Faculty Profiles - KOUNO Yoshiyasu

Risk Factors for Gastric Cancer after the Eradication of Helicobacter pylori Evaluated Based on the Background Gastric Mucosa: A Propensity Score-matched Case-control Study.

Yuka Obayashi, Seiji Kawano, Hiroyuki Sakae, Makoto Abe, Yoshiyasu Kono, Hiromitsu Kanzaki, Masaya Iwamuro, Yoshiro Kawahara, Takehiro Tanaka, Hiroyuki Yanai, Hiroyuki Okada

Internal medicine (Tokyo, Japan) 60 ( 7 ) 969 - 976 2021.4

Language：English Publishing type：Research paper (scientific journal) Publisher：JAPAN SOC INTERNAL MEDICINE

Objective The eradication of Helicobacter pylori (H. pylori) reduces the risk for gastric cancer (GC) development, but it cannot prevent GC completely. We investigated the risk factors of early GC development after the eradication of H. pylori, based on the histological characteristics of gastric mucosa. Methods Sixty-one patients who underwent endoscopic submucosal dissection for early GC after successful H. pylori eradication (Group A) and 122 patients without developing a gastric neoplasm over 3 years after successful H. pylori eradication (Group B) were analyzed. We compared the histological findings of the patients enrolled in Group A and Group B before and after the propensity score-matching. Results Comparing the characteristics of two the groups, Group A consisted predominantly of males, had significantly more elderly patients, and the years after successful eradication tended to be longer. We performed score matching for these three factors to reduce the influence of any confounding factors. After matching, the scores of inflammation for Group A (n=54) was significantly higher than those of Group B (n=54) at the greater curvature of the antrum, the lesser curvature of the corpus, and the greater curvature of the corpus. According to a multivariate analysis, inflammation of the greater curvature of the antrum and lesser curvature of the corpus were found to be independent risk factors. The risk ratio and 95% CI were 5.92 (2.11-16.6) (p<0.01), and 3.56 (1.05-13.2) (p=0.04), respectively. Conclusion A continuous high level of inflammation of the background gastric mucosa may be a risk factor for gastric cancer onset after H. pylori eradication.

DOI： 10.2169/internalmedicine.5486-20

Association Between Immune-Related Adverse Events and the Prognosis of Patients with Advanced Gastric Cancer Treated with Nivolumab. International journal

Yoshiyasu Kono, Yasuhiro Choda, Masahiro Nakagawa, Koji Miyahara, Michihiro Ishida, Tetsushi Kubota, Keiji Seo, Tetsu Hirata, Yuka Obayashi, Tatsuhiro Gotoda, Yuki Moritou, Yoshiko Okikawa, Yasuo Iwamoto, Hiroyuki Okada

Targeted oncology 16 ( 2 ) 237 - 248 2021.3

Language：English Publishing type：Research paper (scientific journal) Publisher：SPRINGER

BACKGROUND: Little is known about the association between immune-related adverse events (irAEs) and the efficacy and survival outcomes of nivolumab in patients with advanced gastric cancer (AGC). OBJECTIVE: The present study examined the association between irAEs and the prognosis of patients with AGC treated with nivolumab. PATIENTS AND METHODS: From July 2017 to November 2020, patients who had been diagnosed with advanced unresected gastric cancer and treated with nivolumab at our institution were included in this analysis. We compared the clinical and survival outcomes between the irAE and non-irAE groups. We also evaluated the factors associated with better survival in patients treated with nivolumab. RESULTS: A total of 52 patients were included in the present study, and irAEs were observed in 13 (25%). Among the patients with measurable lesions (n = 29), the disease control rates were significantly higher in the irAE group than in the non-irAE group (88 vs. 24%; P = 0.0033). At the 8- and 12-week landmark analyses, the median overall survival (OS) in the irAE group was significantly longer than that in the non-irAE group, whereas the median progression-free survival was comparable between the groups. A multivariate analysis by Cox proportional hazard regression at the 8-week landmark revealed that the development of irAEs (hazard ratio 0.18; 95% confidence interval 0.0099-0.86) alone was positively associated with a longer OS. CONCLUSIONS: The development of irAEs might be associated with survival outcomes with nivolumab treatment in patients with AGC.

