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Prognostic factors associated with mortality in patients with gastric fundal variceal bleeding

World Journal of Gastroenterology 2017年第3期23卷 496-504页

作者： Keishi Komori masaru kubokawa Eikichi Ihara Kazuya Akahoshi Kazuhiko Nakamura Kenta Motomura Akihide Masumoto Department of Gastroenterology Aso Iizuka HospitalIizuka 820-8505Japan Department of Medicine and Bioregulatory Science Graduate School of Medical SciencesKyushu UniversityHigashi-kuFukuoka 812-8582Japan Department of Hepatology Aso Iizuka HospitalIizuka 820-8505Japan

AIM To determine the prognostic factors associated with mortality in patients with gastric fundal variceal (GFV) *** In total, 42 patients were endoscopically diagnosed with GFV bleeding from January 2000 to March 2014. We retrospectively reviewed the patients' medical records and assessed their history, etiology of liver cirrhosis, disease conditions, treatment options for GFV bleeding, medications administered before and after onset of GFV bleeding, blood test results(hemoglobin, albumin, and bilirubin concentrations), and imaging results(including computed tomography and abdominal ultrasonography). We also assessed the prognostic factors associated with short-term mortality(up to 90 d) and long-term mortality in all *** Multivariate analysis showed that prophylactic administration of antibiotics was an independent prognostic factor associated with decreases in short-term mortality (OR = 0.08, 95%CI: 0.01-0.52) and longterm mortality (OR = 0.27, 95%CI: 0.08-0.91) in patients with GFV bleeding. In contrast, concurrent hepatocellular carcinoma (HCC) and regular use of proton pump inhibitors (PPI) were independent prognostic factors associated with increases in shortterm mortality(HCC: OR = 15.4, 95%CI: 2.08-114.75; PPI: OR = 12.76, 95%CI: 2.13-76.52) and long-term mortality (HCC: OR = 7.89, 95%CI: 1.98-31.58; PPI: OR = 10.91, 95%CI: 2.86-41.65) in patients with GFV bleeding. The long-term overall survival rate was significantly lower in patients who regularly used PPI than in those who did not use PPI(P = 0.0074).CONCLUSION Administration of antibiotics is associated with decreased short- and long-term mortality, while concurrent HCC and regular PPI administration are associated with increased short- and long-term mortality.

关键词： Antibiotics Gastric varices Gastric fundus Proton pump inhibitors Hemorrhage

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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 *** numerous electrosurgical knives have been developed for ESD,technical difficulties and high complication rates(bleeding and perforation)have limited their use *** grasping-type scissors forceps[clutch cutter(CC)]is the first forceps-type resection device developed with reference to hemostatic *** aim was to allow easy and safe ESD throughout the gastro-intestinal tract,as a biopsy technique,using one *** 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 *** 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 *** 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 *** 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 *** initial reports using CC for these therapies have shown favorable *** 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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Endoscopic submucosal dissection of a rectal carcinoid tumor using grasping type scissors forceps

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World Journal of Gastroenterology 2009年第17期15卷 2162-2165页

作者： Kazuya Akahoshi Yasuaki Motomura masaru kubokawa Noriaki Matsui Manami Oda Risa Okamoto Shingo Endo Naomi Higuchi Yumi Kashiwabara Masafumi Oya Hidefumi Akahane Haruo Akiba Department of Gastroenterology Aso Iizuka Hospital Iizuka 820-8505 Japan Department of Pathology Aso Iizuka Hospital Iizuka 820-8505 Japan Fujifilm Corporation Saitama 331-9624 Japan

Endoscopic submucosal dissection (ESD) with a knife is a technically demanding procedure associated with a high complication rate. The shortcomings of this method are the inability to fix the knife to the target lesion, and compression of the lesion. These can lead to major complications such as perforation and bleeding. To reduce the risk of complications related to ESD, we developed a new grasping type scissors forceps (GSF), which can grasp and incise the targeted tissue using electrosurgical current. Colonoscopy on a 55-year-old woman revealed a 10-mm rectal submucosal nodule. The histological diagnosis of the specimen obtained by biopsy was carcinoid tumor. Endoscopic ultrasonography demonstrated a hypoechoic solid tumor limited to the submucosa without lymph node involvement. It was safely and accurately resected without unexpected incision by ESD using a GSF. No delayed hemorrhage or perforation occurred. Histological examination confirmed the carcinoid tumor was completely excised with negative resection margin.

