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World Journal of gastroenterology 2018年第2期24卷 211-215页

作者： Hirohito Mori Hideki Kobara Noriko Nishiyama Tsutomu Masaki departments of gastroenterology and Neurology Kagawa University

AIM To evaluate appropriate and rapid polyglycolic acid sheet(PGAs) covering time using device delivery station system(DDSS).METHODS This pilot basic study was conducted to evaluate the potential of accurate and rapid PGAs delivery using DDSS. Three 11-month-old female Beagle dogs were used in this study. Two endoscopic submucosal dissections(ESDs) 4 cm in diameter were performed in lesser curvature of middle gastric body and greater curvature of antrum(total 6 ESDs performed). DDSS(3 cm length, 12 mm in outer diameter) has 2 chambers which 16 cm^2 large 2 PGAs were stored, and DDSS was attached post ESD ulcers, respectively. Beriplast P?(CSL Behring K.K., Tokyo, Japan)(combination of fibringlue and thrombin) was applied equally to the artificial ulcer, and tight attachment of 2 PGAs with DDSS were completed. The evaluation items were covering times, post ESD bleeding and perforation during *** The covering time of PGAs(defined as the duration from the beginning of endoscope insertion into the mouth to the end of the fibrin glue coating process) was 6.07(4.86-8.29) min. There was no postESD bleeding(1-7 d after ESD), and there was no perforation during *** DDSS was very useful for rapid delivering and tight attachment of PGAs, and has potentials of multipurpose delivery station system.

关键词： Post-endoscopic submucosal dissection ulcers Bleeding Polyglycolic acid sheet Rapidly delivery Tightly attachment

Alanine aminotransferase normalization at week 8 predicts viral response during hepatitis C treatment

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World Journal of gastroenterology 2013年第46期19卷 8678-8686页

作者： Umit Bilge Dogan Mustafa Salih Akin Serkan Yalaki departments of gastroenterology Adana Numune Training and Research Hospital

AIM:To investigate alanine aminotransferase(ALT)and sustained virological response(SVR)in chronic hepatitis C(CHC)during peginterferon-ribavirin ***:One hundred and fifty-one genotype 1CHC patients underwent treatment for 48 wk with peginterferon and ribavirin,and were retrospectively divided into two groups as having a rapid virological response(RVR)(Group 1,n=52)and not having an RVR(Group 2,n=99).We also subdivided each group into two according to the initial ALT level being high(Group1h and Group 2h)or normal(Group 1n and Group 2n).HCV RNA and ALT levels were measured at baseline;at 4,12,24 and 48 wk during the treatment period;and at 24 wk *** levels were also obtained at 8 *** to the results of ALT,patients were enrolled in either the follow-up abnormal or follow-up normalized ALT groups at each *** with high and normal ALT levels were compared for each interval in terms of ***:The SVR rates were 83%vs 40%(P=0.000),82%vs 84%(P=0.830),and 37%vs 44%(P=0.466)when comparing Group 1 with 2,1h with1n,and 2h with 2n,*** Group 2h,the SVR rates were 34%vs 40%(P=0.701),11%vs 52%(P=0.004),12%vs 50%(P=0.007),7%vs 50%(P=0.003),6%vs 53%(P=0.001),and 0%vs 64%(P=0.000)when comparing patients with high and normalized ALT levels at week 4,8,12,24,48 and 72,*** multiple logistic regression analysis revealed that RVR(OR=7.05;95%CI:3.1-16.05,P=0.000),complete early virological response(cEVR)(OR=17.55;95%CI:6.32-48.76,P=0.000),normalization of ALT at8 wk(OR=3.04;95%CI:1.31-7.06,P=0.008),and at 12 wk(OR=4.21;95%CI:1.65-10.76,P=0.002)were identified as independent significant predictive factors for ***:Normalization of ALT at 8 wk may predict viral response during peginterferon-ribavirin treatment in genotype-1 CHC patients especially without RVR.

