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Endoscopic submucosal dissection for early esophageal neoplasms using the stag beetle knife

World Journal of Gastroenterology 2018年第15期24卷 1632-1640页

作者： Toshio Kuwai Toshiki Yamaguchi Hiroki Imagawa Ryoichi Miura yuki sumida Takeshi Takasago yuki Miyasako Tomoyuki Nishimura Sumio Iio Atsushi Yamaguchi Hirotaka Kouno Hiroshi Kohno Sauid Ishaq Department of Gastroenterology National Hospital Organization Kure Medical Center and Chugoku Cancer Center Department of Gastroenterology DGH SGU WI Birmingham City University

AIM To determine short-and long-term outcomes of endoscopic submucosal dissection(ESD) using the stag beetle(SB) knife, a scissor-shaped *** Seventy consecutive patients with 96 early esophageal neoplasms, who underwent ESD using a SB knife at Kure Medical Center and Chugoku Cancer Center, Japan, between April 2010 and August 2016, were retrospectively evaluated. Clinicopathological characteristics of lesions and procedural adverse events were assessed. Therapeutic success was evaluated on the basis of en bloc, histologically complete, and curative or non-curative resection rates. Overall and tumor-specific survival, local or distant recurrence, and 3-and 5-year cumulative overall metachronous cancer rates were also *** Eligible patients had dysplasia/intraepithelial neoplasia(22%) or early cancers(squamous cell carcinoma, 78%). The median procedural time was 60 min and on average, the lesions measured 24 mm in diameter, yielding 33-mm tissue defects. The en bloc resection rate was 100%, with 95% and 81% of dissections deemed histologically complete and curative, respectively. All procedures were completed without accidental incisions/perforations or delayed bleeding. During follow-up(mean, 35 ± 23 mo), no local recurrences or metastases were observed. The 3-and 5-year survival rates were 83% and 70%, respectively, with corresponding rates of 85% and 75% for curative resections and 74% and 49% for noncurative resections. The 3-and 5-year cumulative rates of metachronous cancer in the patients with curative resections were 14% and 26%, *** ESD procedures using the SB knife are feasible, safe, and effective for treating early esophageal neoplasms, yielding favorable short-and long-term outcomes.

关键词： Neoplasms Stag beetle knife Esophageal Endoscopic submucosal dissection Outcome measures

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Newly developed self-expandable Niti-S MD colonic metal stent for malignant colonic obstruction

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World Journal of Gastrointestinal Surgery 2020年第4期12卷 138-148页

作者： yuki Miyasako Toshio Kuwai Sauid Ishaq Kanae Tao Hirona Konishi Ryoichi Miura yuki sumida Kazutaka Kuroki Yuzuru Tamaru Ryusaku Kusunoki Atsushi Yamaguchi Hirotaka Kouno Hiroshi Kohno Department of Gastroenterology National Hospital OrganizationKure Medical Center and Chugoku Cancer CenterKure 737-0023Japan Gastroenterology Department Russells Hall HospitalBirmingham City UniversityBirmingham B179BEUnited Kingdom St George’s University University Centre GrenadaWest IndiesGrenada

BACKGROUND Colonic stents are increasingly used to treat acute malignant colonic *** Wall Flex and Niti-S D type stents are the commonly used self-expandable metallic stents available in Japan since *** Flex stent has a risk of stentrelated perforation because of its axial force,while the Niti-S D type stent has a risk of obstructive colitis because of its weaker radial ***-S MD type stents not only overcome these limitations but also permit delivery through highly flexible-tipped smaller-caliber *** To compare the efficacy and safety of the newly developed Niti-S MD type colonic *** This single-center retrospective observational study included 110 patients with endoscopic self-expandable metallic stents placed between November 2011 and December 2018:Wall Flex(Group W,n=37),Niti-S D type(Group N,n=53),and Niti-S MD type(Group MD,n=20).The primary outcome was clinical success,defined as a resolution of obstructive colonic symptoms,confirmed by clinical and radiological assessment within 48 *** secondary outcome was technical success,defined as accurate stent placement with adequate stricture coverage on the first attempt without *** The technical success rate was 100%in Groups W,N,and MD,and the overall clinical success rate was 89.2%(33/37),96.2%(51/53),and 100%(20/20)in Groups W,N,and MD,*** adverse events included pain(3/37,8.1%),poor expansion(1/37,2.7%),and fever(1/37,2.6%)in Group W and perforation due to obstructive colitis(2/53,3.8%)in Group N(likely due to poor expansion).Late adverse events(after 7 d)included stent-related perforations(4/36,11.1%)and stent occlusion(1/36,2.8%)in Group W and stent occlusion(2/51,3.9%)in Group *** stent-related perforation rate in Group W was significantly higher than that in Group N(P<0.05).No adverse event was observed in Group *** In our early and limited experience,the newly developed Niti-S MD type colonic stent was effective

关键词： Colonic stenting New endoscopic colonic stent Malignant colonic obstruction Niti-S WallFlex

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Gastric and enteric anisakiasis successfully treated with Gastrografin therapy: A case report

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World Journal of Gastrointestinal Endoscopy 2018年第3期10卷 69-73页

作者： Hiroki Fujikawa Toshio Kuwai Toshiki Yamaguchi Ryoichi Miura yuki sumida Takeshi Takasago yuki Miyasako Tomoyuki Nishimura Sumio Iio Hiroki Imagawa Atsushi Yamaguchi Hirotaka Kouno Hiroshi Kohno Department of Gastroenterology National Hospital OrganizationKure Medical Center and Chugoku Cancer Center

We report a case of a 59-year-old woman who was diagnosed with gastric and small intestinal anisakiasis, which was successfully treated with endoscopic extraction and Gastrografin therapy. She was admitted to our hospital with epigastric pain and vomiting one day after eating raw fish. She exhibited tenderness in the epigastrium without obvious rebound tenderness or guarding. Computed tomography (CT) demonstrated segmental edema of the intestinal wall with proximal dilatation and a small number of ascites. Because enteric anisakiasis was suspected based on the patient's history of recent raw fish consumption and abdominal CT, we performed gastroscopy and confirmed that nine Anisakis larvae were attached to the gastric mucosa. All of the Anisakis larvae were extracted via endoscopy, and the patient was diagnosed with gastric and enteric anisakiasis. Additionally, in the hospital, we performed ileography twice using Gastrografin, which led to shortened hospital stay. Based on the clinical results of this case, we suggest that Gastrografin therapy is a safe, convenient, and useful method to extract enteric Anisakis larvae.

关键词： Enteric anisakiasis Gastrografin Ileus Endoscopic extraction Anisakis larvae

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