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Perforation associated with endoscopic submucosal dissection for duodenal neoplasm without a papillary portion

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World Journal of Gastrointestinal Surgery 2017年第7期9卷 161-166页

作者： Yasuhiro Matsuda Kazuki Sakamoto Naoki Kataoka Tomoyuki Yamaguchi Masafumi Tomita Shinichiro Makimoto Department of Surgery Kishiwada Tokushukai HospitalKishiwada CityOsaka 596-8522Japan

AIM To investigate predictors of perforation after endoscopic resection(ER) for duodenal neoplasms without a papillary *** This was a single-center, retrospective, cohort study conducted between April 2003 and September 2014. A total of 54 patients(59 lesions) underwent endoscopic mucosal resection(EMR)(n = 36) and endoscopic submucosal dissection(ESD)(n = 23). Clinical features, outcomes, and predictors of perforation were *** Cases of perforation occurred in eight(13%) patients(95%CI: 4.7%-22.6%). Three ESD cases required sur-gical management because they could not be repaired by clipping. Delayed perforation occurred in two ESD cases, which required surgical management, although both patients underwent prophylactic clipping. All patients with perforation who required surgery had no postoperative complications and were discharged at anaverage of 13.2 d after ER. Perforation after ER showed a significant association with a tumor size greater than20 mm(P = 0.014) and ESD(P = 0.047).CONCLUSION ESD for duodenal neoplasms exceeding 20 mm may be associated with perforation. ESD alone is not recom-mended for tumor treatment, and LECS should be con-sidered as an alternative.

关键词： Duodenal neoplasm Endoscopic submucosal dissection Laparoscopic and endoscopic cooperative surgery

Usefulness of a novel slim type Flush Knife-BT over conventional Flush Knife-BT in esophageal endoscopic submucosal dissection

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World Journal of Gastroenterology 2017年第9期23卷 1657-1665页

作者： Yoshiko Ohara Takashi Toyonaga Namiko Hoshi Shinwa Tanaka Shinichi Baba Hiroshi Takihara Fumiaki Kawara Tsukasa Ishida Yoshinori Morita Eiji Umegaki Takeshi Azuma Division of Gastroenterology Department of Internal MedicineGraduate School of MedicineKobe University Department of Endoscopy Kobe University Hospital Department of Endoscopy Kishiwada Tokushukai Hospital

To investigated the usefulness of a novel slim type ball-tipped FlushKnife (FlushKnife-BTS) over ball-tipped FlushKnife (FlushKnife-BT) in functional experiments and clinical *** order to evaluate the functionality of FlushKnife-BTS, water aspiration speed, resistance to knife insertion through the scope, and waterjet flushing speed were compared between FlushKnife-BTS and BT. In clinical practice, esophageal endoscopic submucosal dissection (ESD) performed using FlushKnife-BTS or BT by an experienced endoscopist between October 2015 and January 2016 were retrospectively reviewed. The treatment speed and frequency of removing and reinserting the knife to aspirate fluid and air during ESD sessions were *** experiments revealed that water aspiration speed by the endoscope equipped with a 2.8-mm working channel with FlushKnife-BTS was 7.7-fold faster than that with conventional FlushKnife-BT. Resistance to knife insertion inside the scope with a 2.8-mm working channel was reduced by 40% with FlushKnife-BTS. The waterjet flushing speed was faster with the use of FlushKnife-BT. In clinical practice, a comparison of 6 and 7 ESD using FlushKnife-BT and BTS, respectively, revealed that the median treatment speed was 25.5 mm2/min (range 19.6-30.3) in the BT group and 44.2 mm2/min (range 15.5-55.4) in the BTS group (P = 0.0633). However, the median treatment speed was significantly faster with FlushKnife-BTS when the resection size was larger than 1000 m2 (n = 4, median 24.2 mm2/min, range 19.6-27.7 vs n = 4, median 47.4 mm2/min, range 44.2-55.4, P = 0.0209). The frequency of knife replacement was less in the BTS group (median 1.76 times in one hour, range 0-5.45) than in the BT group (7.02 times in one hour, range 4.23-15) (P = 0.0065).CONCLUSIONOur results indicate that FlushKnife-BTS enhances the performance of ESD, particularly for large lesions, by improving air and fluid aspirat

