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Identifying high-risk individuals for gastric cancer surveillance from western and eastern perspectives: Lessons to learn and possibility to develop an integrated approach for daily practice

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World Journal of Gastroenterology 2019年第27期25卷 3546-3562页

作者： Duc Trong Quach toru hiyama Takuji Gotoda Department of Internal Medicine University of Medicine and Pharmacy at Hochiminh CityHo Chi Minh 70000Vietnam Health Service Center Hiroshima UniversityHigashihiroshima 739-8514Japan Division of Gastroenterology and Hepatology Department of MedicineNihon University School of MedicineTokyo 101-8309Japan

Current evidence shows that individuals with gastric dysplasia, severe and extensive gastric atrophy, extensive gastric intestinal metaplasia and the incomplete subtype of intestinal metaplasia are at high risk for gastric cancer(GC) development. There are several approaches to identifying these subjects,including noninvasive methods, esophagogastroduodenoscopy and *** main approach in Western countries is histology-based while that in Eastern countries with a high prevalence of GC is endoscopy-based. Regarding asymptomatic individuals, the key issues in selecting applicable approaches are the ability to reduce GC mortality and the cost-effectiveness of the approach. At present, population-based screening programs have only been applied in a few Asian countries with a high risk of GC. Pre-endoscopic risk assessment based on demographic and clinical features, such as ethnicity, age, gender, smoking and Helicobacter pylori status, is helpful for identifying subjects with high pre-test probability for a possibly cost-effective approach, especially in intermediate-and low-risk countries. Regarding symptomatic patients with indications for esophagogastroduodenoscopy, the importance of opportunistic screening should be emphasized. The combination of endoscopic and histological approaches should always be considered as endoscopy provides a real-time assessment of the patient’s risk level. In addition, imaging enhanced endoscopy(IEE) has been shown to facilitate targeted biopsies resulting in better correlation between endoscopic and histological findings. Currently, the use of IEE is recommended for endoscopic examinations, and the Operative Link for Gastric Intestinal Metaplasia or Operative Link on Gastritis Assessment grading systems are recommended for histological examinations whenever available. However,resource limitations are an important barrier in many regions worldwide. Thus,for an approach to be applicable in real-life practice, it should be not only

关键词： Gastric cancer Precancerous gastric lesions Dysplasia Gastric atrophy Chronic atrophic gastritis Intestinal metaplasia Surveillance Screening Costeffective

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Strategy for treatment of nonerosive reflux disease in Asia

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World Journal of Gastroenterology 2008年第20期14卷 3123-3128页

作者： toru hiyama Masaharu Yoshihara Shinji Tanaka Ken Haruma Kazuaki Chayama Health Service Center Hiroshima University Department of Endoscopy Hiroshima University Hospital Division of Gastroenterology Department of Internal Medicine Kawasaki Medical School Department of Medicine and Molecular Science Division of Frontier Medical Science Programs for Biomedical Research Graduate School of Biomedical Sciences Hiroshima University

The paper is to review the clinical and pathophysiologic differences between of nonerosive reflux disease (NERD) and reflux esophagitis (RE), and to propose a treatment strategy for NERD, especially for patients in Asia. A Medline search was performed regarding the clinical and pathophysiologic differences between NERD and RE, and treatment of NERD and RE. The characteristics of NERD patients in Asia are as follows: (1) high proportion of female patients, (2) low frequency of hiatal hernia, (3) high frequency of H pylori infection, (4) severe glandular atrophy of the gastric mucosa, and (5) frequent resistance to proton pump inhibitor (PPI) therapy. In Asian NERD patients, exposure of the esophagus to acid is not increased, and esophageal motility is normal. These characteristics are similar to those of patients in Western countries. Our recommended first-choice treatment is administration of PPI in combination with a prokinetic agent. However, at present, because there is limited evidence regarding effective treatments for NERD, it is best to try several different treatment strategies to find the best treatment for each patient.

关键词： Nonerosive reflux disease Asia Treatment

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Value of a new stick-type rapid urine test for the diagnosis of Helicobacter pylori infection in the Vietnamese population

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World Journal of Gastroenterology 2014年第17期20卷 5087-5091页

作者： Duc T Quach toru hiyama Fumio Shimamoto Quang D Le Linh X Ho Nhu HT Vu Masaharu Yoshihara Naomi Uemura Department of Endoscopy University Medical CenterHo Chi Minh 70000Vietnam Health Service Center Hiroshima UniversityHigashihiroshima 739-8514Japan Faculty of Human Culture and Science Prefectural University of HiroshimaHiroshima 734-8558Japan Department of Gastroenterology Gia-Dinh People’s HospitalHo Chi Minh 70000Vietnam Department of Gastroenterology and Hepatology National Center for Global Health and MedicineIchikawa 272-8516Japan

AIM: To assess the value of a new test for the diagnosis of Helicobacter pylori (H. pylori) infection, Rapirun®H. pylori Antibody Stick (Rapirun® Stick), in a Vietnamese population.