关键词：直肠类癌黏膜下内镜剪刀剥离并发症发生率落刺激因子组织学诊断

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Improved techniques for double-balloon-enteroscopy-assisted endoscopic retrograde cholangiopancreatography

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World Journal of Gastroenterology 2012年第46期18卷 6843-6849页

作者： Takashi Osoegawa Yasuaki Motomura Kazuya Akahoshi Naomi Higuchi Yoshimasa Tanaka Terumasa Hisano Souichi Itaba Junya Gibo Mariko Yamada masaru kubokawa Yorinobu Sumida Hirotada Akiho Eikichi Ihara Kazuhiko Nakamura Department of Gastroenterology Aso Iizuka Hospital Department of Medicine and Bioregulatory Science Graduate School of Medical Sciences Kyushu University

AIM: To investigate the clinical outcome of double balloon enteroscopy (DBE)-assisted endoscopic retrograde cholangiopancreatography (DB-ERCP) in patients with altered gastrointestinal anatomy. METHODS: Between September 2006 and April 2011, 47 procedures of DB-ERCP were performed in 28 patients with a Roux-en-Y total gastrectomy (n = 11), Billroth Ⅱ gastrectomy (n = 15), or Roux-en-Y anastomosis with hepaticojejunostomy (n = 2). DB-ERCP was performed using a short-type DBE combined with several technical innovations such as using an endoscope attachment, marking by submucosal tattooing,selectively applying contrast medium, and CO2 insufflations. RESULTS: The papilla of Vater or hepaticojejunostomy site was reached in its entirety with a 96% success rate (45/47 procedures). There were no significant differences in the success rate of reaching the blind end with a DBE among Roux-en-Y total gastrectomy (96%), Billroth Ⅱ reconstruction (94%), or pancreatoduodenectomy (100%), respectively (P = 0.91). The total successful rate of cannulation and contrast enhancement of the target bile duct in patients whom the blind end was reached with a DBE was 40/45 procedures (89%). Again, there were no significant differences in the success rate of cannulation and contrast enhancement of the target bile duct with a DBE among Roux-en-Y total gastrectomy (88 %), Billroth Ⅱ reconstruction (89%), or pancreatoduodenectomy (100%), respectively (P = 0.67). Treatment was achieved in all 40 procedures (100%) in patients whom the contrast enhancement of the bile duct was successful. Common endoscopic treatments were endoscopic biliary drainage (24 procedures) and extraction of stones (14 procedures). Biliary drainage was done by placement of plastic stents. Stones extraction was done by lithotomy with the mechanical lithotripter followed by extraction with a basket or by the balloon pull-through method. Endoscopic sphincterotomy was performed in 14 procedures with a needle precutting knife us

关键词：技术创新双气囊造影剂胆管内镜小肠对比度增强平均时间

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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 mucosal resection vs endoscopic submucosal dissection for superficial non-ampullary duodenal tumors

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World Journal of Gastrointestinal Oncology 2020年第8期12卷 918-930页

作者： Mitsuru Esaki Kazuhiro Haraguchi Kazuya Akahoshi Naru Tomoeda Akira Aso Soichi Itaba Haruei Ogino Yusuke Kitagawa Hiroyuki Fujii Kazuhiko Nakamura masaru kubokawa Naohiko Harada Yosuke Minoda Sho Suzuki Eikichi Ihara Yoshihiro Ogawa Department of Medicine and Bioregulatory Science Graduate School of Medical SciencesKyushu UniversityFukuoka 8128582Japan Division of Gastroenterology and Hepatology Department of MedicineNihon University School of MedicineTokyo 1738610Japan Department of Gastroenterology Hara-Sanshin HospitalFukuoka 8120033Japan Department of Gastroenterology Aso Iizuka HospitalIizuka 8208502Japan Department of Gastroenterology Clinical Research InstituteNational Hospital Organization Kyushu Medical CenterFukuoka 8108564Japan Department of Gastroenterology Kitakyushu Municipal Medical CenterKitakyushu 8020077Japan Department of Gastroenterology Kyushu Rosai HospitalKitakyushu 8000296Japan Department of Internal Medicine Saiseikai Fukuoka General HospitalFukuoka 8100001Japan Department of Gastroenterology and Hepatology National Hospital Organization Fukuokahigashi Medical CenterKoga 81103195Japan Department of Gastroenterology and Metabolism Graduate School of Medicine SciencesKyushu UniversityFukuoka 8128582Japan