DOI： 10.1007/s11523-021-00790-w

[Clinical characteristics of five patients with gastric emphysema].

Masaya Iwamuro, Makoto Abe, Yoshiyasu Kono, Hiromitsu Kanzaki, Keisuke Hori, Seiji Kawano, Yoshiro Kawahara, Hiroyuki Okada

Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology 118 ( 9 ) 851 - 858 2021

Language：Japanese Publishing type：Research paper (scientific journal)

Gastric emphysema is a rare condition in which gas from a nonbacterial source accumulates within the gastric wall. In this study, we retrospectively analyzed the cases of five patients who were diagnosed with gastric emphysema at the Okayama University Hospital between January 2010 and April 2021, to reveal the clinical features of the disease. Based on their reviews, we revealed that:i) gastric emphysema occurred in hospitalized bedridden patients (n=5), such as those during/after endotracheal intubation (n=3), those undergoing gastric tube placement (n=3), those undergoing percutaneous endoscopic gastrostomy (n=1), and those undergoing treatment for cerebral infarction (n=1);ii) gastric emphysema was accompanied by the accumulation of gas in the portal (n=4) or gastric veins (n=1);iii) gastric emphysema was accompanied by colon wall thickness increase (n=4);iv) esophagogastroduodenoscopy showed redness, erosions, coarse mucosa, and/or ulcers (n=5);v) a clear boundary between the damaged area and the intact mucosa was observed (n=5);vi) the anterior wall of the stomach was less affected (n=4);vii) mucosal damage was predominant in the gastric folds, whereas the furrow of the mucosa was less affected;and viii) treatment with enteral nutrition suspension and the administration of proton pump inhibitors and antibiotics resulted in the recovery of patients from gastric emphysema (n=5). These results indicate that patients with gastric emphysema have distinct clinical, endoscopic, and radiological features. Furthermore, our results show that these patients can be conservatively managed.

DOI： 10.11405/nisshoshi.118.851

Reality of Gastric Cancer in Young Patients: The Importance and Difficulty of the Early Diagnosis, Prevention and Treatment.

Yoshiyasu Kono, Hiromitsu Kanzaki, Masaya Iwamuro, Seiji Kawano, Yoshiro Kawahara, Hiroyuki Okada

Acta medica Okayama 74 ( 6 ) 461 - 466 2020.12

Language：English Publishing type：Research paper (scientific journal) Publisher：OKAYAMA UNIV MED SCHOOL

Gastric cancer usually arises in middle-aged to older patients, and is rarely found in younger patients. The clin-ical characteristics, etiology, prognosis, preventive methods and treatment of gastric cancer in young patients have not been fully investigated because of its low prevalence. In this review, we discuss the current under-standing and clinical problems associated with gastric cancer in young patients. Helicobacter pylori (H. pylori), which is a major cause of gastric cancer, especially in older populations, is closely associated with gastric cancer in young patients as well as in older patients. Gastric cancer in young patients tends to be diagnosed at an advanced stage with alarm symptoms. However, young patients with advanced gastric cancer tend to have a favorable general condition and organ function, so they can tolerate intensive systematic chemotherapy. Unfortunately, the prognosis of gastric cancer in young patients with an advanced stage is not favorable. We should not take this rare disease lightly, given its poor prognosis if patients are diagnosed at an unresectable stage. The evaluation of the H. pylori infection status and performance of H. pylori eradication therapy to prevent gastric cancer in young patients as well as the development of more intensive chemotherapy regimens for unre-sectable gastric cancer in young patients are warranted.

DOI： 10.18926/AMO/61204

Current evidence and issues of endoscopic submucosal dissection for gastric neoplasms during antithrombotic therapy.

