Faculty Profiles - KOUNO Yoshiyasu

Papers - KOUNO Yoshiyasu

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Clinical outcome of patients with obscure gastrointestinal bleeding during antithrombotic drug therapy. International journal

Yoshiyasu Kono, Seiji Kawano, Yuki Okamoto, Yuka Obayashi, Yuki Baba, Hiroyuki Sakae, Makoto Abe, Tatsuhiro Gotoda, Toshihiro Inokuchi, Hiromitsu Kanzaki, Masaya Iwamuro, Yoshiro Kawahara, Hiroyuki Okada

Therapeutic advances in gastroenterology 11 1756283X17746930 2018

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

Background: The clinical outcome of patients with obscure gastrointestinal bleeding (OGIB) during antithrombotic drug therapy has not been fully investigated. Methods: Patients who underwent video capsule endoscopy (VCE) for the investigation of OGIB at Okayama University Hospital from January 2009 to March 2016 were enrolled. We evaluated the VCE findings, the patterns of OGIB, and the rate of rebleeding within 1 year in antithrombotic drug users and antithrombotic drug nonusers. Results: A total of 181 patients were enrolled. Among the antithrombotic drug users, the rate of VCE positivity in the patients with overt OGIB was significantly higher in comparison with patients with occult OGIB (45% versus 16%, p = 0.014), whereas there was no significant difference among the antithrombotic drug nonusers (27% versus 26%, p = 1.0). Among the antithrombotic drug users, the rate of rebleeding among the VCE-positive patients was significantly higher in comparison with the VCE-negative patients (50% versus 5.9%, p = 0.011). Moreover, among antithrombotic drug users who did not receive therapeutic intervention, the rate of rebleeding among the VCE-positive patients was significantly higher in comparison with the VCE-negative patients (75% versus 6.3%, p = 0.001). However, among the antithrombotic drug nonusers who did not receive therapeutic intervention, the rebleeding rate of the VCE-positive patients was not significantly different from that of the VCE-negative patients (20% versus 9.4%, p = 0.43). Conclusion: Therapeutic intervention should be considered for patients with overt OGIB who are VCE positive and who use antithrombotic drugs due to the high risk of rebleeding.

DOI： 10.1177/1756283X17746930

Linked color imaging (LCI), a novel image-enhanced endoscopy technology, emphasizes the color of early gastric cancer. International journal

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

Endoscopy international open 5 ( 10 ) E1005-E1013 2017.10

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

Background and study aims: Linked color imaging (LCI) and blue laser imaging (BLI) are novel image-enhanced endoscopy technologies with strong, unique color enhancement. We investigated the efficacy of LCI and BLI-bright compared to conventional white light imaging (WLI) by measuring the color difference between early gastric cancer lesions and the surrounding mucosa. Patients and methods: Images of early gastric cancer scheduled for endoscopic submucosal dissection were captured by LCI, BLI-bright, and WLI under the same conditions. Color values of the lesion and surrounding mucosa were defined as the average of the color value in each region of interest. Color differences between the lesion and surrounding mucosa (ΔE) were examined in each mode. The color value was assessed using the CIE L*a*b* color space (CIE: Commission Internationale d'Eclairage). Results: We collected images of 43 lesions from 42 patients. Average ΔE values with LCI, BLI-bright, and WLI were 11.02, 5.04, and 5.99, respectively. The ΔE was significantly higher with LCI than with WLI ( P < 0.001). Limited to cases of small ΔE with WLI, the ΔE was approximately 3 times higher with LCI than with WLI (7.18 vs. 2.25). The ΔE with LCI was larger when the surrounding mucosa had severe intestinal metaplasia ( P = 0.04). The average color value of a lesion and the surrounding mucosa differed. This value did not have a sufficient cut-off point between the lesion and surrounding mucosa to distinguish them, even with LCI. Conclusion: LCI had a larger ΔE than WLI. It may allow easy recognition and early detection of gastric cancer, even for inexperienced endoscopists.