BACKGROUND The selection of endoscopic treatments for superficial non-ampullary duodenal epithelial tumors(SNADETs)is *** To compare the efficacy and safety of endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)for *** We retrospectively analyzed the data of patients with SNADETs from a database of endoscopic treatment for SNADETs,which included eight hospitals in Fukuoka,Japan,between April 2001 and October 2017.A total of 142 patients with SNADETs treated with EMR or ESD were *** score matching was performed to adjust for the differences in the patient characteristics between the two *** analyzed the treatment outcomes,including the rates of en bloc/complete resection,procedure time,adverse event rate,hospital stay,and local or metastatic *** Twenty-eight pairs of patients were *** characteristics of patients between the two groups were similar after *** EMR group had a significantly shorter procedure time and hospital stay than those of the ESD group[median procedure time(interquartile range):6(3-10.75)min vs 87.5(68.5-136.5)min,P<0.001,hospital stay:8(6-10.75)d vs 11(8.25-14.75)d,P=0.006].Other outcomes were not significantly different between the two groups(en bloc resection rate:82.1%vs 92.9%,P=0.42;complete resection rate:71.4%vs 89.3%,P=0.18;and adverse event rate:3.6%vs 17.9%,P=0.19,local recurrence rate:3.6%vs 0%,P=1;metastatic recurrence rate:0%in both).Only one patient in the ESD group underwent emergency surgery owing to intraoperative *** EMR has significantly shorter procedure time and hospital stay than ESD,and provides acceptable curability and safety compared to ***,EMR for SNADETs is associated with lower medical costs.

关键词： Endoscopic mucosal resection Endoscopic submucosal dissection Superficial non-ampullary duodenal epithelial tumor Short-term Outcome Propensity score matching

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Double-balloon endoscopy in the diagnosis and management of GI tract diseases:Methodology,indications,safety,and clinical impact

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World Journal of Gastroenterology 2006年第47期12卷 7654-7659页

作者： Kazuya Akahoshi masaru kubokawa Masahiro Matsumoto Shingo Endo Yasuaki Motomura Jiro Ouchi Mitsuhide Kimura Atsuhiko Murata Michiaki Murayama Department of Gastroenterology Aso Iizuka Hospital Iizuka 820-8505 Japan

AIM: To prospectively evaluate the indications, method-ology, safety, and clinical impact of double-balloon ***: A total of 60 patients with suspected or documented small- or large-bowel diseases were investi-gated by double balloon endoscopy. A total of 103 proce-dures were performed (42 from the oral route, 60 from the anal route, and 1 from the stoma route). The main outcome measurements were the time of insertion and the entire examination, complications, diagnostic yields, and the ability to successfully perform ***: Observation of the entire small intestine was possible in 10 (40%) of 25 patients with total enteros-copy. The median insertion time was 122 min (range, 74-199 min). Observation of the entire colon was possi-ble in 13 (93%) of 14 patients after failure of total colo-noscopy using a conventional colonoscope. Small-intes-tine abnormalities were found in 20 (43%) of 46 patients with indications of suspected or documented small bowel diseases, obscure GI tract bleeding, or a history of ileus. Endoscopic procedures including tattooing (n = 33), bite biopsy (n = 17), radiographic examination (n = 7), EUS (n = 5), hemostasis (n = 1), polypectomy (n = 5), balloon dilatation (n = 1), endoscopic mucosal resection (n = 1) and lithotripsy (n = 1) were all successfully performed. No relevant technical problems or severe complications were ***: Double balloon endoscopy is a feasible technique that allows adequate small and large bowel examination and potentially various endoscopic proce-dures of small-intestinal lesions. It is safe, useful, and also provides a high clinical impact.

