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World Journal of Gastroenterology 2018年第2期24卷 211-215页

作者： hirohito mori Hideki Kobara Noriko Nishiyama Tsutomu Masaki Departments of Gastroenterology and Neurology Kagawa University

AIM To evaluate appropriate and rapid polyglycolic acid sheet(PGAs) covering time using device delivery station system(DDSS).METHODS This pilot basic study was conducted to evaluate the potential of accurate and rapid PGAs delivery using DDSS. Three 11-month-old female Beagle dogs were used in this study. Two endoscopic submucosal dissections(ESDs) 4 cm in diameter were performed in lesser curvature of middle gastric body and greater curvature of antrum(total 6 ESDs performed). DDSS(3 cm length, 12 mm in outer diameter) has 2 chambers which 16 cm^2 large 2 PGAs were stored, and DDSS was attached post ESD ulcers, respectively. Beriplast P?(CSL Behring K.K., Tokyo, Japan)(combination of fibringlue and thrombin) was applied equally to the artificial ulcer, and tight attachment of 2 PGAs with DDSS were completed. The evaluation items were covering times, post ESD bleeding and perforation during *** The covering time of PGAs(defined as the duration from the beginning of endoscope insertion into the mouth to the end of the fibrin glue coating process) was 6.07(4.86-8.29) min. There was no postESD bleeding(1-7 d after ESD), and there was no perforation during *** DDSS was very useful for rapid delivering and tight attachment of PGAs, and has potentials of multipurpose delivery station system.

关键词： Post-endoscopic submucosal dissection ulcers Bleeding Polyglycolic acid sheet Rapidly delivery Tightly attachment

Difficulty in differentiating two cases of sigmoid stenosis by diverticulitis from cancer

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World Journal of Gastroenterology 2012年第27期18卷 3623-3626页

作者： Noriko Nishiyama hirohito mori Hideki Kobara Kazi Rafiq Shintarou Fujihara Mitsuyoshi Kobayashi Tsutomu Masaki Department of Gastroenterology and Neurology Faculty of MedicineKagawa UniversityKagawa 761-0793Japan Department of Pharmacology Faculty of MedicineKagawa UniversityKagawa 761-0793Japan

The incidence of colonic diverticulosis with or without diverticulitis has increased in the Japanese population due to the modernization of food and *** rate of diverticulitis in colon diverticulosis ranges from 8.1% to 9.6%.However,few cases of stenosis due to diverticulitis have been *** reports suggest that the differentiation between sigmoid diverticulitis and colon cancer is *** report describes two cases of colon stenosis due to diverticulitis that were difficult to differentiate from colon *** 1 was a 70-year-old woman with narrowed stools for 1 month who underwent colonofiberscopy (CFS).CFS revealed a diverticulum and circumferential stenosis in the sigmoid *** enema revealed a marked,hourglassshaped,2-cm circumferential stenosis in the sigmoid *** (FDG)-positron emission tomography computed tomography (CT) revealed an increased FDG uptake at the affected portion of the sigmoid *** colon cancer was suspected,and laparoscopic sigmoidectomy was *** examination demonstrated active inflammation with no evidence of *** 2 was a 50-yearold man who presented to a nearby clinic with reduced stool output despite the urge to *** detected severe stenosis in the sigmoid colon approximately 25 cm from the dentate ***-enhanced abdominal CT revealed multiple diverticula,wall thickening,and swelling of the lymph nodes around the peritoneal aorta and the inferior mesenteric artery.A partial sigmoidectomy was *** examination of the resected specimen revealed no changes in the mucosal epithelial surface,but a marked infiltration of inflammatory cells was observed.

关键词：结肠癌狭窄正电子发射断层扫描计算机断层扫描癌症食物安全病理检查脱氧葡萄糖

Bleeding duodenal hemangioma: Morphological changes and endoscopic mucosal resection

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World Journal of Gastroenterology 2012年第22期18卷 2872-2876页

作者： Noriko Nishiyama hirohito mori Hideki Kobara Shintarou Fujihara Takako Nomura Mitsuyoshi Kobayashi Tsutomu Masaki Department of Gastroenterology and Neurology Faculty of Medicine Kagawa Medical University