关键词： Helicobacter pylori, Urine test, Rapirun® Stick, Vietnamese, Rapid urease test

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Involvement of Krüppel-like factor 6 (KLF6) mutation in the development of nonpolypoid colorectal carcinoma

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World Journal of Gastroenterology 2007年第29期13卷 3932-3938页

作者： Shinichi Mukai toru hiyama Shinji Tanaka Masaharu Yoshihara Koji Arihiro Kazuaki Chayama Department of Medicine and Molecular Science Division of Frontier Medical Science Program for Biomedical Research Graduate School of Biomedical Sciences Hiroshima University Hiroshima Japan Health Service Center Hiroshima University Higashihiroshima Japan Department of Endoscopy Hiroshima University Hospital Hiroshima Japan Department of Anatomical Pathology Hiroshima University Hospital Hiroshima Japan

AIM： To examine Kruppel-like factor 6 （KLF6） mutations in nonpolypoid-type tumors and alterations of K-ras, p53, and B-raf in relation between mutation and morphologic type, particularly nonpolypoid-type colorectal carcinomas. METHODS： Fifty-five early nonpolypoid colorectal carcinomas were analyzed. Loss of heterozygosity （LOH） of KLF6 and p53 was determined by microsatellite assay. Mutations of KLF6, K-ras, and B-raf were examined by polymerase chain reaction-single-strand conformation polymorphism followed by direct sequencing. In LOH- positive and/or mutation-positive tumors, multiple （4-7） samples in each tumor were microdissected and examined for genetic alterations, p53 expression was evaluated by immunohistochemistry. RESULTS： LOH of KLF6 and p53 was found in 14 of 29 （48.3%） and 14 of 31 （45.2%） tumors, respectively. In tO of the 14 （71.4%） KLF6 LOH-positive tumors and 9 of the 14 （64.3%） p53 LOH-positive tumors, LOH was found in all of the microdissected samples. In 1 of the tO （10.0%） KLF6 LOH-positive tumors, a single missense mutation was identified. K-ras and B-raf mutations were found in 5 of 55 （9.1%） and 6 of 55 （10.9%） tumors, respectively. However, these mutations were detected only in subsets of microdissected tumor samples. CONCLUSION： These data suggest that KLF6 and p53 mutations are involved in the development of nonpolypoid colorectal carcinoma, whereas K-ras and B-raf mutations are not.

关键词： Nonpolypoid colorectal carcinoma KLF6 p53 K-ras B-raf

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Medical malpractice litigation related to gastrointestinal endoscopy in Japan:A two-decade review of civil court cases

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World Journal of Gastroenterology 2006年第42期12卷 6857-6860页

作者： toru hiyama Shinji Tanaka Masaharu Yoshihara Tatsuma Fukuhara Shinichi Mukai Kazuaki Chayama Health Service Center Hiroshima University Higashihiroshima Department of Endoscopy Hiroshima University Hospital Hiroshima Department of Medicine and Molecular Science Division of Frontier Medical Science Programs for Biomedical Research Graduate School of Biomedical Sciences Hiroshima University Hiroshima Japan

AIM: To examine the allegations in malpractice litigations related to gastrointestinal endoscopy in Japan. METHODS: A retrospective review of cases tried in the civil court system during the 21-year period from 1985 to 2005, identified in a computerized legal database, was undertaken. RESULTS: Eighteen malpractice litigations and a total of 30 allegations were identified. Of the 18 (44%) malpractice litigations, 8 (44%) were related to eso- phagogastroduodenoscopy, 4 (22%) to colonoscopy, 4 (22%) to endoscopic sphincterotomy, and 2 (11%) to endoscopic retrograde cholangiopancreatography. Seventeen (94%) cases pertained to complications, and the remaining (6%) case pertained to misdiagnosis. In 10 cases, the patient died of the complications. Allegations were categorized as: (1) performance error during the endoscopic procedure (n = 12, 40%); (2) lack of informed consent (n = 9, 30%); (3) performance error during the treatment after the endoscopic procedure (n = 4, 13%); (4) premedication error (n = 3, 10%); (5) diagnostic error (n = 1, 3%); and (6) indication error for the endoscopic procedure (n = 1, 3%). CONCLUSION: These data may aid in the design of risk prevention strategies to be used by gastrointestinal endoscopists.

