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Efficacy and safety of over-the-scope clip: Including complications after endoscopic submucosal dissection

World Journal of Gastroenterology 2013年第18期19卷 2752-2760页

作者： Noriko nishiyama Hirohito Mori Hideki Kobara Kazi Rafiq Shintarou Fujihara Mitsuyoshi Kobayashi Makoto Oryu Tsutomu Masaki Department of Gastroenterology and Neurology Faculty of Medicine Kagawa University Kagawa 761-0796 Japan Department of Pharmacology Faculty of Medicine Kagawa University Kagawa 761-0796 Japan

AIM: To retrospectively review the results of over-thescope clip (OTSC) use in our hospital and to examine the feasibility of using the OTSC to treat perforations after endoscopic submucosal dissection (ESD). METHODS: We enrolled 23 patients who presented with gastrointestinal (GI) bleeding, fistulae and perforations and were treated with OTSCs (Ovesco Endoscopy GmbH, Tuebingen, Germany) between November 2011 and September 2012. Maximum lesion size was defined as lesion diameter. The number of OTSCs to be used per patient was not decided until the lesion was completely closed. We used a twin grasper (Ovesco Endoscopy GmbH, Tuebingen, Germany) as a grasping device for all the patients. A 9 mm OTSC was chosen for use in the esophagus and colon, and a 10 mm device was used for the stomach, duodenum and rectum. The overall success rate and complications were evaluated, with a particular emphasis on patients who had undergone ESD due to adenocarcinoma. In technical successful cases we included not only complete closing by using OTSCs, but also partial closing where complete closure with OTSCs is almost difficult. In overall clinical successful cases we included only complete closing by using only OTSCs perfectly. All the OTSCs were placed by 2 experienced endoscopists. The sites closed after ESD included not only the perforation site but also all defective ulcers ***: A total of 23 patients [mean age 77 years (range 64-98 years)] underwent OTSC placement during the study period. The indications for OTSC placement were GI bleeding (n = 9), perforation (n = 10), fistula (n = 4) and the prevention of post-ESD duodenal artificial ulcer perforation (n = 1). One patient had a perforation caused by a glycerin enema, after which a fistula formed. Lesion closure using the OTSC alone was successful in 19 out of 23 patients, and overall success rate was 82.6%. A large lesion size (greater than 20 mm) and a delayed diagnosis (more than 1 wk) were the major contributing fac

关键词： Over-the-scope clip Gastrointestinal bleed-ing Endoscopic submucosal dissection complications Gastrointestinal fistulae Gastrointestinal perforation

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Mucinous phenotype and CD10 expression of primary adenocarcinoma of the small intestine

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World Journal of Gastroenterology 2015年第9期21卷 2700-2710页

作者： Reiko Kumagai Kenichi Kohashi Shunsuke Takahashi Hidetaka Yamamoto Minako Hirahashi Kenichi Taguchi Kenichi nishiyama Yoshinao Oda Department of Anatomic Pathology Pathological SciencesGraduate School of Medical SciencesKyushu UniversityFukuoka 812-8582Japan Department of Pathology National Hospital Organization Kyushu Cancer CenterFukuoka 811-1395Japan Division of Pathology Japanese Red Cross Fukuoka HospitalFukuoka 815-8555Japan

AIM:To clarify the correlation with phenotypic expression,clinicopathological features,genetic alteration and microsatellite-instability status in small intestinal adenocarcinoma(SIA).METHODS:The cases of 47 patients diagnosed with primary SIAs that were surgically resected at our institution in 1975-2005 were *** reviewed clinicopathological findings(age,gender,tumor size,gross appearance,histological morphologic type,invasion depth,lymphatic permeation,venous invasion,and lymph node metastasis),and the immunohistochemical expression of MUC5 AC,MUC6,MUC2,CD10,and mismatch-repair(MMR) proteins(MLH1 and MSH2).We analyzed KRAS and BRAF gene mutations,and the microsatellite instability(MSI) *** immunohistochemical staining of CD10,MUC2,MUC5 AC and MUC6 was considered positive when distinct staining in > 5% of the adenocarcinoma cells was *** evaluate of MMR protein expression,we used adjacent normal tissue including lymphoid follicles,inflammatory cells,and stromal cells as an internal positive *** without nuclear staining in the tumor cells were considered to have lost the expression of the respective MMR ***:There were 29 males and 18 females patients(mean age 59.9 years,range:23-87 years).Tumors were located in the duodenum in 14 cases(30%),the jejunum in 21 cases(45%),and the ileumin 12 cases(25%).A phenotypic expression analysis revealed 20 MUC2-positive tumors(42.6%),11 MUC5AC-positive(23.4%),4 MUC6-positive(8.5%),and 7 CD10-positive(14.9%).The tumor sizes of the MUC2(+) tumors were significantly larger than those of the MUC2(-) tumors(mean,5.7 ± 1.4 cm vs 4.7 ± 2.1 cm,P < 0.05).All three tumors with adenomatous component were positive for MUC2(P < 0.05).Polypoid appearance was seen significantly more frequently in the CD10(+) group than in the CD10(-) group(P < 0.05).The tumor size was significantly larger in the CD10(+) group than in the CD10(-) group(mean,5.9 ± 1.4 cm vs 5.0 ± 2.1 cm,P < 0.05).Of 34 SIAs with succ

