Journal of Gastrointestinal Endoscopy 2017年第7期9卷 334-340页

作者： Kazuya Akahoshi Masaru Kubokawa Junya Gibo Shigeki Osada Kayo Tokumaru Eriko Yamaguchi Hiroko Ikeda Takao Sato Kazuaki Miyamoto Yusuke Kimura yuki shiratsuchi Kazuaki Akahoshi Masafumi Oya Hidenobu Koga Eikichi Ihara Kazuhiko Nakamura Department of Gastroenterology Aso Iizuka Hospital Department of Pathology Aso Iizuka Hospital Clinical Research Support Office Aso Iizuka Hospital Department of Medicine and Bioregulatory Science Graduate School of Medical SciencesKyushu University

AIM To evaluate the efficacy and safety of endoscopic submucosal dissection(ESD) using the clutch cutter(CC)(ESD-CC) for gastric adenoma(GA).METHODS From June 2007 to August 2015,122 consecutive patients with histological diagnoses of GA from specimens resected by ESD-CC were enrolled in this prospective study.The CC was used for all ESD steps(marking,mucosal incision,submucosal dissection,and hemostatic treatment),and itstherapeutic efficacy and safety were assessed.RESULTS Both the en-bloc resection rate and the R0 resection rate were 100%(122/122).The mean surgical time was 77.4 min,but the time varied significantly according to tumor size and location.No patients suffered perforation.Post-ESD-CC bleeding occurred in six cases(4.9%) that were successfully resolved by endoscopic hemostatic treatment.CONCLUSION ESD-CC is a technically efficient,safe,and easy method for resecting GA.

关键词：内视镜的 submucosal 解剖离合器切割器胃的腺瘤

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