DOI： 10.1055/s-0043-117881

Clinicopathological features of gastric cancer in young patients; Multicenter retrospective study

Yoshiyasu Kono, Hiromitsu Kanzaki, Masahiro Takatani, Junichirou Nasu, Ryuta Takenaka, Hiroyuki Sakae, Ko Miura, Takehiro Tanaka, Shunsuke Kagawa, Hiroyuki Okada

ANNALS OF ONCOLOGY 28 2017.10

早期胃癌に対するLCI(linked color image)とAIM色素を併用した画像強調内視鏡(IEE)の有用性

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

Gastroenterological Endoscopy 59 ( Suppl.2 ) 2132 - 2132 2017.9

Evaluation of the bleeding risk with various antithrombotic therapies after gastric endoscopic submucosal dissection. International journal

Tatsuhiro Gotoda, Keisuke Hori, Masaya Iwamuro, Yoshiyasu Kono, Kou Miura, Hiromitsu Kanzaki, Seiji Kawano, Yoshiro Kawahara, Hiroyuki Okada

Endoscopy international open 5 ( 7 ) E653-E662 2017.7

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

BACKGROUND AND STUDY AIMS : Patients receiving antithrombotic drugs have a higher risk of postoperative bleeding and thromboembolic events related to endoscopic procedures. The aim of this study was to evaluate the relationship between various antithrombotic therapies and bleeding after gastric endoscopic submucosal dissection (ESD) (post-ESD bleeding). PATIENTS AND METHODS: Among 529 consecutive gastric ESD procedures (483 patients with 579 legions), 100 patients with 121 lesions who underwent 108 procedures were on antithrombotic therapy (group A) and 382 patients with 458 lesions who underwent 421 procedures were not on antithrombotic therapy (group B). The ratio of post-ESD bleeding between the two groups and the bleeding risk related to various antithrombotic therapies were investigated. RESULTS : Postoperative bleeding was more frequent in group A (11.1 %) than in group B (3.3 %). No thromboembolic events were reported in either group. Further investigation of antithrombotic therapies in group A demonstrated that various combinations of antithrombotic agents and heparin replacement were associated with a higher ratio of post-ESD bleeding. Multivariate analyses revealed that dual antiplatelet therapy (odds ratio [OR] 10.9, 95 % confidence interval [CI] 2.1 - 49.5; P = 0.005) and heparin replacement (OR 34.4, 95 %CI 9.4 - 133.2; P < 0.001) were associated with the increased risk of post-ESD bleeding. In patients on antiplatelet therapy, post-ESD bleeding tended to occur in the early postoperative period compared with patients on anticoagulant therapy. CONCLUSIONS: It is necessary to be cautious regarding post-ESD bleeding in patients requiring antithrombotic therapy, especially patients receiving dual antiplatelet therapy and heparin replacement. A further prospective study with a large sample will be needed to confirm these findings.

DOI： 10.1055/s-0043-110050

Citrobacter braakii bacteremia-induced septic shock after colonoscopy preparation with polyethylene glycol in a critically ill patient: a case report. Reviewed International journal

Tetsuya Yumoto, Yoshiyasu Kono, Seiji Kawano, Chihiro Kamoi, Atsuyoshi Iida, Motoko Nose, Keiji Sato, Toyomu Ugawa, Hiroyuki Okada, Yoshihito Ujike, Atsunori Nakao

Annals of clinical microbiology and antimicrobials 16 ( 1 ) 22 - 22 2017.4

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

BACKGROUND: Polyethylene glycol (PEG) is widely used for bowel cleaning in preparation for colonoscopy because of its safety. Septic shock after PEG preparation is an extremely rare complication. Herein, we describe a case of septic shock that occurred immediately after colonoscopy preparation with PEG. CASE PRESENTATION: A 75-year-old Japanese male who had previously developed diabetes after total pancreatectomy received PEG in preparation for colonoscopy. He had been admitted to the emergency intensive care unit 4 days earlier due to hematochezia presenting with shock. He ingested PEG to prepare for a colonoscopy examination, which was performed to identify the source of his bleeding over a 5-h period, but suddenly exhibited septic shock and markedly elevated procalcitonin levels. A blood culture subsequently revealed Citrobacter braakii. Immediate resuscitation and intensive care with appropriate antibiotics improved his condition. CONCLUSIONS: Clinicians should be aware of the possibility of deteriorating conditions after bowel preparation with PEG among severely ill patients with recent episodes of hemorrhagic shock.