关键词： Small intestine Adenocarcinoma Mucin CD10 Microsat

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Management of a large mucosal defect after duodenal endoscopic resection

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World Journal of Gastroenterology 2016年第29期22卷 6595-6609页

作者： Shintaro Fujihara Hirohito Mori Hideki Kobara Noriko nishiyama Tae Matsunaga Maki Ayaki Tatsuo Yachida Tsutomu Masaki Departments of Gastroenterology and Neurology Kagawa University Faculty of Medicine

Duodenal endoscopic resection is the most difficult type of endoscopic treatment in the gastrointestinal tract(GI) and is technically challenging because of anatomical specificities. In addition to these technical difficulties, this procedure is associated with a significantly higher rate of complication than endoscopic treatment in other parts of the GI tract. Postoperative delayed perforation and bleeding are hazardous complications, and emergency surgical intervention is sometimes required. Therefore, it is urgently necessary to establish a management protocol for preventing serious complications. For instance, the prophylactic closure of large mucosal defects after endoscopic resection may reduce the risk of hazardous complications. However, the size of mucosal defects after endoscopic submucosal dissection(ESD) is relatively large compared with the size after endoscopic mucosal resection, making it impossible to achieve complete closure using only conventional clips. The over-the-scope clip and polyglycolic acid sheets with fibrin gel make it possible to close large mucosal defects after duodenal ESD. In addition to the combination of laparoscopic surgery and endoscopic resection, endoscopic full-thickness resection holds therapeutic potential for difficult duodenal lesions and may overcome the disadvantages of endoscopic resection in the near future. This review aims to summarize the complications and closure techniques of large mucosal defects and to highlight some directions for management after duodenal endoscopic treatment.

关键词： Endoscopic mucosal resection Endoscopic submucosal dissection Duodenum Complication Bleeding Perforation Over-the-scope clip Clip Closure Endoscopic full-thickness resection

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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

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Two rare gastric hamartomatous inverted polyp cases suggest the pathogenesis of growth

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World Journal of Gastroenterology 2014年第19期20卷 5918-5923页

作者： Hirohito Mori Hideki Kobara Takaaki Tsushimi Shintaro Fujihara Noriko nishiyama Tae Matsunaga Maki Ayaki Tatsuo Yachida Tsutomu Masaki Department of Gastroenterology and Neurology Kagawa University School of Medicine1750-1 IkenobeMikiKitaKagawa 761-0793Japan Department of Gastroenterological Surgery Ehime Rosai Hospital13-27MinamikomatsubaraNiihamaEhime 792-8550Japan

Gastric hamartomatous inverted polyps(GHIP)are difficult to diagnose accurately because of inversion into the submucosal *** are diagnosed using the pathological characteristics of the tumor,including the fibroblast cells,smooth muscle,nerve components,glandular hyperplasia,and cystic gland *** Peutz-Jeghers syndrome,juvenile polyposis,and Cowden disease are hereditary,it is rare to encounter 2 cases of monostotic and asymptomatic gastric *** pathogeneses of hamartomatous inverted polyps and inverted hyperplastic polyps remain controversial because of the paucity of reported *** are 3 hypotheses regarding the pathogenesis of complete gastric inverted *** on our experience with 2 successive,rare GHIP cases,we affirm the hypothesis that after a hamartomatous change occurs in the submucosal layer,some of these components are exposed to the gastric mucosa and,consequently,form a hypertrophic *** Case 1,our hypothesis explains why a tiny hypertrophic change was first detected on the top of the submucosal tumor using a detailed narrow band imaging-magnified *** was no confirmation that the milky white mucous and calcification structures were exuding directly from the biopsy site like Case 1,and in Case 2 the presence of this mucous was indirectly confirmed during an endoscopic submucosal dissection(ESD).Regarding the pathogenesis of GHIP,a submucosal hamartomatous change may occur prior to the growth of hypertrophic *** en bloc resection using ESD is recommended for treatment.