关键词： Endoscopic submucosal dissection Novel slim type ball-tipped FlushKnife Ball-tipped FlushKnife Resistance to knife insertion Water aspiration speed

Efficacy of forced coagulation with low high-frequency power setting during endoscopic submucosal dissection

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World Journal of Gastroenterology 2017年第29期23卷 5422-5430页

作者： Tsukasa Ishida Takashi Toyonaga Yoshiko Ohara Tadao Nakashige Yasuaki Kitamura Ryusuke Ariyoshi Hiroshi Takihara Shinichi Baba Tetsuya Yoshizaki Fumiaki Kawara Shinwa Tanaka Yoshinori Morita Eiji Umegaki Namiko Hoshi Takeshi Azuma Division of Gastroenterology Department of Internal Medicine Graduate School of Medicine Kobe University Department of Endoscopy Kobe University Hospital Department of Endoscopy Kishiwada Tokushukai Hospital

To investigated the hemostatic ability of the S and F1-10 methods in clinical and ex vivo studies. METHODSThe hemostatic abilities of the two methods were analyzed retrospectively in all six gastric endoscopic submucosal dissection cases. The treated vessel diameter, compressed vessel frequency, and bleeding frequency after cutting the vessels were noted by the recorded videos. The coagulation mechanism of the two power settings was evaluated using the data recording program and histological examination on macro- and microscopic levels in the ex vivo experiments using porcine tissues. RESULTSF1-10 method showed a significantly better hemostatic ability for vessels ≥ 2 mm in diameter and a trend of overall better coagulation effect, evaluated by the bleeding rate after cutting the vessels. F1-10 method could sustain electrical current longer and effectively coagulate the tissue wider and deeper than the S method in the porcine model. CONCLUSIONF1-10 method is suggested to achieve a stronger hemostatic effect than the S method in clinical procedures and ex vivo models.

关键词： Endoscopic submucosal dissection Electrosurgery Endoknife Hemostatic effect The forced coagulation mode

Pancreatectomy and splenectomy for a splenic aneurysm associated with segmental arterial mediolysis

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World Journal of Gastrointestinal Surgery 2015年第5期7卷 78-81页

作者： Yasuhiro Matsuda Kazuki Sakamoto Eisei Nishino Naoki Kataoka Tomoyuki Yamaguchi Masafumi Tomita Arito Kazi Masahiro Shinozaki Shinichiro Makimoto Department of Surgery Kishiwada Tokushukai Hospital Department of Pathology Kishiwada Tokushukai Hospital Department of Emergency and Critical Care Medical Center Kishiwada Tokushukai Hospital

Segmental arterial mediolysis(SAM) is characterized by intra-abdominal, retroperitoneal bleeding or bowel ischemia, and the etiology is unknown. A 44-year-old man complaining of abdominal pain was admitted to our hospital. He had been admitted for a left renal infarction three days earlier and had a past medical history of cerebral aneurysm with spontaneous remission. The ruptured site of the splenic arterial aneurysm was clear via a celiac angiography, and we treated it using trans-arterial embolization. Unfortunately, the aneurysm reruptured after two weeks, and we successfully treated it with distal pancreatomy and splenectomy. We recommended a close follow-up and prompt radiological or surgical intervention because SAM can enlarge rapidly and rupture.