DOI： 10.1186/s12941-017-0201-5

Erratum to: Multicenter Prospective Study on the Safety of Upper Gastrointestinal Endoscopic Procedures in Antithrombotic Drug Users. International journal

Yoshiyasu Kono, Minoru Matsubara, Tatsuya Toyokawa, Ryuta Takenaka, Seiyu Suzuki, Junichirou Nasu, Masao Yoshioka, Masahiro Nakagawa, Motowo Mizuno, Hiroyuki Sakae, Makoto Abe, Tatsuhiro Gotoda, Ko Miura, Hiromitsu Kanzaki, Masaya Iwamuro, Keisuke Hori, Takao Tsuzuki, Masahide Kita, Seiji Kawano, Yoshiro Kawahara, Hiroyuki Okada

Digestive diseases and sciences 62 ( 4 ) 1101 - 1102 2017.4

Multicenter Prospective Study on the Safety of Upper Gastrointestinal Endoscopic Procedures in Antithrombotic Drug Users. International journal

Yoshiyasu Kono, Minoru Matsubara, Tatsuya Toyokawa, Ryuta Takenaka, Seiyu Suzuki, Junichirou Nasu, Masao Yoshioka, Masahiro Nakagawa, Motowo Mizuno, Hiroyuki Sakae, Makoto Abe, Tatsuhiro Gotoda, Ko Miura, Hiromitsu Kanzaki, Masaya Iwamuro, Keisuke Hori, Takao Tsuzuki, Masahide Kita, Seiji Kawano, Yoshiro Kawahara, Hiroyuki Okada

Digestive diseases and sciences 62 ( 3 ) 730 - 738 2017.3

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

BACKGROUND: The Japan Gastroenterological Endoscopy Society updated its guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment in July 2012. However, the safety of endoscopic procedures in antithrombotic drug users has not been fully investigated. AIMS: To evaluate the safety of upper gastrointestinal endoscopic procedures in antithrombotic drug users. METHODS: From September 2013 to September 2015, patients who were taking antithrombotic drugs and who underwent upper gastrointestinal endoscopic procedures were prospectively enrolled at five hospitals. Incidences of bleeding and thrombosis during endoscopic procedures were evaluated. RESULTS: A total of 270 patients [221 for endoscopic mucosal biopsy and 49 for endoscopic mucosal resection (EMR)/endoscopic submucosal dissection (ESD) were enrolled. The bleeding rate was 0.9% for endoscopic mucosal biopsy and 22% for EMR/ESD, respectively. The bleeding rate after endoscopic mucosal biopsy was not significantly high, even if antithrombotic drugs were continued (0 vs. 1%, P > 0.99), while it was significantly higher among multiple antithrombotic drug users than single drug users (5.9 vs. 0%, P < 0.05). The bleeding rate after EMR/ESD was also higher among multiple antithrombotic drug users than single drug users, but was not significantly different (33 vs. 14%, P = 0.17). Moreover, there were no differences in bleeding rates according to the cessation or continuance of antithrombotic drugs (20 vs. 25%, P = 0.74). There were no thromboembolisms in all cases. CONCLUSIONS: Upper gastrointestinal endoscopic procedures performed under the new guidelines appear acceptable. However, endoscopic procedures among multiple antithrombotic drug users show a greater potential for bleeding.

DOI： 10.1007/s10620-016-4437-2

Oxidative stress controlling agents are effective for small intestinal injuries induced by non-steroidal anti-inflammatory drugs. International journal

Yoshiyasu Kono, Seiji Kawano, Akinobu Takaki, Yasuyuki Shimomura, Masahiro Onji, Hisashi Ishikawa, Sakuma Takahashi, Joichiro Horii, Sayo Kobayashi, Daisuke Kawai, Kazuhide Yamamoto, Hiroyuki Okada

Journal of gastroenterology and hepatology 32 ( 1 ) 136 - 145 2017.1

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

BACKGROUND AND AIM: Video-capsule endoscopy (VCE) has shown that intestinal ulcers are common in non-steroidal anti-inflammatory drugs (NSAIDs) users, although the mechanisms and management have not been clearly defined. To explore the contribution of oxidative stress and potential of anti-oxidants for NSAIDs-induced intestinal ulcers, we assessed human serum oxidative stress balance and the effect of anti-oxidants using a mouse model. METHODS: A total of 30 NSAIDs users (17 aspirin and 13 non-aspirin users) received VCE. Serum reactive oxygen metabolite (d-ROM) and antioxidative OXY-adsorbent test (OXY) were measured. The indomethacin (IND)-induced mouse intestinal ulcer model was used to assess the effect of anti-oxidants. Eight-week-old mice were divided into four groups; control diet and diet including IND (N group), IND and L-carnitine (NC group), and IND and vitamin E (NE group). RESULTS: Serum OXY levels among non-aspirin users were lower in the mucosal injuries positive group than the negative group (P < 0.05). In the mouse models, the degree of mucosal injuries was lower in NC and NE than N (P < 0.01). Serum d-ROM levels were lower in NC and NE than N (P < 0.01), and OXY levels were higher in NC than N and NE (P < 0.01). The degeneration of intestinal mitochondria was mild in NC and NE. The serum KC/CXCL-1 level and hepatic expression of the anti-oxidant molecule Gpx4 were lower in NC than N. CONCLUSIONS: Non-aspirin NSAID-induced intestinal ulcers are related to decreased anti-oxidative stress function. Anti-oxidants, especially L-carnitine, are good candidates for intestinal ulcers.