关键词： Gastrointestinal endoscopy Malpractice Litigation Risk management

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Defensive medicine practices among gastroenterologists in Japan

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World Journal of Gastroenterology 2006年第47期12卷 7671-7675页

作者： toru hiyama Masaharu Yoshihara Shinji Tanaka Yuji Urabe Yoshihiko Ikegami Tatsuma Fukuhara Kazuaki Chayama Health Service Center Hiroshima University Higashihiroshima Japan Department of Endoscopy Hiroshima University Hospital Hiroshima Japan Department of Medicine and Molecular Science Division of Frontier Medical Science Programs for Biomedical Research Graduate School of Biomedical Sciences Hiroshima University Hiroshima Japan

AIM： To clarify the prevalence of defensive medicine and the specific defensive medicine practices among gastroenterologists in Japan. METHODS： A survey of gastroenterologists in Hiroshima, Japan, was conducted by mail in March 2006. The number of gastroenterologists reporting defensive medicine behaviors or changes in their scope of practice and the reported defensive medicine practices, i.e., assurance and avoidance behaviors, were examined. RESULTS： A total of 131 （77%） out of 171 gastroenterologists completed the survey. Three （2%） respondents were sued, and most respondents （96%） had liability insurance. Nearly all respondents （98%） reported practicing defensive medicine. Avoidance behaviors, such as avoiding certain procedures or interventions and avoiding caring for high-risk patients, were very common （96%）. Seventy-five percent of respondents reported often avoiding certain procedures or interventions. However, seasoned gastroenterologists （those in practice for more than 20 years） adopted avoidance behaviors significantly less often than those in practice for less than 10 years. Assurance behaviors, i.e., supplying additional services of marginal or no medical value, were also widespread （91%）. Sixty-eight percent of respondents reported that they sometimes or often referred patients to other specialists unnecessarily. CONCLUSION： Defensive medicine may be highly prevalent among gastroenterologists throughout 3apan, with potentially serious implications regarding costs, access, and both technical and interpersonal quality of care.

关键词： Defensive medicine Gastroenterologist Japan Survey Clinical practice

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Immunohistochemical molecular markers as predictors of curability of endoscopically resected submucosal colorectal cancer

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World Journal of Gastroenterology 2007年第28期13卷 3829-3835页

作者： Iwao Kaneko Shinji Tanaka Shiro Oka Shigeto Yoshida toru hiyama Koji Arihiro Fumio Shimamoto Kazuaki Chayama Department of Medicine and Molecular Science Hiroshima University Graduate School of Biomedical ScienceHiroshimaJapan Department of Endoscopy Hiroshima University HospitalHiroshimaJapan Health Service Center Hiroshima UniversityHiroshimaJapan Department of Pathology Hiroshima University HospitalHiroshimaJapan Department of Health Science Prefectural University of HiroshimaFaculty of Human Culture and SocietyHiroshimaJapan

AIM: To clarify the usefulness of immunohistochemical molecular markers in predicting lymph node metastasis of submucosal colorectal cancer. METHODS: We examined microvessel density, lymphatic vessel density, the Ki-67 labeling index, expression of MUC1 and Matrix metalloproteinase-7 (MMP-7) in tumor cells, and expression of cathepsin D in stromal cells at the invasive front by immunostaining of samples resected from 214 patients with submucosal colorectal cancer. Pathologic features were assessed on hematoxylin-eosin- stained samples. We evaluated the relations between clinicopathologic/immunohistochemical features and lymph node metastasis. RESULTS: Lesions of the superficial type, with an unfavorable histologic grade, budding, lymphatic involvement, high microvessel density (≥ 40), high lymphatic vessel density (≥ 9), high Ki-67 labeling index (≥ 42), and positivity of MUC1, cathepsin D, and MMP-7 showed a significantly high incidence of lymph node metastasis. Multivariate analysis revealed that high microvessel density, unfavorable histologic grade, cathepsin D positivity, high lymphatic vessel density, superficial type, budding, and MUC1 positivity were independent risk factors for lymph node metastasis.A combined examination with four independent immunohistochemical markers (microvessel density, cathepsin D, lymphatic vessel density, and MUC1) revealed that all lesions that were negative for all markers or positive for only one marker were negative for lymph node metastasis. CONCLUSION: Analysis of a combination of immuno- histochemical molecular markers in endoscopically resected specimens of submucosal colorectal cancer allows prediction of curability regardless of the pathologic features visible of hematoxylin-eosin-stained sections.