Recently, the development of endoscopic procedures has increased the availability of minimally invasive treatments; however, there have been few case reports of duodenal hemangioma treated by endoscopic mucosal resection. The present report describes a case of duodenal hemangioma that showed various endoscopic changes over time and was treated by endoscopic mucosal resection. An 80-year-old woman presented with tarry stools and a loss of appetite. An examination of her blood revealed severe anemia, and her hemoglobin level was 4.2 g/dL. An emergency upper gastrointestinal endoscopy was performed. A red, protrusive, semipedunculated tumor (approximately 20 mm in diameter) with spontaneous bleeding on its surface was found in the superior duodenal angle. Given the semipedunculated appearance of the tumor, it was suspected to be an epithelial tumor with a differential diagnosis of hyperplastic polyp. The biopsy results suggested a telangiectatic hemangioma. Because this lesion was considered to be responsible for her anemia, endoscopic mucosal resection was performed for diagnostic and treatment purposes after informed consent was obtained. A histopathological examination of the resected specimen revealed dilated and proliferated capillary lumens of various sizes, which confirmed the final diagnosis of duodenal hemangioma. Neither anemia nor tumor recurrence has been observed since the endoscopic mucosal resection (approximately 1 year). Duodenal hemangiomas can be treated endoscopically provided that sufficient consideration is given to all of the possible treatment strategies. Interestingly, duodenal hemangiomas show morphological changes that are influenced by various factors, such as mechanical stimuli.

关键词：毛细血管扩张十二指肠形态学变化切除术内镜黏膜出血鉴别诊断

Oval mucosal opening bloc biopsy after incision and widening by ring thread traction for submucosal tumor

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World Journal of Gastroenterology 2017年第39期23卷 7185-7190页

作者： hirohito mori Hideki Kobara Yu Guan Yasuhiro Goda Nobuya Kobayashi Noriko Nishiyama Tsutomu Masaki Department of Gastroenterology and Neurology Kagawa University Departments of Pharmacology Kagawa University

Gastric submucosal tumors(SMTs) less than 2 cm are generally considered benign neoplasms, and endoscopic observation is recommended, but SMTs over 2 cm, 40% of which are gastrointestinal stromal tumors(GISTs), have malignant potential. Although the Japanese Guidelines for GIST recommend partial surgical resection for GIST over 2 cm with malignant potential as well as en bloc large tissue sample to obtain appropriate and large specimens of SMTs, several reports have been published on tissue sampling of SMTs, such as with endoscopic ultrasound sound fine needle aspiration, submucosal tunneling bloc biopsy, and the combination of bite biopsy and endoscopic mucosal resection. Because a simpler, more accurate method is needed for appropriate treatment, we developed oval mucosal opening bloc biopsy after incision and widening by ring thread traction for submucosal tumor(OMOB) approach. OMOB was simple and enabled us to obtain large samples under direct procedure view as well as allowed us to restore to original mucosa.

关键词：胃的 submucosal 肿瘤胃肠的 stromal 肿瘤可逆开始活体检视内视镜的 ultrasonography 大样品

Case of pediatric traditional serrated adenoma resected via endoscopic submucosal dissection

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World Journal of Gastroenterology 2017年第24期23卷 4462-4466页

作者： Sonoko Kondo hirohito mori Noriko Nishiyama Takeo Kondo Ryuichi Shimono Hitoshi Okada Takashi Kusaka Department of Pediatrics Faculty of MedicineKagawa University Department of Gastroenterology and Neurology Faculty of MedicineKagawa University Department of Pediatric Surgery Faculty of MedicineKagawa University

Traditional serrated adenoma(TSA)is a type of serrated polyp of the colorectum and is thought to be a precancerous *** are three types of serrated polyps,namely,hyperplastic polyps,sessile serrated adenomas/polyps,and *** is the least common of the three types and accounts for about 5% of serrated *** we report a pediatric case of TSA that was successfully resected by endoscopic submucosal dissection(ESD).This rare case report describes a pediatric patient with no family history of colonic polyp who was admitted to our hospital with *** colonoscopy,we found a polypoid lesion measuring 10 mm in diameter in the lower *** selected ESD as a surgical option for en bloc resection,and histopathological examination revealed *** findings in this case suggest that TSA with precancerous potential can occur in children,and that ESD is useful for treating this lesion.