DOI： 10.1111/jgh.13424

Corrigendum to "Safety and Efficacy of Small Bowel Examination by Capsule Endoscopy for Patients before Liver Transplantation". International journal

Seiji Kawano, Akinobu Takaki, Masaya Iwamuro, Tetsuya Yasunaka, Yoshiyasu Kono, Kou Miura, Toshihiro Inokuchi, Yoshiro Kawahara, Yuzo Umeda, Takahito Yagi, Hiroyuki Okada

BioMed research international 2017 6418529 - 6418529 2017

Safety and Efficacy of Small Bowel Examination by Capsule Endoscopy for Patients before Liver Transplantation. International journal

Kawano Seiji, Takaki Akinobu, Iwamuro Masaya, Yasunaka Tetsuya, Kono Yoshiyasu, Miura Kou, Inokuchi Toshihiro, Kawahara Yoshiro, Umeda Yuzo, Yagi Takahito, Okada Hiroyuki

BioMed research international 2017 8193821 - 8193821 2017

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

Background and Aims. Gastrointestinal surveillance is a requirement prior to liver transplantation (LT), but small intestine examination is not generally undertaken. The aim of the present study was to evaluate the safety and efficacy of capsule endoscopy (CE) for patients with end-stage liver disease. Methods. 31 patients who needed LT were enrolled, and 139 patients who underwent CE over the same period of time acted as controls. Results. Frequency of successful achievement of evaluation of the full length of the small bowel, the mean gastric transit time, and the mean small bowel transit time were not significantly different between the two groups. Abnormalities in the small bowel were found in 26 patients. Comparative analysis revealed that history of EV rupture, history of EV treatment, red color sign of EV, and presence of PHG or HCC were significantly associated with patients with >2 two such findings (high score group). Conclusions. Small bowel examination by CE in patients before liver transplantation could be performed safely and is justified by the high rate of abnormal lesions detected particularly in patients with history of EV therapy or bleeding, red color sign, and presence of PHG or HCC. This study was registered in the UMIN Clinical Trial Registry (UMIN 000008672).

DOI： 10.1155/2017/8193821

胃癌内視鏡治療後に適応外病変と診断された症例の転帰ならびにその長期成績

三浦公, 神崎洋光, 榮浩行, 後藤田達洋, 河野吉泰, 岩室雅也, 川野誠司, 河原祥朗, 田中健大, 岡田裕之

Gastroenterological Endoscopy 58 ( Suppl.2 ) 1917 - 1917 2016.10

Propofol sedation with a target-controlled infusion pump and bispectral index monitoring system in elderly patients during a complex upper endoscopy procedure. International journal

Tatsuhiro Gotoda, Hiroyuki Okada, Keisuke Hori, Yoshiro Kawahara, Masaya Iwamuro, Makoto Abe, Yoshiyasu Kono, Kou Miura, Hiromitsu Kanzaki, Masahide Kita, Seiji Kawano, Kazuhide Yamamoto

Gastrointestinal endoscopy 83 ( 4 ) 756 - 64 2016.4

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

BACKGROUND AND AIMS: Although the usefulness of propofol sedation during endoscopic submucosal dissection (ESD) for gastric neoplasms was reported previously, information is limited on its use in elderly patients. We investigated the safety and efficacy of propofol sedation with a target-controlled infusion (TCI) pump and bispectral index (BIS) monitoring system (TCI/BIS system) in elderly patients during gastric ESD. METHODS: Included were 413 consecutive gastric ESD procedures involving 455 lesions (379 patients) performed in patients under propofol sedation with a TCI/BIS system between October 2009 and September 2013. Patients were divided into 3 groups: group A, age <70 years (n = 162); group B, age ≥70 and <80 years (n = 171); and group C, age ≥80 years (n = 80). We compared the propofol dose and adverse events (eg, hypotension and hypoxemia) during ESD. RESULTS: Older groups required a lower target concentration of propofol (group A: median 2.1 μg/mL [interquartile range (IQR), 1.9-2.3]; group B: median 1.6 μg/mL [IQR, 1.3-1.8]; and group C: median 1.4 μg/mL [IQR, 1.2-1.6]; P < .0001). Hypotension tended to occur in the younger group, and hypoxemia occurred at a significantly higher rate in the older groups, although the number of cases was small. Low preoperative systolic blood pressure (≤125 mm Hg) was associated with hypotension (odds ratio [OR], 1.73; 95% confidence interval [CI], 1.12-2.70; P = .013) and abnormal pulmonary function was associated with hypoxemia in groups B and C (OR, 4.54; 95% CI, 1.01-31.5; P = .048). CONCLUSIONS: Elderly patients required lower doses of propofol with the TCI/BIS system than younger patients. Attention to hypoxemia is necessary in elderly patients, particularly patients with abnormal pulmonary function.