关键词： Chronic hepatitis C Genotype-1 Alanine aminotransferase Rapid virological response Sustained virological response,Interferon Ribavirin

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

Oval mucosal opening bloc biopsy after incision and widening by ring thread traction for submucosal tumor

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World Journal of gastroenterology 2017年第39期23卷 7185-7190页

作者： Hirohito Mori Hideki Kobara Yu Guan Yasuhiro Goda Nobuya Kobayashi Noriko Nishiyama Tsutomu Masaki Department of gastroenterology and Neurology Kagawa University departments of Pharmacology Kagawa University

Gastric submucosal tumors(SMTs) less than 2 cm are generally considered benign neoplasms, and endoscopic observation is recommended, but SMTs over 2 cm, 40% of which are gastrointestinal stromal tumors(GISTs), have malignant potential. Although the Japanese Guidelines for GIST recommend partial surgical resection for GIST over 2 cm with malignant potential as well as en bloc large tissue sample to obtain appropriate and large specimens of SMTs, several reports have been published on tissue sampling of SMTs, such as with endoscopic ultrasound sound fine needle aspiration, submucosal tunneling bloc biopsy, and the combination of bite biopsy and endoscopic mucosal resection. Because a simpler, more accurate method is needed for appropriate treatment, we developed oval mucosal opening bloc biopsy after incision and widening by ring thread traction for submucosal tumor(OMOB) approach. OMOB was simple and enabled us to obtain large samples under direct procedure view as well as allowed us to restore to original mucosa.

关键词： Gastric submucosal tumors Gastrointestinal stromal tumor Reversible opening biopsy Endoscopic ultrasonography Large sample

Azathioprine-induced fever in autoimmune hepatitis

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World Journal of gastroenterology 2013年第25期19卷 4083-4086页

作者： Tawfik Khoury Jacob E Ollech Shmuel Chen Meir Mizrahi Meir Shalit departments of Internal Medicine Hadassah-Hebrew University Medical Center departments of gastroenterology and Hepatology Gastroenterology and Liver Disease Institute Hadassah-Hebrew University Medical Center Jerusalem

Underdiagnosis of drug-induced fever leads to extensive investigation and prolongation of hospitalization, and may lead to multiple unnecessary invasive procedures and a wrong diagnosis. Azathioprine is a widely used immunosuppressive drug. We report a case of a 53-year-old female patient diagnosed with autoimmune hepatitis treated with azathioprine, who presented to the emergency room with a 6-wk history of fever and chills without other associated symptoms. Since the patient's fever was of unknown origin, she was hospitalized. All treatment was stopped and an extensive workup to explore the source of fever and chills was performed. Results of chest X-ray, viral, urine, and blood cultures, autoimmune serology, transthoracic and transesophageal echocardiography, and abdominal ultrasound revealed no source of infection. A rechallenge test of azathioprine was performed and the fever and chills returned within a few hours. Azathioprine was established as the definite cause following rechallenge. Fever as an adverse drug reaction is often unrecognized. Azathioprine has been reported to cause druginduced fever in patients with inflammatory bowel disease, rheumatoid arthritis, and sarcoidosis. To the bestof our knowledge there have been no previous reports documenting azathioprine-induced fever in patients with autoimmune hepatitis. The occurrence of fever following the readministration of azathioprine suggests the diagnosis of drug-induced fever, particularly after the exclusion of other causes. A careful rechallenge is recommended to confirm the diagnosis.

关键词： Autoimmune hepatitis Adverse drug reactions Azathioprine Drug fever

Accurate hemostasis with a new endoscopic overtube for emergency endoscopy

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World Journal of gastroenterology 2013年第17期19卷 2723-2726页

作者： Hirohito Mori Hideki Kobara Shintaro Fujihara Noriko Nishiyama Makoto Oryu Kazi Rafiq Tsutomu Masaki departments of gastroenterology and Neurology Kagawa Medical University School of Medicine departments of Pharmacology Kagawa Medical University School of Medicine

Endoscopic hemostasis performed in the emergency room is difficult due to the presence of blood clots and food residue that makes obtaining a clear view of the bleeding vessel difficult. We experienced the efficacy of a newly developed inverted overtube to shorten the hemostatic time and obtain a clear endoscopic view with upper gastrointestinal bleeding patient who were transferred by ambulance car and required emergency endoscopy. The technique improved the endoscopic views and enabled us to perform the hemostatic procedures from the conventional standing position while freely and easily changing the patient's position. The presence of blood clots and food residue in the gastric fornix or upper gastric body makes identifying a bleeding exposed vessel impossible. This set-up significantly shortened the procedure time. The inverted overtube helped us obtain a clear view in patients who were laid in the right lateral position. Rapid identification of ex-posed vessels resulted in success of hemostasis.

