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Management and associated factors of delayed perforation after gastric endoscopic submucosal dissection

World Journal of Gastroenterology 2015年第44期21卷 12635-12643页

作者： Haruhisa Suzuki ichiro oda Masau Sekiguchi Seiichiro Abe Satoru Nonaka Shigetaka Yoshinaga Takeshi Nakajima Yutaka Saito Endoscopy Division National Cancer Center Hospital

AIM: To identify the actual clinical management and associated factors of delayed perforation after gastric endoscopic submucosal dissection(ESD).METHODS: A total of 4943 early gastric cancer(EGC) patients underwent ESD at our hospital between January 1999 and June 2012. We retrospectively assessed the actual management of delayed perforation. In addition, to determine the factors associated with delayed perforation, after excluding 123 EGC patients with perforations that occurred during the ESD procedure, we analyzed the following clinicopathological factors among the remaining 4820 EGC patients by comparing the ESD cases with delayed perforation and the ESD cases without perforation: age, sex, chronological periods, clinical indications for ESD, status of the stomach, location, gastric circumference, tumor size, invasion depth, presence/absence of ulceration, histological type, type of resection, and procedure ***: Delayed perforation occurred in 7(0.1%) cases. The median time until the occurrence of delayed perforation was 11 h(range, 6-172 h). Three(43%) of the 7 cases required emergency surgery, while four were conservatively managed without surgical intervention. Among the 4 cases with conservative management, 2 were successfully managed endoscopically using the endoloop-endoclip technique. The median hospital stay was 18 d(range, 15-45 d). There were no delayed perforation-related deaths. Based on a multivariate analysis, gastric tube cases(OR = 11.0; 95%CI: 1.7-73.3; P = 0.013) were significantly associated with delayed ***: Endoscopists must be aware of not only the identified factors associated with delayed perforation, but also how to treat this complicationeffectively and promptly.

关键词： Early gastric cancer Endoscopic submucosal dissect

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Dehiscence following successful endoscopic closure of gastric perforation during endoscopic submucosal dissection

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World Journal of Gastroenterology 2012年第31期18卷 4224-4227页

作者： Masau Sekiguchi Haruhisa Suzuki ichiro oda Shigetaka Yoshinaga Satoru Nonaka Makoto Saka Hitoshi Katai Hirokazu Taniguchi Ryoji Kushima Yutaka Saito Endoscopy Division National Cancer Center HospitalTokyo 104-0045Japan Gastric Surgery Division National Cancer Center HospitalTokyo 104-0045Japan Pathology Division National Cancer Center HospitalTokyo 104-0045Japan

Gastric perforation is one of the most serious complications that can occur during endoscopic submucosal dissection(ESD).In terms of the treatment of such perforations,we previously reported that perforations immediately observed and successfully closed with endoclips during endoscopic resection could be managed *** now report the first case in our medical facility of a gastric perforation during ESD that was ineffectively treated conservatively even after successful endoscopic *** December 2006,we performed ESD on a recurrent early gastric cancer in an 81-year-old man with a medical history of laparotomy for cholelithiasis.A perforation occurred during ESD that was immediately observed and successfully closed with endoclips so that ESD could be continued resulting in an en-bloc *** conservative management was conducted following ESD,however,an endoscopic examination five days after ESD revealed dehiscence of the perforation requiring an emergency laparotomy.

关键词： Early gastric cancer Endoscopic closure Endoscopic submucosal dissection Gastric perforation Laparotomy

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Small undifferentiated intramucosal gastric cancer with lymph-node metastasis:Case report

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World Journal of Gastroenterology 2013年第20期19卷 3157-3160页

作者： Tomoyuki odagaki Haruhisa Suzuki ichiro oda Shigetaka Yoshinaga Satoru Nonaka Hitoshi Katai Hirokazu Taniguchi Ryoji Kushima Yutaka Saito Endoscopy Division National Cancer Center HospitalTokyo 104-0045Japan Gastric Surgery Division National Cancer Center HospitalTokyo 104-0045Japan Pathology Division National Cancer Center HospitalTokyo 104-0045Japan