关键词：内窥镜检查法肠病病理特征诊断方法

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Preoperative diagnosis of gastrointestinal stromal tumor by endoscopic ultrasound-guided fine needle aspiration

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World Journal of Gastroenterology 2007年第14期13卷 2077-2082页

作者： Kazuya Akahoshi Yorinobu Sumida Noriaki Matsui Masafumi Oya Rie Akinaga masaru kubokawa Yasuaki Motomura Kuniomi Honda Masayuki Watanabe Takashi Nagaie Department of Gastroenterology Aso Iizuka Hospital Iizuka 820-8505Japan Department of Pathology Aso Iizuka Hospital Iizuka 820-8505Japan Department of Surgery Aso Iizuka Hospital Iizuka820-8505Japan

瞄准：在胃肠的基质肿瘤(大意) 的外科手术前的诊断评估内视镜的指导 ultrasonography 的好针渴望(EUS-FNA ) 的角色。方法：从 2002 年 9 月到 2006 年 6 月，有到合适的肌肉层的连续性的上皮的低亚硫酸钠拟声肿瘤由标准 EUS 作为大意... 详细信息

瞄准：在胃肠的基质肿瘤(大意) 的外科手术前的诊断评估内视镜的指导 ultrasonography 的好针渴望(EUS-FNA ) 的角色。方法：从 2002 年 9 月到 2006 年 6 月，有到合适的肌肉层的连续性的上皮的低亚硫酸钠拟声肿瘤由标准 EUS 作为大意怀疑了的官方补给的道潜水艇的 53 连续 EUS-FNAs 有希望地被评估。为最后的诊断的参考标准是外科(n = 31 ) ，或临床的后续(n = 22 ) 。另外，标本的免疫 phenotyping 由 EUS-FNA 获得了，外科的切除术标本被比较。结果：因为解剖问题，没在 2 情况刺被执行。从官方补给的道的足够的标本的收集率与连续性代替上皮的低亚硫酸钠拟声肿瘤到合适的肌肉层是 82%(42/51 ) 。为肿瘤的诊断的率不到 2 厘米， 2 ～ 4 厘米，和 4 厘米或更多是 71%(15/21 ) ， 86%(18/21 ) ，并且 100%(9/9 ) 分别地。在 29 通过手术用免疫的 EUS-FNA 的 resected 盒子，敏感，特性，积极预兆的价值，否定预兆的价值，和诊断精确性大意的组织化学的分析是100%( 24/24 )，80%( 4/5 )，96%( 24/25 )，100%( 4/4 )，并且97%( 28/29 )分别地。没有主要复杂并发症被遇到。结论：有免疫的 EUS-FNA 组织化学的分析是在大意的 prethera-peutic 诊断的一个安全、精确的方法。它应该在决策被考虑，特别在跟随为大意的最小的侵略外科的早诊断。

关键词：胃肠间质瘤术前诊断内镜超声引导细针活检

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Low skeletal muscle mass and high visceral adiposity are associated with recurrence of acute cholecystitis after conservative management:A propensity score-matched cohort study

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Hepatobiliary & Pancreatic Diseases International 2024年第1期23卷 64-70页

作者： Yudai Koya Michihiko Shibata Yuki Maruno Yoshitaka Sakamoto Shinji Oe Koichiro Miyagawa Yuichi Honma masaru Harada Department of Gastroenterology Kyushu Rosai HospitalMoji Medical Center3-1 HigashiminatomachiMoji-kuKitakyushu 801-8502Japan Third Department of Internal Medicine School of MedicineUniversity of Occupational and Environmental HealthKitakyushu 807-8555Japan Department of Surgery Kyushu Rosai Hospital Moji Medical CenterKitakyushu 801-8502Japan