关键词： Emergency endoscopic hemostasis Right lateral decubitus position Identification of exposed vessel Newly developed inverted overtube Clear endoscopic view

Para-aortic node involvement is not an independent predictor of survival after resection for pancreatic cancer

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World Journal of gastroenterology 2017年第24期23卷 4399-4406页

作者： Cosimo Sperti Mario Gruppo Stella Blandamura Michele Valmasoni Gioia Pozza Nicola Passuello Valentina Beltrame Lucia Moletta departments of Surgery Oncology and Gastroenterology3rd Surgical ClinicUniversity of Padua departments of Medicine section of PathologyUniversity of Padua

To analyze the importance of para-aortic node status in a series of patients who underwent pancreaticoduodenectomy (PD) in a single Institution. METHODSBetween January 2000 and December 2012, 151 patients underwent PD with para-aortic node dissection for pancreatic adenocarcinoma in our Institution. Patients were divided into two groups: patients with negative PALNs (PALNs-), and patients with metastatic PALNs (PALNs+). Pathologic factors, including stage, nodal status, number of positive nodes and lymph node ratio, invasion of para-aortic nodes, tumor’s grading, and radicality of resection were studied by univariate and multivariate analysis. Survival curves were constructed with Kaplan-Meier method and compared with Log-rank test: significance was considered as P < 0.05. RESULTSA total of 107 patients (74%) had nodal metastases. Median number of pathologically assessed lymph nodes was 26 (range 14-63). Twenty-five patients (16.5%) had para-aortic lymph node involvement. Thirty-three patients (23%) underwent R1 pancreatic resection. One-hundred forty-one patients recurred and died for tumor recurrence, one is alive with recurrence, and 9 are alive and free of disease. Overall survival was significantly influenced by grading (P = 0.0001), radicality of resection (P = 0.001), stage (P = 0.03), lymph node status (P = 0.04), para-aortic nodes metastases (P = 0.02). Multivariate analysis showed that grading was an independent prognostic factor for overall survival (P = 0.0001), while grading (P = 0.0001) and radicality of resection (P = 0.01) were prognostic parameters for disease-free survival. Number of metastatic nodes, node ratio, and para-aortic nodes involvement were not independent predictors of disease-free and overall survival. CONCLUSIONIn this experience, lymph node status and para-aortic node metastases were associated with poor survival at univariate analysis, but they were not independent prognostic factors.

关键词： Lymphadenectomy Pancreas Pancreatic cancer Pancreatectomy Lymph node metastasis Para-aortic nodes Survival

Frequency and risk factors of low immunoglobulin levels in patients with inflammatory bowel disease

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gastroenterology Report 2015年第2期3卷 115-121页

作者： Tarun Rai Xianrui Wu Bo Shen departments of General Internal Medicine and gastroenterology/Hepatology the Cleveland Clinic FoundationClevelandOHUSA

Background and aims:Inflammatory bowel diseases(IBD)are considered to be dysregulated,immune-mediated disorders;and immunosuppressive medications are the mainstay of their ***,we have often observed low serum immunoglobulin(Ig)levels in these *** aim of this study was to assess the frequency and risk factors of secondary humoral immunodeficiency in IBD ***:We conducted a cross-sectional study of eligible IBD patients with Crohn’s disease(CD),ulcerative colitis(UC),indeterminate colitis(IC)or restorative proctocolectomy with ileal pouch,who having serum Ig *** and clinical variables were *** and multivariate analyses were ***:A total of 324 patients was included,with a mean age of 38.8 years and 158(48.8%)being *** IgG,IgG1,IgA,and IgM were found in 22.7%,23.4%,7.9%,and 10.9%of patients,*** shared risk factors for a low IgG or IgM level were increasing age[odds ratio(OR)=1.13;95%confidence interval(CI)1.03–1.23 for low IgG level and OR=1.33;95%CI 1.15–1.56 for low IgM level]and hypoalbuminemia(OR=1.83;95%CI 1.01–3.33 for low IgG level and OR=3.17;95%CI 1.23–8.15 for low IgM level).In addition,thioprine use was associated with low IgA level(OR=2.76;95%CI 1.03–7.39).IBD disease duration was a risk factor for low IgG1 level(OR=1.40;95%CI 1.12–1.76).The presence of concurrent primary sclerosing cholangitis(OR=0.064;95%CI 0.007–0.60)and the use of biologics(OR=0.16;95%CI 0.033–0.79)were associated with normal IgG1 *** level was lower in CD patients than that in UC/IC and ileal pouch patients(P=0.042).IgG and IgA levels were elevated in patients with inflammatory conditions of the pouch(P=0.01;P=0.003,respectively).Conclusions:Low Ig level appears to be common in IBD *** age,disease duration and hypoalbuminemia appeared to be risk *** findings may provide rationale for targeted therapy to boost humoral immunity in selected patients with IBD.