关键词：小儿科的结肠的息肉 Hematochezia Colorectal serrated 损害传统的 serrated 腺瘤内视镜的 mucosal 切除术内视镜的 submucosal 解剖

Rectal perforations and fistulae secondary to a glycerin enema:Closure by over-the-scope-clip

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World Journal of Gastroenterology 2012年第24期18卷 3177-3180页

作者： hirohito mori Hideki Kobara Shintaro Fujihara Noriko Nishiyama Mitsuyoshi Kobayashi Tsutomu Masaki Kunihiko Izuishi Yasuyuki Suzuki Department of Gastroenterology and Neurology Kagawa Medical University School of MedicineKagawa 761-0793Japan Department of Gastroenterological Surgery Kagawa Medical University School of MedicineKagawa 761-0793Japan

Rectal perforations due to glycerin enemas(GE) typically occur when the patient is in a seated or lordotic standing *** the perforation occurs and peritonitis results,death is usually *** describe two cases of rectal perforation and fistula caused by a *** 88-year-old woman presented with a large rectal perforation and a fistula just after receiving a *** case was further complicated by an abscess in the right rectal *** second patient was a 78-year-old woman who suffered from a rectovesical fistula after a *** both cases,we performed direct endoscopic abscess lavage with a saline solution and closed the fistula using an over-the-scope-clip(OTSC) *** procedures resulted in dramatic improvement in both *** endoscopic lavage and OTSC closure are very useful for pararectal abscess lavage and fistula closure,respectively,in elderly patients who are in poor general *** two cases are the first reports of the successful endoscopic closure of fistulae using double OTSCs after endoscopic lavage of the debris and an abscess of the rectum secondary to a GE.

关键词：直肠穿孔封闭剪辑灌肠甘油继发盐水溶液

Outcomes of gastrointestinal defect closure with an overthe-scope clip system in a multicenter experience: An analysis of a successful suction method

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World Journal of Gastroenterology 2017年第9期23卷 1645-1656页

作者： Hideki Kobara hirohito mori Shintaro Fujihara Noriko Nishiyama Taiga Chiyo Takayoshi Yamada Masao Fujiwara Keiichi Okano Yasuyuki Suzuki Masayuki Murota Yoshitaka Ikeda Makoto Oryu Mohamed Abo Ellail Tsutomu Masaki Department of Gastroenterology and Neurology Faculty of MedicineKagawa University Department of Gastroenterology Kochi Health Sciences Center Department of Gastroenterological Surgery Faculty of MedicineKagawa University Department of Gastroenterology Sakaide City Hospital Department of Surgery Ehime Rosai Hospital Department of Gastroenterology Kagawa Saiseikai Hospital Department of Gynecology Faculty of MedicineKagawa University

AIM To demonstrate the clinical outcomes of a multicenter experience and to suggest guidelines for choosing a suction method. METHODS This retrospective study at 5 medical centers involved 58 consecutive patients undergoing over-the-scope clips(OTSCs) placement. The overall rates of technical success (TSR), clinical success (CSR), complications, and procedure time were analyzed as major outcomes. Subsequently, 56 patients, excluding two cases that used the Anchor device, were divided into two groups: 14 cases of simple suction (SS-group) and 42 cases using the Twin Grasper (TG-group). Secondary evaluation was performed to clarify the predictors of OTSC *** The TSR, CSR, complication rate, and median procedure time were 89.7%, 84.5%, 1.8%, and 8 (range 1-36) min, respectively, demonstrating good outcomes. However, significant differences were observed between the two groups in terms of the mean procedure time (5.9 min vs 14.1 min). The CSR of the SS- and TG-groups among cases with a maximum defect size ≤ 10 mm and immediate or acute refractory bleeding was 100%, which suggests that SS is a better method than TG in terms of time efficacy. The CSR in the SS-group (78.6%), despite the technical success of the SS method (TSR, 100%), tended to decrease due to delayed leakage compared to that in the TG-group (TSR, CSR; 88.1%), indicating that TG may be desirable for leaks and fistulae with defects of the entire layer. CONCLUSION OTSC system is a safe and effective therapeutic option for gastrointestinal defects. Individualized selection of the suction method based on particular clinical conditions may contribute to the improvement of OTSC success.