It has been reported recently that small undifferentiated intramucosal early gastric cancer(EGC) < 20 mm in size without any lymphovascular involvement or ulcerative findings had virtually no risk of lymph-node(LN) ***,the indications for endoscopic resection were expanded to include such undifferentiated EGC *** describe herein a case of a small undifferentiated intramucosal EGC < 20 mm in size without lymphovascular involvement or ulcerative findings that involved lymph-node metastasis.A 57-year-old female underwent pylorus preserving gastrectomy as standard treatment for an undifferentiated EGC 15 mm in size without any ulcerative *** surgical specimen revealed a signet-ring cell carcinoma with a moderately to poorly differentiated adenocarcinoma limited to the mucosa that was 15 mm in size with no lymphovascular involvement or ulcerative *** case involved LN metastasis,however,and the lesion was diagnosed as pathological stage ⅡA(T1N2M0) according to the Japanese Classification of Gastric Carcinoma.

关键词： Early gastric cancer Endoscopic submucosal dissection Expanded indications Lymph-node metastasis Undifferentiated type

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Bone metastasis from early gastric cancer following non-curative endoscopic submucosal dissection

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World Journal of Gastroenterology 2013年第30期19卷 5016-5020页

作者： Hiroyuki Kawabata ichiro oda Haruhisa Suzuki Satoru Nonaka Shigetaka Yoshinaga Hitoshi Katai Hirokazu Taniguchi Ryoji Kushima Yutaka Saito Endoscopy Division National Cancer Center Hospital Department of Internal Medicine Saiseikai Matsusaka General Hospital Gastric Surgery Division National Cancer Center Hospital Pathology Division National Cancer Center Hospital

A 67-year-old male underwent endoscopic submucosal dissection(ESD)to treat early gastric cancer(EGC)in *** lesion(50 mm × 25 mm diameter)was histologically diagnosed as poorly differentiated adenocarcinoma,with an ulcer *** the tumor was confined to the mucosa with no evidence of lymphovascular involvement,the ESD was regarded as a noncurative resection due to the histological type,tumor size,and existence of an ulcer finding(as indicated by the 2010 Japanese gastric cancer treatment guidelines,ver.3).Despite strong recommendation for subsequent gastrectomy,the patient refused *** alternative follow-up routine was designed,which included five years of biannual clinical examinations to detect and measure serum tumor markers and perform visual assessment of recurrence by endoscopy and computed tomography scan after which the examinations were performed *** patient's condition remained stable for eight years,until a complaint of back pain in 2010 prompted further clinical *** scintigraphy indicated increased *** examination of biopsy specimens taken from the lumbar spine revealed adenocarcinoma resembling the carcinoma cells from the EGC that had been treated previously by ESD,and which was consistent with immunohistochemical findings of gastrointestinal tract ***,the diagnosis of bone metastasis from EGC was *** reported rates of EGC recurrence in surgically resected cases range 1.4%-3.4%,but among these bone metastasis is very *** our knowledge,this is the first reported case of bone metastasis from EGC following a non-curative ESD and occurring after an eight-year disease-free interval.

关键词： Endoscopic submucosal dissection Early gastric cancer Non-curative resection Bone metastasis Late recurrence

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Can endoscopic atrophy predict histological atrophy? Historical study in United Kingdom and Japan

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World Journal of Gastroenterology 2015年第46期21卷 13113-13123页

作者： Shin Kono Takuji Gotoda Shigeaki Yoshida ichiro oda Hitoshi Kondo Luigi Gatta Greg Naylor Michael Dixon Fuminori Moriyasu Anthony Axon Department of Gastroenterology and Hepatology Tokyo Medical University Aomori Prefectural Central Hospital Endoscopy Division National Cancer Center Hospital Center for Digestive Diseases Tonan Hospital Gastroenterology and Digestive Endoscopy Unit Versilia Hospital Chesterfield Royal Hospital Academic Unit of Pathology University of Leeds Centre for Digestive Disease Leeds General Infirmary