关键词： inflammatory bowel disease immunoglobulins biologics Crohn’s disease ulcerative colitis ileal pouch

Two cases of adenocarcinoma occurring in sporadic fundic gland polyps observed by magnifying endoscopy with narrow band imaging

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World Journal of gastroenterology 2016年第40期22卷 9028-9034页

作者： Kazumi Togo Tetsuya Ueo Hirotoshi Yonemasu Hideho Honda Tetsuya Ishida Hiroshi Tanabe Kenshi Yao Akinori Iwashita Kazunari Murakami departments of gastroenterology Oita Red Cross Hospital departments of Pathology Oita Red Cross Hospital Department of Pathology Fukuoka University Chikushi Hospital Department of Endoscopy Fukuoka University Chikushi Hospital Department of gastroenterology Faculty of Medicine Oita University

Gastric fundic gland polyps(FGPs) are common nonadenomatous gastric polyps arising from normal fundic mucosa without Helicobacter pylori(H. pylori) infection. Although systemic FGPs associated with familial adenomatous polyposis(FAP) often have dysplasia, there are few reports of dysplasia occurring in sporadic F G P s, e s p e c i a l l y w h e n d e t e c t e d b y m a g n i f y i n g endoscopy with narrow band imaging(ME-NBI). We experienced two cases of adenocarcinoma occurring in sporadic FGPs, and their ME-NBI findings were very useful for differentiating FGP with cancer from nondysplastic FGP. A 68-year-old man and a 63-year-old woman were referred to our institution for medical checkup. H. pylori was negative in both patients. Endoscopic examination revealed a small reddishpolypoid lesion on the anterior wall of the upper gastric body and several FGPs. ME-NBI showed an irregular microvascular architecture composed of closed loop- or open loop-type vascular components, plus an irregular microsurface structure composed of oval-type surface components which was different from that of FGPs. FAP was denied because of the absence of colon polyps and no familial history of FAP. Pathological diagnosis was adenocarcinoma occurring in sporadic FGP.

关键词： Sporadic type Adenocarcinoma Magnifying endoscopy with narrow band imaging Adenocarcinoma without Helicobacter pylori infection Fundic gland polyp

Gastric schwannoma treated by endoscopic full-thickness resection and endoscopic purse-string suture:A case report

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World Journal of gastroenterology 2021年第25期27卷 3940-3947页

作者： Zhi-Yu Lu Dun-Yong Zhao departments of gastroenterology Institute of DigestiveSouthwest HospitalArmy Military Medical UniversityChongqing 400038China

BACKGROUND Schwannomas,also known as neurinomas,are tumors that derive from Schwann *** schwannomas are extremely rare,but the stomach is the most common *** schwannomas are usually *** and imaging modalities might offer useful preliminary diagnostic ***,to diagnose schwannoma,the immunohistochemical positivity for S-100 protein is essential,whereas CD117,CD34,SMA,desmin,and DOG-1 are *** SUMMARY A 45-year-old female was found to have a gastric mass during a medical examination,which was diagnosed as a gastric *** performed endoscopic full-thickness resection and endoscopic purse-string *** and immunohistochemical staining confirmed the diagnosis of gastric schwannoma through the positivity of S-100 ***,to exclude the misdiagnosis of gastrointestinal stromal tumor,we performed a mutational detection of the c-Kit and PDGFRA *** follow-up revealed that the patient recovered *** Immunohistochemical staining is essential for the diagnosis of *** full-thickness resection is an effective treatment method for gastric schwannoma.

关键词： Gastric schwannoma Endoscopic full-thickness resection Endoscopic pursestring suture Immunohistochemical staining Gene mutational analysis Case report