Yoshiyasu Kono, Issei Hirata, Tetsuya Katayama, Hisahiro Uemura, Tetsu Hirata, Tatsuhiro Gotoda, Koji Miyahara, Yuki Moritou, Masahiro Nakagawa

Clinical journal of gastroenterology 13 ( 5 ) 650 - 659 2020.10

Language：English Publishing type：Research paper (scientific journal) Publisher：SPRINGER JAPAN KK

Endoscopic submucosal dissection (ESD) for gastric neoplasms is a useful treatment globally. However, postoperative bleeding after gastric ESD is a serious, and sometimes life-threatening complication in patients receiving antithrombotic drugs, because antithrombotic drugs are considered to increase the risk of postoperative bleeding after gastric ESD. In contrast, withdrawal of antithrombotic drugs during the perioperative period increases the risk of thrombotic complications. Guidelines for the management of antithrombotic drugs during the periendoscopic period have been published by different countries, and recent guidelines place greater emphasis on the risk of thromboembolism with the discontinuation of antithrombotic drugs than on the risk of bleeding with the continuation of antithrombotic drugs. Several studies have reported on the validity of these guidelines, and clinical evidence is being established. Most studies reported that gastric ESD under continuation of aspirin or cilostazol did not increase the risk of bleeding, whereas heparin replacement was strongly associated with a higher risk of bleeding. However, the data regarding some clinical issues about the management of antithrombotic drugs, such as the safety of gastric ESD under continuation of thienopyridine, administration of multiple antithrombotic drugs including dual antiplatelet and anticoagulants (warfarin and direct oral anticoagulant), and effective prophylactic methods for postoperative bleeding after gastric ESD are lacking. Larger clinical data are needed to resolve the remaining issues in the future.

DOI： 10.1007/s12328-020-01171-y

A case of esophagitis induced by apixaban. International journal

Yoshiyasu Kono, Koji Miyahara, Masahiro Nakagawa

Journal of gastrointestinal and liver diseases : JGLD 29 ( 3 ) 471 - 471 2020.9

Acetic Acid Spray With Narrow-Band Imaging Is Useful to Clarify the Margin of Sessile Serrated Adenoma/Polyp. International journal

Kana Onishi, Yoshiyasu Kono, Reiji Higashi

The American journal of gastroenterology 115 ( 8 ) 1160 - 1160 2020.8

Successful treatment of primary gastric follicular lymphoma with radiotherapy

Kana Onishi, Reiji Higashi, Yoshiyasu Kono, Yuki Moritou, Kouji Miyahara, Masaki Kunihiro, Yasuhiro Shiote, Kouichi Ichimura, Masahiro Nakagawa

Gastroenterological Endoscopy 62 ( 7 ) 771 - 777 2020.7

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Japan Gastroenterological Endoscopy Society

A 74-year-old woman was referred to our institute after undergoing a medical checkup during which barium meal examination identified the presence of wall irregularity at the greater curvature of the gastric body. Esophagogastroduodenoscopy (EGD) revealed an elevated submucosal tumor (SMT) -like lesion of 20 mm, and subsequent endoscopic ultrasonography showed a heterogeneous hypoechoic mass of 15 mm in diameter with clear borders in the second layer. Boring biopsy showed follicular and nodular lymphatic proliferations composed of small to medium-sized cells. Histopathological and immunohistochemical analyses resulted in the diagnosis of follicular lymphoma Grade 1. Imaging studies revealed Lugano Classification Stage Ⅰ. Radiotherapy at 30 Gy to the entire stomach was carried out, and EGD confirmed the presence of only a residual white scar at the corresponding location two months later. Event-free survival of one and one-half years has been observed at the time of this writing.

DOI： 10.11280/gee.62.771

Scopus

Clinical Characteristics and Risk Factors for Rebleeding in Patients with Obscure Gastrointestinal Bleeding.