AIM: To assess the diagnostic concordance between endoscopic and histological atrophy in the United Kingdom and ***: Using published data,a total of 252 patients,126 in the United Kingdom and 126 in Japan,aged 20 to 80 years,were evaluated. The extent of endoscopic atrophy was classified into five subgroups according to a modified Kimura-Takemoto classification system and was compared with histological findings of atrophy at five biopsy sites according to the updated Sydney ***: The strength of agreement of the extent of atrophy between histology and visual endoscopic inspection showed good reproducibili ty,wi th a weighted kappa value of 0.76(P < 0.001). Multivariate analysis showed that three factors were associated with decreased concordance: Japanese ethnicity [odds ratio(OR) 0.22,95% confidence interval(CI) 0.11-0.43],older age(OR = 0.32,95%CI: 0.16-0.66) and endoscopic atrophy(OR = 0.10,95%CI: 0.03-0.36). The strength of agreement between endoscopic and histological atrophy,assessed by cancer risk-oriented grading,was reproducible,with a kappa value of 0.81(95%CI: 0.75-0.87). Only nine patients(3.6%) were endoscopically underdiagnosed with antral predominant rather than extensive atrophy and were considered false ***: Endoscopic grading can predict histological atrophy with few false negatives,indicating that precancerous conditions can be identified during screening endoscopy,particularly in patients in western countries.

关键词： Gastritis Atrophy Histology Endoscopy Diagnosis

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Fatal submucosal invasive gastric adenosquamous carcinoma detected at surveillance after gastric endoscopic submucosal dissection

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World Journal of Gastroenterology 2015年第14期21卷 4385-4390页

作者： Akinori Shirahige Haruhisa Suzuki ichiro oda Masau Sekiguchi Genki Mori Seiichiro Abe Satoru Nonaka Shigetaka Yoshinaga Shigeki Sekine Ryoji Kushima Yutaka Saito Takeo Fukagawa Hitoshi Katai Endoscopy Division National Cancer Center Hospital Pathology Division National Cancer Center Hospital Department of Clinical Laboratory Medicine and Diagnostic Pathology Shiga University of Medical Science Gastric Surgery Division National Cancer Center Hospital

An 80-year-old man was under annual surveillance esophagogastroduodenoscopy after endoscopic submucosal dissection(ESD) for early gastric cancer(EGC).Two years after the initial ESD, a 0-Ⅱc type metachronous EGC lesion, 8 mm in size, without an ulcer scar, was found in the gastric *** estimated tumor depth was up to the mucosa, and biopsy revealed well and poorly differentiated *** was performed for this lesion and en bloc resection with negative margins was *** examination revealed an adenosquamous carcinoma 8 mm in size invading the deep submucosal layer(1600 μm), with lymphovascular invasion, consistent with the diagnosis of non-curative *** gastrectomy was recommended for this patient; however, two months after the ESD, preoperative computed tomography revealed multiple liver metastases, and the patient was considered as an unsuitable candidate for surgical *** chemotherapy was therefore started; however, the patient died of gastric cancer 27 mo after the second *** gastric adenosquamous carcinoma localized to the mucosa and submucosa is extremely rare and its clinical behavior is not well *** present report is very significant in that it underscores the distinct possibility of gastric adenosquamous carcinoma being very aggressive and fatal even when detected at an early cancer.

关键词： Early gastric cancer Endoscopic submucosal dissect

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Endoscopic ultrasound using ultrasound probes for the diagnosis of early esophageal and gastric cancers

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World Journal of Gastrointestinal Endoscopy 2012年第6期4卷 218-226页

作者： Shigetaka Yoshinaga ichiro oda Satoru Nonaka Ryoji Kushima Yutaka Saito Endoscopy Division National Cancer Center Hospital5-1-1 TsukijiChuo-kuTokyo 104-0045Japan Pathology Division National Cancer Center Hospital5-1-1 TsukijiChuo-kuTokyo 104-0045Japan