关键词： Submucosal colorectal cancer Microvessel density Lymphatic vessel density Mucin 1 Ki-67 Cathepsin D Matrix metalloproteinase-7 Lymph node metastasis Immunohistochemistry

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Prevalence and impact of musculoskeletal pain in Japanese gastrointestinal endoscopists:A controlled study

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World Journal of Gastroenterology 2011年第11期17卷 1488-1493页

作者： Takayasu Kuwabara Yuji Urabe toru hiyama Shinji Tanaka Takako Shimomura Shiro Oko Masaharu Yoshi-hara Kazuaki Chayama Department of Gastroenterology and Metabolism Hiroshima University HospitalHiroshima 739-8514Japan Health Service Center Hiroshima UniversityHigashihiroshima 739-8514Japan Department of Endoscopy Hiroshima University HospitalHiroshima 739-8514Japan

AIM:To examine the frequency and prevention of musculoskeletal pain in Japanese gastrointestinal endoscopists and non-endoscopist ***:Questionnaires were sent to 275 endoscopists and 173 non-endoscopists working in Hiroshima University Hospital and its affiliated ***:The completed questionnaires were returned by 190(69%)endoscopists and 120(69%)*** frequency of pain in the hand and wrist,and especially the left thumb,was significantly higher in endoscopists than in non-endoscopists(17%vs 6%,P=0.004).Using multivariate analysis,the only significant factor associated with this pain was the age of the endoscopist(odds ratio 2.77,95%confidence interval,1.23-6.71,P=0.018).Interestingly,endoscopists had made significantly fewer modifications to their endoscopic practices than non-endoscopists(12%vs 33%,P <0.0001)to prevent ***:Pain in the hand and wrist may be ***,endoscopists made little modifications in practice to prevent such *** attention to prevention appears necessary.

关键词： Endoscopy Musculoskeletal pain Pain prevention

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Population-based X-ray gastric cancer screening in Hiroshima prefecture, Japan

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World Journal of Clinical Oncology 2024年第2期15卷 271-281页

作者： Nhu Thi Hanh Vu Yuji Urabe Duc Trong Quach Shiro Oka toru hiyama Department of Internal Medicine University of Medicine and Pharmacy at Ho Chi Minh CityHo Chi Minh 700000Viet Nam Department of Endoscopy Hiroshima University HospitalHiroshima 734-8551Japan Department of Gastrointestinal Endoscopy and Medicine Hiroshima University HospitalHiroshima 734-8551Japan Department of Gastroenterology Hiroshima University HospitalHiroshima 734-8551Japan Health Service Center Hiroshima UniversityHigashihiroshima 739-8514Japan

BACKGROUND X-ray gastric cancer(GC)screening has been shown to decrease ***-based X-ray GC screening has been performed in Hiroshima Prefe-cture,Japan,since 1983 but time trends and the efficacy of the method over 39 years have not been *** This was a population-based retrospective *** data were derived from aggregated data of the Hiroshima Regional Health Medical Promotion Organization,including the number and rate of participants and those requiring esophagogastroduodenoscopies(EGDs),the number and rate of participants diagnosed as having GC,and the positive predictive value of the abnormal findings detected by X-ray and confirmed by *** number and rate of esophageal cancers were also ***,the cost of detecting one GC was *** The number of participants has decreased during the last four decades,from 39925 in 1983 to 12923 in *** rate of those requiring EGDs decreased significantly in recent years(P<0.001).The number of participants diagnosed as having GC has also declined,from 76 to 10 ***,the rate of cases diagnosed as GC among the participants remained around 0.1%.The positive predictive value increased significantly in recent years except during *** number and rate of accidentally detected esophageal cancers have risen recently,from 0%in 2008 to 0.02%in 2021,one-fifth of the diagnosis rate of *** GC diagnosis costs approximately 4200000 Japanese Yen(30000 United States Dollars)for the X-ray screenings and *** X-ray GC screening in Hiroshima has been efficient,but one challenge is the *** cancers may also need to be considered because they have gradually increased in recent years.

关键词： Population Retrospective studies X-ray Gastric cancer Screening

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