关键词： Hamartomatous inverted polyps Hypotheses of pathogenesis Milky white mucous Endoscopic submucosal dissection Pathological findings

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Novel and safer endoscopic cholecystectomy using only a flexible endoscope via single port

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World Journal of Gastroenterology 2016年第13期22卷 3558-3563页

作者： Hirohito Mori Nobuya Kobayashi Hideki Kobara Noriko nishiyama Shintaro Fujihara Taiga Chiyo Maki Ayaki Takashi Nagase Tsutomu Masaki Department of Gastroenterology and Neurology Kagawa University Department of Gastroenterological Surgery Ehime Rosai Hospital

AIM: To apply the laparoscopic and endoscopic cooperative surgery concept, we investigated whether endoscopic cholecystectomy could be performed more safely and rapidly via only 1 port or ***: Two dogs(11 and 13-mo-old female Beagle) were used in this study. Only 1 blunt port was created, and a flexible endoscope with a tip attachment was inserted between the fundus of gallbladder and liver. After local injection of saline to the gallbladder bed, resection of the gallbladder bed from the liver was performed. After complete resection of the gallbladder bed, the gallbladder was pulled up to resect its neck using the Ring-shaped thread technique. The neck of the gallbladder was cut using scissor forceps. Resected gallbladder was retrieved using endoscopic net forceps via a port. RESULTS: The operation times from general anesthetizing with sevoflurane to finishing the closure of the blunt port site were about 50 min and 60 min respectively. The resection times of gallbladder bed were about 15 min and 13 min respectively without liver injury and bleeding at all. Feed were given just after next day of operation, and they had a good appetite. Two dogs are in good health now and no complications for 1 mo after endoscopic cholecystectomy using only a flexible endoscope via one ***: We are sure of great feasibility of endoscopic cholecystectomy via single port for human.

关键词： Laparoscopic and endoscopic cooperative surgery Endoscopic cholecystectomy Single port Safer and complete resection Feasibility

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Overexpression of ETS-1 is associated with malignan＇ biological features of prostate cancer

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Asian Journal of Andrology 2012年第6期14卷 860-863页

作者： Bo Li Yosuke Shimizu Takashi Kobayashi Naoki Terada Koji Yoshimura Tomomi Kamba Yoshiki Mikami Takahiro Inoue Hiroyuki nishiyama Osamu Ogawa Department of Urology Kyoto University Graduate School of Medicine Kyoto 606-8507 Japan Minimally Invasive Urology Center Shandong Provincial Hospital Affiliated to Shandong University Jinan 250000 China Department of Urology Columbia University Herbert Irving Cancer Center New York NY 10032 USA Department of Diagnostic Pathology Kyoto University Hospital Kyoto 606-8507 Japan Department of Urology Faculty of Medicine University of Tsukuba Ibaraki 305-8575 Japan

E26 transformation-specific-1 （ETS-1）, an ETS family transcription factor, has been reported to play an important role in a variety of physiological and pathological processes, but clinical implications of ETS-1 expression in prostate cancer （PCa）, particularly high-risk cases, including response to androgen-deprivation therapy （ADT） have yet to be elucidated. We examined the expression of ETS- 1 using immunohistochemical staining of paraffin-embedded prostate carcinoma tissue obtained by needle biopsy from 69 mostly advanced PCa patients. ETS-1 expression was compared with the clinicopathological characteristics of the 69 patients, including 25 who underwent ADT as a primary treatment. As a result, PCa patients with higher expression of ETS-1 were significantly more likely to be of high stage and high Gleason score （P〈O.05）. There was no significant association between ETS-1 expression and the initial prostate-specific antigen （PSA） level. In the 25 patients treated by ADT, the staining score for ETS-1 was significantly associated with rapid development of castration-resistant disease within 24 months （P〈O.05）, whereas the Gleason score and PSA level were not. In conclusion, increased ETS-1 expression was associated with a higher stage, higher Gleason score and shorter time to castration-resistant progression. These data suggest that immunostaining for ETS-1 could be a molecular marker for predicting a poor clinical outcome for PCa patients, oarticularlv those with hi^h-risk disease.