关键词： Re-rupture Segmental arterial mediolysis Trans-arterial embolization Spontaneous remission Splenic artery aneurysm

Reactive lymphoid hyperplasia of the liver:Perinodular enhancement on contrast-enhanced computed tomography and magnetic resonance imaging

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World Journal of Gastroenterology 2015年第21期21卷 6759-6763页

作者： Tetsuo Sonomura Shinpei Anami Taizo Takeuchi Motoki Nakai Shinya Sahara Hirohiko Tanihata Kazuki Sakamoto Morio Sato Department of Radiology Wakayama Medical University Department of Radiology Kishiwada Tokushukai Hospital Department of Surgery Kishiwada Tokushukai Hospital

We report the case of a 69-year-old woman with reactive lymphoid hyperplasia(RLH) of the *** underwent partial hepatectomy under a preoperative diagnosis of hepatocellular carcinoma; however,histopathological analysis revealed *** liver nodule showed the imaging feature of perinodular enhancement in the arterial dominant phase on contrast-enhanced computed tomography and magnetic resonance imaging,which could be a useful clue for identifying RLH in the ***,the perinodular enhancement was compatible with prominent sinusoidal dilatation surrounding the liver nodule.

关键词： Reactive lymphoid hyperplasia Liver Perinodular enhancement Computed tomography Magnetic resonance imaging

Emergency balloon-occluded retrograde transvenous obliteration of ruptured gastric varices

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World Journal of Gastroenterology 2013年第31期19卷 5125-5130页

作者： Tetsuo Sonomura Wataru Ono Morio Sato Shinya Sahara Kouhei Nakata Hiroki Sanda Nobuyuki Kawai Hiroki Minamiguchi Motoki Nakai Kazushi Kishi Department of Radiology Wakayama Medical University Wakayama 641-8510 Japan Department of Gastroenterology Kishiwada Tokushukai Hospital Kishiwada 596-8522 Japan Department of Radiology Kishiwada Tokushukai Hospital Kishiwada 596-8522 Japan

AIM: To evaluate the effectiveness and safety of emergency balloon-occluded retrograde transvenous obliteration(BRTO) for ruptured gastric ***: Emergency BRTO was performed in 17 patients with gastric varices and gastrorenal or gastrocaval shunts within 24 h of hematemesis and/or tarry *** gastric varices were confirmed by endoscopy,and the gastrorenal or gastrocaval shunts were identified by contrast-enhanced computed tomography(CE-CT).A 6-Fr balloon catheter(Cobra type) was inserted into the gastrorenal shunt via the right internal jugular vein,or into the gastrocaval shunt via the right femoral vein,depending on the varices drainage *** sclerosant,5% ethanolamine oleate iopamidol,was injected into the gastric varices through the catheter during balloon *** patients with incom plete thrombosis of the varices after the first BRTO,a second BRTO was performed the following *** were followed up by endoscopy and CE-CT at 1 d,1 wk,and 1,3 and 6 mo after the procedure,and every 6 mo ***: Complete thrombosis of the gastric varices was not achieved with the first BRTO in 7/17 patients because of large gastric *** patients underwent a second BRTO on the next day,and additional sclerosant was injected through the *** thrombosis which led to disappearance of the varices was achieved in 16/17 patients,while the remaining patient had incomplete thrombosis of the *** of the patients experienced rebleeding or recurrence of the gastric varices after a median follow-up of 1130 d(range 8-2739 d).No major complications occurred after the ***,esophageal varices worsened in 5/17 patients after a mean follow-up of 8.6 ***: Emergency BRTO is an effective and safe treatment for ruptured gastric varices.

关键词： Emergency balloon-occluded retrograde transvenous obliteration Gastric varices Bleeding Portal hypertension Ethanolamine oleate

Intraperitoneal chemotherapy and its evolving role in management of gastric cancer with peritoneal metastases

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Chinese Journal of Cancer Research 2014年第1期26卷 1-3页