Yuki Baba, Seiji Kawano, Yoshiyasu Kono, Toshihiro Inokuchi, Hiromitsu Kanzaki, Masaya Iwamuro, Keita Harada, Sakiko Hiraoka, Yoshiro Kawahara, Hiroyuki Okada

Internal medicine (Tokyo, Japan) 59 ( 11 ) 1345 - 1350 2020.6

Language：English Publishing type：Research paper (scientific journal)

Objective With the advent of capsule endoscopy (CE) and double-balloon endoscopy (DBE), the diagnosis and treatment of obscure gastrointestinal bleeding (OGIB) have markedly progressed. However, rebleeding sometimes occurs and is difficult to diagnose and treat. The aim of the present study was to investigate the clinical features of OGIB and risk factors for rebleeding in our hospital. Methods A total of 195 patients who underwent CE and/or DBE for OGIB in our hospital from January 2009 to July 2016 were included in the present study. We analyzed 168 cases of small intestinal OGIB, after excluding 27 cases of extra small intestinal bleeding. The clinical characteristics and risk factors related to rebleeding were retrospectively studied. Results Among the 168 patients who were included in the analysis, 95 patients (56.5%) were male. The mean age was 64.5 years (range, 8 to 87 years). Hypertension (31.0%) was the most frequent comorbidity, followed by chronic kidney disease (19.0%). The final diagnoses were ulcerative lesions (n=50, 29.8%), vascular lesions (n=30, 17.9%), tumors (n=7, 4.2%), and diverticula (n=2, 1.2%). The bleeding source was undetermined in the remaining 79 cases (47.0%). Rebleeding was confirmed in 29 cases (17.3%). In a univariate analysis, chronic kidney disease, vascular lesions, and overt previous bleeding were significantly associated with the risk of rebleeding. A multivariate analysis showed that chronic kidney disease, vascular lesion, and overt previous bleeding were significantly associated with the risk of rebleeding. Conclusion Patients with OGIB with overt previous bleeding, vascular lesions, and/or chronic kidney disease had a higher risk of rebleeding.

DOI： 10.2169/internalmedicine.3628-19

Evaluation of the Usefulness and Convenience of the Kyoto Classification of Gastritis in the Endoscopic Diagnosis of the Helicobacter pylori Infection Status. International journal

Hiroyuki Sakae, Masaya Iwamuro, Yuki Okamoto, Yuka Obayashi, Yuki Baba, Kenta Hamada, Tatsuhiro Gotoda, Makoto Abe, Yoshiyasu Kono, Hiromitsu Kanzaki, Seiji Kawano, Yoshiro Kawahara, Takehiro Tanaka, Hiroyuki Yanai, Hiroyuki Okada

Digestion 101 ( 6 ) 771 - 778 2020

Language：English Publishing type：Research paper (scientific journal) Publisher：KARGER

BACKGROUND/AIMS: The Kyoto Classification of Gastritis was published in 2014. Although this classification is now widely used in Japan, its usefulness and convenience have not been sufficiently evaluated. This study aimed to evaluate the usefulness and convenience of this classification in the endoscopic diagnosis of Helicobacter pylori infection. METHODS: We made a test for the endoscopic diagnosis of H. pylori infection comprising 30 cases who had representative endoscopic features of non-, active, or inactive gastritis. Thirty-eight participants took the test before and after a brief mini-lecture on the Kyoto Classification of Gastritis. Eighteen participants took the test again 3 months later. We investigated the accuracy before, just after, and 3 months after the mini-lecture. RESULTS: The accuracy of endoscopists after the lecture was significantly improved in comparison to before the lecture (77.6 vs. 83.3%). Medical students also showed significantly improved accuracy after the lecture (56.7 vs. 71.7%). Among endoscopists, this improvement was maintained after 3 months. Before the lecture, the accuracy of diagnosing non-gastritis was 90.3%; it tended to be further improved 3 months later (96.5%). A >10% point increase was observed in diagnosing active (72.7-83.3%) and inactive gastritis (73.2-84.3%) at 3 months after the lecture in comparison to before the lecture. CONCLUSION: A brief mini-lecture on the Kyoto Classification of Gastritis improved the accuracy in the endoscopic diagnosis of gastritis, indicating that understanding this classification is useful for the prompt diagnosis of H. pylori infection during esophagogastroduodenoscopy.