Background:Recurrent acute cholecystitis(RAC)can occur after non-surgical treatment for acute cholecystitis(AC),and can be more severe in comparison to the first episode of *** skeletal muscle mass or adiposity have various effects in several *** aimed to clarify the relationship between RAC and body ***:Patients with AC who were treated at our hospital between January 2011 and March 2022 were *** psoas muscle mass and adipose tissue area at the third lumbar level were measured using computed tomography at the first episode of *** areas were divided by height to obtain the psoas muscle mass index(PMI)and subcutaneous/visceral adipose tissue index(SATI/VATI).According to median VATI,SATI and PMI values by sex,patients were divided into the high and low PMI *** performed propensity score matching to eliminate the baseline differences between the high PMI and low PMI groups and analyzed the cumulative incidence and predictors of ***:The entire cohort was divided into the high PMI(n=81)and low PMI(n=80)*** the propensity score-matched cohort there were 57 patients in each *** Kaplan-Meier analysis,the low PMI group and the high VATI group had a significantly higher cumulative incidence of RAC than their counterparts(log-rank P=0.001 and 0.015,respectively).In a multivariate Cox regression analysis,the hazard ratios of low PMI and low VATI for RAC were 5.250(95%confidence interval 1.083-25.450,P=0.039)and 0.158(95%confidence interval:0.026-0.937,P=0.042),***:Low skeletal muscle mass and high visceral adiposity were independent risk factors for RAC.

关键词： Acute cholecystitis Low skeletal muscle mass Recurrent acute cholecystitis Sarcopenia Visceral adiposity

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Safety advantage of endocut mode over endoscopic sphincterotomy for choledocholithiasis

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World Journal of Gastroenterology 2006年第13期12卷 2086-2088页

作者： Hirotada Akiho Yorinobu Sumida Kazuya Akahoshi Atsuhiko Murata Jiro Ouchi Yasuaki Motomura Taisuke Toyomasu Mitsuhide Kimura masaru kubokawa Masahiro Matsumoto Shingo Endo Kazuhiko Nakamura Division of Gastroenterology Aso Iizuka Hospital JapanDepartment of Medicine and Bioregulatory ScienceGraduate School of Medical SciencesKyushu UniversityJapan Division of Gastroenterology Aso Iizuka Hospital Japan Division of Surgery Aso Iizuka Hospital Japan Division of Qastroenterology Aso Iizuka Hospital Japan Department of Medicine and Bioregulatory Science Graduate School of Medical Sciences Kyushu UniversityJapan

瞄准：评估一个自动地控制的切割系统(endocut 模式) 是否能与常规混合切割模式相比在 EST 以后减少内视镜的括约肌切开术(EST ) 和浆液血淀粉酶过多的复杂并发症率。方法：从 2001 年 1 月到 2003 年 10 月，有胆总管石病的 134 个病... 详细信息

瞄准：评估一个自动地控制的切割系统(endocut 模式) 是否能与常规混合切割模式相比在 EST 以后减少内视镜的括约肌切开术(EST ) 和浆液血淀粉酶过多的复杂并发症率。方法：从 2001 年 1 月到 2003 年 10 月，有胆总管石病的 134 个病人在括约肌切开术的时候被分到任何一个 endocut 模式组或常规混合切割模式组。二个组回顾地在 EST 和浆液淀粉酶以后为复杂并发症被比较水平在前和在过程以后的 24 h。结果：对待的 134 个病人， 79 被分到常规混合切割模式组， 55 组织到 endocut 模式。在年龄，性别，和在在二个组之间的 EST 前的浆液淀粉酶水平没有有效差量。复杂并发症在 endocut 模式组(9%) 的 5 个病人被发现：血淀粉酶过多(比正常高 5 倍) 在 4 并且在 1 的中等胰腺炎。复杂并发症在常规混合切割模式组(16%) 的 13 个病人被发现：在 12 的血淀粉酶过多和在 1 的中等胰腺炎。浆液淀粉酶层次在两个组被提高在 EST (P<0.02 ) 以后的 24 h。在在常规混合切割模式的 EST 以后的 24 h 组织的平均浆液淀粉酶水平在 endocut 模式组(P<0.05 ) 比那显著地高。结论：Endocut 模式由减少血淀粉酶过多在 EST 以后为胰腺炎在常规混合切割模式上提供一个安全优点。

关键词：内窥镜括约肌切开术总胆管造口术手术安全

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