作者： Emel Canbay Yutaka Yonemura Bjorn Brucher Seung Hyuk Baik Paul H.Sugarbaker NPO HIPEC ISTANBUL Akkavak Sokak No:4/2NisantasiIstanbul 34365Turkey Ethica Incirli hospital NPO to support Peritoneal Dissemination Treatment 1-26 HarukimotomachiKishiwada CityOsaka 596-8522Japan NPO HIPEC ISTANBUL Akkavak Sokak No:4/2NisantasiIstanbul 34365Turkey NPO to support Peritoneal Dissemination Treatment 1-26HarukimotomachiKishiwada CityOsaka 596-8522Japan Department of General Surgery Kusatsu General Hospital Department of General Surgery Kishiwada Tokushukai Hospital Department of Peritoneal Surface Malignancy Bon Secours Cancer Institute Deparment of General Surgery Yonsei University College of Medicine Center for Gastrointestinal Malignancies Program in Peritoneal Surface OncologyMedStar Washington Hospital CenterNWPOB North Tower 3900 WashingtonDC 20010USA

Advanced gastric cancer （GC） has been recognized as lethal disease when peritoneal metastases （PM） *** is no standard treatment for advanced GC with *** 1980s,the therapeutic arena for these patients had remained stagnant,with no therapeutic approach having shown a survival gain in GC with ***,cytoreductive surgery （CRS） with peritonectomy procedures and intraperitoneal chemotherapy （IPC） promising new combined therapeutic approach to achieve disease control for GC with *** recent publications changed the GC with PM treatment landscape by providing an evidence that CRS and IPC led to prolongation in overall survival （OS）.This review will provide an overview of the evolving role of CRS and IPC in the management of advanced GC with PM in the current era.

关键词： Gastric cancer (GC) peritoneal carcinomatosis intraperitoneal and systemic induction chemotherapy cytoreductive surgery (CRS) hyperthermic intraperitoneal chemotherapy (IPC)

Delayed esophageal perforation occurring with endoscopic submucosal dissection:A report of two cases

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World Journal of Gastrointestinal Surgery 2015年第7期7卷 123-127页

作者： Yasuhiro Matsuda Naoki Kataoka Tomoyuki Yamaguchi Masafumi Tomita Kazuki Sakamoto Shinichiro Makimoto Department of Surgery Kishiwada Tokushukai Hospital

We report two cases of delayed esophageal perforation occurring with endoscopic submucosal dissection. Our cases involved delayed perforation after 10 d in case 1 and after 6 d in case 2. Both cases were related to solid food. We performed subtotal esophagectomy with gastric tube reconstruction of the esophagus via the subcutaneous route anterior to the thoracic wall without conservative treatment because both cases involved chest pain and major leakage of food into the mediastinum. Postoperative complications were a local factor(including suture failure and esophageal stricture) in case 1, and we performed endoscopic balloon dilatation five times for esophageal stricture. There was no intrathoracic and mediastinal infection in either case. Surgical treatment for delayed esophageal perforation can be performed safely and surely if diagnosis and assessment are not delayed.

关键词： Esophageal cancer Endoscopic submucosaldissection Delayed perforation

A case of very large intrahepatic bile duct adenoma followed for 7 years

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World Journal of Clinical Oncology 2012年第4期3卷 63-66页

作者： Futa Koga Hiroto Tanaka Seigo Takamatsu Shinnichi Baba Hiroshi Takihara Akioko Hasegawa Eri Yanagihara Taro Inoue Toshihiro Nakano Chie Ueda Wataru Ono The Department of Gastroenterology Kishiwada Tokushukai Hospital

A 70-year-old man was referred to our hospital due to abnormal liver function. A tumor of 92 mm × 61 mm was detected on ultrasound screening of the left liver lobe. Although the tumor was suspected to be intrahepatic bile duct carcinoma, he had chronic heart disease and was unable to undergo surgery. Therefore, he was followed without further testing. No increase in tumor serum markers or tumor size was observed for the subsequent 7 years. We continued to suspect intrahepatic bile duct carcinoma, and we decided to perform a tumor biopsy. Tumor biopsy findings indicated intrahepatic bile duct adenoma(BDA), which is a rare benign epithelial liver tumor typically ranging from 1 mm to20 mm. We herein report a case of very large BDA followed for 7 years.

关键词： Intrahepatic bile duct adenoma Large tumor Differential diagnosis Benign liver tumor