DOI： 10.1159/000502573

Underwater endoscopic mucosal resection for a colonic polyp located at the scar after endoscopic band ligation. International journal

Yoshiyasu Kono, Tetsuya Katayama, Koji Miyahara, Yuki Moritou, Reiji Higashi, Masaki Kunihiro, Masahiro Nakagawa

Endoscopy 51 ( 7 ) E181-E182 - E182 2019.7

A multicenter observational study on the clinicopathological features of gastric cancer in young patients.

Yoshiyasu Kono, Hiromitsu Kanzaki, Takao Tsuzuki, Masahiro Takatani, Junichirou Nasu, Daisuke Kawai, Ryuta Takenaka, Takehiro Tanaka, Masaya Iwamuro, Seiji Kawano, Yoshiro Kawahara, Toshiyoshi Fujiwara, Hiroyuki Okada

Journal of gastroenterology 54 ( 5 ) 419 - 426 2019.5

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: The details of gastric cancer in young patients remain unclear because of the low prevalence of the disease. This study aimed to clarify the clinicopathological features and prognosis of gastric cancer in young patients. METHODS: From January 2007 to January 2016, patients in their 20s and 30s who were diagnosed with primary gastric cancer at 4 hospitals were enrolled. Their clinical characteristics and prognosis were evaluated. RESULTS: The total number of patients was 72. The median age was 36 years, and the ratio of males to females was 1:1. The dominant histological type was undifferentiated type (66/72, 92%). Helicobacter pylori (H. pylori) was positive in 81% (54/67). Although there were some asymptomatic patients in stages I-III, all stage IV patients had some clinical symptoms at the diagnosis. The percentage of stage IV was significantly higher in patients in their 20s than in those in their 30s (75% vs. 25%, P < 0.001). The Kaplan-Meier method showed that the overall survival of patients in their 20s was significantly lower than that of patients in their 30s (P = 0.037). CONCLUSIONS: A high rate of H. pylori infection was revealed in young gastric cancer patients. The patients in their 20s had a worse prognosis than those in their 30s. We should consider examining the H. pylori infection status for young patients as well as older patients to identify high-risk populations.

DOI： 10.1007/s00535-018-1525-4

Intramucosal gastric cancer on the prepylorus completely resected by underwater endoscopic mucosal resection. International journal

Hisahiro Uemura, Yoshiyasu Kono, Masahiro Nakagawa

Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 31 ( 3 ) 332 - 332 2019.5

A case of celecoxib-induced multiple ulcers of the small intestine observed on capsule endoscopy

Yuki Aoyama, Sakuma Takahashi, Tomoki Inaba, Mariko Colvin, Shigenao Ishikawa, Masaki Wato, Yoshiyasu Kono, Seiji Kawano, Akinobu Takaki, Hiroyuki Okada

Gastroenterological Endoscopy 60 ( 10 ) 2297 - 2302 2018.10

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Japan Gastroenterological Endoscopy Society

The patient was a 75-year-old man with melena. Capsule endoscopy revealed colonic diverticular bleeding as well as 2-to 3-mm erosions scattered in the small intestine. The colonic diverticular bleeding was treated by endoscopic clipping. Two months later, administration of celecoxib was started for knee pain. Nine months later, black stools and iron-deficiency anemia were observed, and multiple ulcers were found in the intestine on capsule endoscopy. The patient was diagnosed as having nonsteroidal anti-inflammatory drug-induced small intestinal ulcer. The cele-coxib therapy was discontinued, and administration of misoprostol, rebamipide, and polaprezinc was started. Capsule endoscopy performed three months after starting the treatment demonstrated improvement of the ulcers. Celecoxib is a cyclooxygenase-2 (COX-2) selective inhibitor and is considered to confer a low risk of mucosal injury, but the risk of mucosal injury may increase with chronic administration of celecoxib or combination therapy with a proton pump inhibitor. Therefore, careful attention should be paid to patients who are being treated with celecoxib.