关键词： castration resistant E26 transformation-specific-1 (ETS-1) immunohistochemistry prostate cancer

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Radical excision of Barrett's esophagus and complete recovery of normal squamous epithelium

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World Journal of Gastroenterology 2013年第31期19卷 5195-5198页

作者： Hirohito Mori Hideki Kobara Kazi Rafiq Noriko nishiyama Shintaro Fujihara Maki Ayagi Tatsuo Yachida Kiyohito Kato Tsutomu Masaki Department of Gastroenterology and Neurology Kagawa University Kagawa 761-0793 Japan Department of Pharmacology Kagawa UniversityKagawa 761-0793 Japan

To treat Barrett's esophagus(BE),radiofrequency ablation or cryotherapy are effective treatments for eradicating BE with dysplasia and intestinal metaplasia,and reduce the rates of Barrett's esophageal adenocarcinoma(BAC).However,patients with BE and dysplasia or early cancer who achieved complete eradication of intestinal metaplasia,BE recurred in 5% within a year,requiring expensive endoscopic *** performed endoscopic submucosal dissection as complete radically curable treatment procedure for BE with dysplasia,intestinal metaplasia and BAC.

关键词： Barrett’s esophagus Radiofrequency ablation Cryotherapy Endoscopic submucosal dissection Radically curable treatment

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Endoscopic management of a rare granulation polyp in a colonic diverticulum

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World Journal of Gastroenterology 2013年第48期19卷 9481-9484页

作者： Hirohito Mori Takaaki Tsushimi Hideki Kobara Noriko nishiyama Shintaro Fujihara Tae Matsunaga Maki Ayagi Tatsuo Yachida Tsutomu Masaki Departments of Gastroenterology and Neurology Kagawa University School of Medicine Kagawa 761-0793 Japan Department of Gastroenterological Surgery Ehime Rosai Hospital Ehime 792-8550 Japan

There are many case reports on colon diverticula that cause irritable bowel syndrome,constipation,bleeding,diverticulitis,stricture due to multiple recurrences of diverticulitis,and ***,few articles have examined neoplasms that arise from a diverticulum,such as adenoma and adenocarcinoma,and there have been no reports of granulation polyps that arise from a colon diverticulum after recurrent *** observed a rare granulation polyp that arose from a diverticulum as a result of repeated episodes of local *** band imaging magnified colonoscopy was very useful to diagnose the polyp as a granulation polyp because of the absence of a pit pattern on the surface of the *** successfully resected the polyp using endoscopic mucosal *** inverted the diverticulum,and the resected stalk of the polyp was used to close the diverticulum with an over-thescope *** a granulomatous polyp could arise from a diverticulum,differential diagnosis between a colon neoplasm and a granulomatous polyp would not only be difficult but also necessary for suitable endoscopic treatment.

关键词： Diverticulitis Endoscopy Granulation polyp Mucosal resection Neoplasm Recurrence

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Novel method to prevent gastric antral strictures after endoscopic submucosal dissection: Using triamcinolone

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World Journal of Gastroenterology 2014年第33期20卷 11910-11915页

作者： Noriko nishiyama Hirohito Mori Hideki Kobara Kazi Rafiq Shintaro Fujihara Tae Matsunaga Maki Ayaki Tatsuo Yachida Makoto Oryu Tsutomu Masaki Departments of Gastroenterology and Neurology Faculty of Medicine Kagawa University Kagawa 761-0796 Japan Departments ofPharmacology Faculty of Medicine Kagawa University Kagawa 761-0796 Japan

Endoscopic submucosal dissection(ESD) of large gastric lesions often leads to severe gastric strictures, especially in cases of large ESD in the antrum of the stomach. It has recently been reported that balloon dilation, mucosal incision, and local steroid injections can successfully treat gastric strictures. However, there are some complications with existing methods and decreasing the quality of life. We have developed a novel method to prevent severe gastric strictures that does not involve balloon dilation, mucosal incision, or steroid injections after circumferential ESD. Our original method involves the submucosal injection of a mixed solution composed of triamcinolone acetonide and a general solution of glycerol, hyaluronic acid, and a small amount of indigo carmine and epinephrine dur-ing the ESD procedure; this mixture is called a mixed solution of triamcinolone(MST). According to standard ESD procedures, several milliliters of MST are injected into the submucosal layer for the purpose of elevating the submucosa during ESD resulting in prevention of severe strictures. Our method using MST take several advantages such as MST method suppress inflammation in ulcer from initial phase, prevention of stricture without obstructive symptoms, and does not require several ballooning. Therefore, MST method is safe and gentle, shorten the hospitalization duration. Here, we described two cases in which we prevented severe strictures of the gastric antrum after completing a circumferential ESD using MST without any complications.

关键词： Early gastric cancer Endoscopic submuco-sal dissection Stricture of antrum Triamcinolone

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