Endoscopic ultrasound (EUS) devices were first designed and manufactured more than 30 years ago, and since then investigators have reported EUS is effective for determining both the staging and the depth of invasion of esophageal and gastric cancers. We review the present status, the methods, and the findings of EUS when used to diagnose and stage early esophageal and gastric cancer. EUS using high-frequency ultrasound probes is more accurate than conventional EUS for the evaluation of the depth of invasion of superficial esophageal carcinoma. The rates of accurate evaluation of the depth of invasion by EUS using high-frequency ultrasound probes were 70%-88% for intramucosal cancer, and 83%-94% for submucosal invasive cancer. But the sensitivity of EUS using high-frequency ultrasound probes for the diagnosis of submucosal invasive cancer was relatively low, making it difficult to confirm minute submucosal invasion. The accuracy of EUS using high-frequency ultrasound probes for early gastric tumor classification can be up to 80% compared with 63% for conventional EUS, although the accuracy of EUS using high-frequency ultrasound probes relatively decreases for those patients with depressed-type lesions, undifferentiated cancer, concomitant ulceration, expanded indications, type 0-I?lesions, and lesions located in the upper-third of the stomach. A 92% overall accuracy rate was achieved when both the endoscopic appearance and the findings from EUS using high-frequency ultrasound probes were considered together for tumor classification. Although EUS using high-frequency ultrasound probes has limitations, it has a high depth of invasion accuracy and is a useful procedure to distinguish lesions in the esophagus and stomach that are indicated for endoscopic resection.

关键词： Endoscopic ultrasound High-frequency ultrasound probe Esophageal cancer Gastric cancer Depth diagnosis

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Evaluation of the margins of differentiated early gastric cancer by using conventional endoscopy

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World Journal of Gastrointestinal Endoscopy 2015年第6期7卷 659-664页

作者： Shigetaka Yoshinaga ichiro oda Seiichiro Abe Satoru Nonaka Haruhisa Suzuki Hajime Takisawa Hirokazu Taniguchi Yutaka Saito Endoscopy Division National Cancer Center Hospital Pathology Division National Cancer Center Hospital

AIM: To evaluate the determination of the margin of differentiated-type early gastric cancers by using conventional ***: We retrospectively evaluated 364 differentiated early gastric cancers that were endoscopically resected as en-bloc specimens and diagnosed pathologically in detail between November 2007 and October 2008. All procedures were done with conventional endoscopes and all endoscopic samples, before and after indigo carmine dye, were re-evaluated using a digital filing system by one endoscopist. We analyzed the incidence of lesions with unclear margins and the relationship between unclear margins and relevant clinicopathological findings. RESULTS: The rate of lesions with unclear margins was 20.6%(75/364). Multivariate regression analysis suggested that the factors that make the determination of the margin difficult were normal color, presence of components of flat area(0-IIb), a diameter ≥ 21 mm, ulceration, and components of poorly differentiated adenocarcinoma in the mucosal ***: As many as 20% of differentiated early gastric cancers show unclear margins. Consideration of the factors associated with unclear margins may help endoscopists to accurately determine the margins of the lesion.

关键词： Early gastric cancer Conventional endoscopy Determination of the margin

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Rational double points on Enriques surfaces

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Science China Mathematics 2021年第4期64卷 665-690页

作者： ichiro Shimada Department of Mathematics Graduate School of ScienceHiroshima UniversityHigashi-Hiroshima 739-8526Japan

We classify,up to some lattice-theoretic equivalence,all possible configurations of rational double points that can appear on a surface whose minimal resolution is a complex Enriques surface.

关键词： Enriques surface rational double points hyperbolic lattice

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Dual ultracontractivity and its applications

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Frontiers of Mathematics in China 2014年第4期9卷 899-928页

作者： ichiro SHIGEKAWA Department of Mathematics Kyoto University Kyoto 606-8502 Japan

The ultracontractivity is well studied and several equivalent conditions are known. In this paper, we introduce the dual notion of the ultracontractivity, which we call the dual ultracontractivity. We give necessary and sufficient conditions for the dual ultracontractivity. As an application, we discuss one-dimensional diffusion processes. We can write the conditions for the dual ultracontractivity in terms of speed measures.

关键词： Dual ultracontractivity one-dimensional diffusion processes Nashinequality interpolation

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