DOI： 10.11280/gee.60.2297

Scopus

Underwater endoscopic mucosal resection for gastric polyp. International journal

Yoshiyasu Kono, Hiroyuki Sakae, Hiroyuki Okada

Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 30 ( 4 ) 525 - 525 2018.7

The Combination Use of an Acetic Acid Indigo Carmine Mixture and Linked-Color Imaging to Detect Early Gastric Cancer. International journal

Yoshiyasu Kono, Yoshiro Kawahara, Hiroyuki Okada

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association 16 ( 6 ) e61 2018.6

On going OGIBに対する安全な緊急ダブルバルーン内視鏡止血術成功への取り組み

川野誠司, 岡本雄貴, 大林由佳, 榮浩行, 安部真, 後藤田達洋, 河野吉泰, 井口俊博, 神崎洋光, 岩室雅也, 河原祥朗, 岡田裕之

Gastroenterological Endoscopy 60 ( Suppl.1 ) 686 - 686 2018.4

超高齢者の早期胃癌に対するESDの安全性と有効性に関する検討

後藤田達洋, 川野誠司, 岡本雄貴, 馬場雄己, 大林由佳, 安部真, 河野吉泰, 神崎洋光, 岩室雅也, 田中健大, 河原祥朗, 岡田裕之

日本高齢消化器病学会誌 20 ( 2 ) 57 - 63 2018.3

Language：Japanese Publisher：(NPO)日本高齢消化器病学会

高齢化社会の進展とともに85歳以上の超高齢者に対し胃ESDを行う機会が増加している。2009年9月から2016年6月に75歳以上の高齢者に対して当科でESDを施行した早期胃癌340例を対象とし、高齢者群(75歳以上85歳未満)、超高齢者群(85歳以上)の2群に分類し、両群における安全性と有効性を比較検討した。併存疾患、麻酔関連合併症発生率、偶発症発生率において両群間に有意差は認めず、85歳以上の超高齢者においてもESDの安全性が示唆された。病理組織学的な根治性評価および3年生存率において有意差はなく、ESDの有効性に関して超高齢者においても良好な成績が得られていた。胃ESDは超高齢者においても高齢者と同等の安全性、有効性が期待される。(著者抄録)

Postoperative bleeding risk after gastric endoscopic submucosal dissection during antithrombotic drug therapy. International journal

Yoshiyasu Kono, Yuka Obayashi, Yuki Baba, Hiroyuki Sakae, Tatsuhiro Gotoda, Ko Miura, Hiromitsu Kanzaki, Masaya Iwamuro, Seiji Kawano, Yoshiro Kawahara, Takehiro Tanaka, Hiroyuki Okada

Journal of gastroenterology and hepatology 33 ( 2 ) 453 - 460 2018.2

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND AND AIM: The safety of gastric endoscopic submucosal dissection (ESD) in the antithrombotic drug users remains controversial. METHODS: Patients who underwent gastric ESD at Okayama University Hospital between March 2006 and February 2016 were enrolled. This study investigated the risk of post-ESD bleeding according to the management of the antithrombotic drugs. RESULTS: One thousand twenty lesions (872 patients) were enrolled. In a multivariate analysis, heparin replacement (odds ratio [OR] 5.0, 95% confidence interval [CI] 1.8-14), multiple antithrombotic drug use (OR 2.9, 95% CI 1.1-6.9), a resected specimen of ≥ 33 mm in diameter (OR 2.7, 95% CI 1.5-5.4), Helicobacter pylori negativity (OR 2.2, 95% CI 1.3-3.7), and tumors located in the lower third of the stomach (OR 1.7, 95% CI 1.0-2.9) were significant risk factors for post-ESD bleeding, while the continuation of aspirin or cilostazol was not (OR 2.6, 95% CI 0.72-7.8). The bleeding rate of the continuation group was comparable with that of the all cessation group among single antithrombotic drug users (4.5% vs 4.4%, P = 1.0); however, the rate of the continuation group was significantly higher than that of the all cessation group among multiple antithrombotic drug users (67% vs 15%, P = 0.020). CONCLUSIONS: The risk of post-ESD bleeding differed according to the management of the antithrombotic drugs. The gastric ESD under the cessation or continuation of aspirin or cilostazol monotherapy was acceptable. However, multiple antithrombotic drug use or heparin replacement was associated with a higher risk of post-ESD bleeding.

DOI： 10.1111/jgh.13872