关键词： Over-the-scope 片断漏胃肠的倔强的流血管内视镜的闭合

A case of plasmablastic lymphoma of the liver without human immunodeficiency virus infection

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World Journal of Gastroenterology 2013年第37期19卷 6299-6303页

作者： Joji Tani Hisaaki Miyoshi Takako Nomura hirohito Yoneyama Hideki Kobara hirohito mori Asahiro morishita Takashi Himoto Tsutomu Masaki Department of Gastroenterology and Neurology Kagawa University Faculty of Medicine Department of Integrated Medicine Kagawa University Faculty of Medicine

Plasmablastic lymphoma(PBL)is a very rare B-cell lymphoproliferative disorder was with an aggressive clinical behavior that recently characterized by the World Health *** PBL is most commonly observed in the oral cavity of human immunodeficiency virus(HIV)-positive patients,it can also be observed at extra-oral sites in HIV-negative ***-Barr virus(EBV)may be closely related the pathogenesis of *** shows different clinicopathological characteristics between HIV-positive and-negative ***,we report a case of PBL of the liver in a 79-yearold HIV-negative *** patient died approximately1.5 mo after examination and autopsy showed that the main lesion was a very large liver *** examination of the excised lesion showed large-cell lymphoma with plasmacytic differentiation diffusely infiltrating the liver and involving the surrounding *** neoplastic cells were diffusely positive for CD30,EBV,Bob-1,and *** autopsy findings suggested a diagnosis of *** our knowledge,the present case appears to be the first report of PBL with initial presentation of the liver in a patient without HIV infection.

关键词： Plasmablastic lymphoma Human immunodeficiency virus-negative Normal liver Pathogenesis Immunohistochemistry

Accurate hemostasis with a new endoscopic overtube for emergency endoscopy

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World Journal of Gastroenterology 2013年第17期19卷 2723-2726页

作者： hirohito mori Hideki Kobara Shintaro Fujihara Noriko Nishiyama Makoto Oryu Kazi Rafiq Tsutomu Masaki Departments of Gastroenterology and Neurology Kagawa Medical University School of Medicine Departments of Pharmacology Kagawa Medical University School of Medicine

Endoscopic hemostasis performed in the emergency room is difficult due to the presence of blood clots and food residue that makes obtaining a clear view of the bleeding vessel difficult. We experienced the efficacy of a newly developed inverted overtube to shorten the hemostatic time and obtain a clear endoscopic view with upper gastrointestinal bleeding patient who were transferred by ambulance car and required emergency endoscopy. The technique improved the endoscopic views and enabled us to perform the hemostatic procedures from the conventional standing position while freely and easily changing the patient's position. The presence of blood clots and food residue in the gastric fornix or upper gastric body makes identifying a bleeding exposed vessel impossible. This set-up significantly shortened the procedure time. The inverted overtube helped us obtain a clear view in patients who were laid in the right lateral position. Rapid identification of ex-posed vessels resulted in success of hemostasis.

关键词： Emergency endoscopic hemostasis Right lateral decubitus position Identification of exposed vessel Newly developed inverted overtube Clear endoscopic view

Cytomegalovirus-associated gastric ulcer:A side effect of steroid injections for pyloric stenosis

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World Journal of Gastroenterology 2013年第7期19卷 1143-1146页

作者： hirohito mori Shintaro Fujihara Noriko Nishiyama Hideki Kobara Makoto Oryu Kiyohito Kato Kazi Rafiq Tsutomu Masaki Departments of Gastroenterology and Neurology Kagawa Medical University School of MedicineKagawa 761-0793Japan Departments of Pharmacology Kagawa Medical University School of MedicineKagawa 761-0793Japan

The local injection of triamcinolone acetonide(TA) is effective in preventing pyloric stenosis and deformity following large endoscopic submucosal dissection(ESD).However,because of its long-acting nature,TA can induce long-term local immunosuppression and subsequent adverse *** report a case of a cytomegalovirus(CMV) ulcer that formed only at the TA local injection site.A 68-year-old man underwent ESD to treat early gastric cancer that formed over the *** lesion extended to the duodenum,and an artificial ulcer covered more than two-thirds of the circumference of the *** prevent pyloric stenosis,TA was locally injected into the ulcer *** day 12,a deeper ulcer 10 mm in diameter was discovered in the center of the post-ESD *** revealed large cells with intranuclear inclusion bodies,which stained positive for the anti-CMV *** TA injections are useful,however,CMV ulcer might occur as adverse events.

关键词： Pyloric stenosis Local triamcinolone acetonide injection Local immunosuppression Cytomegalovirus-associated ulcer Adverse events