DOI： 10.1016/j.gie.2015.08.034

Does Helicobacter pylori Exacerbate Gastric Mucosal Injury in Users of Nonsteroidal Anti-Inflammatory Drugs? A Multicenter, Retrospective, Case-Control Study. International journal

Yoshiyasu Kono, Hiroyuki Okada, Ryuta Takenaka, Ko Miura, Hiromitsu Kanzaki, Keisuke Hori, Masahide Kita, Takao Tsuzuki, Seiji Kawano, Yoshiro Kawahara, Kazuhide Yamamoto

Gut and liver 10 ( 1 ) 69 - 75 2016.1

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

BACKGROUND/AIMS: The interaction between nonsteroidal anti-inflammatory drugs (NSAIDs) and Helicobacter pylori remains controversial. We retrospectively investigated whether H. pylori infection exacerbates severe gastric mucosal injury among chronic NSAID users. METHODS: From January 2010 to December 2013, a total of 245 long-term NSAID (including low-dose aspirin) users who had undergone an esophagogastroduodenoscopy and had been evaluated for H. pylori infection were enrolled at Okayama University Hospital and Tsuyama Chuo Hospital. The degree of gastric mucosal injury was assessed according to the modified Lanza score (MLS). Severe gastric mucosal injury was defined as an MLS ≥4. Univariate and multivariate logistic regression analyses were performed. RESULTS: In the univariate analysis, age ≥75 years (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.3 to 4.2), H. pylori-positivity (OR, 2.0; 95% CI, 1.2 to 3.5), and the concomitant use of proton pump inhibitors (PPIs) (OR, 0.48; 95% CI, 0.26 to 0.86) were significantly associated with severe gastric mucosal injury. The multivariate analysis was adjusted by age and sex and demonstrated that H. pylori-positivity (OR, 1.8; 95% CI, 1.0 to 3.3) and the concomitant use of PPIs (OR, 0.53; 95% CI, 0.28 to 0.99) significantly contributed to severe gastric mucosal injury. CONCLUSIONS: H. pylori infection exacerbates severe gastric mucosal injury among chronic NSAID users.

DOI： 10.5009/gnl14372

Long-term survival of two patients with esophageal neuroendocrine carcinoma who underwent multidisciplinary therapy

Gotoda Tatsuhiro, Kawano Seiji, Kono Yoshiyasu, Miura Kou, Kanzaki Hiromitsu, Iwamuro Masaya, Kawahara Yoshiro, Tanaka Takehiro, Yoshino Tadashi, Shirakawad Yasuhiro, Tabata Masahiro, Tanimoto Mitsune, Okada Hiroyuki

Okayama Igakkai Zasshi (Journal of Okayama Medical Association) 128 ( 3 ) 207 - 212 2016

Language：Japanese Publisher：Okayama Medical Association

Esophageal neuroendocrine carcinoma (ECC) is rare and has a poor prognosis when presenting with vascular invasion and distant metastasis from an early stage. Multidisciplinary therapy with surgery, chemotherapy, and radiation therapy may prolong survival in patients with advanced ECC, but there is as yet no standard therapy for advanced ECC. We treated two patients who have achieved long-term survival (> 4 years) who underwent multidisciplinary therapy, including chemotherapy, for ECC. Our experience with these two cases suggests that multidisciplinary therapy, including chemotherapy, may be effective for treating ECC at an advanced stage.

DOI： 10.4044/joma.128.207

Polycythemia vera diagnosed after esophageal variceal rupture

Yoshiyasu Kono, Akinobu Takaki, Hideo Gobara, Ken Ichi Matsuoka, Masato Nishino, Hiroyuki Okada, Kazuhide Yamamoto

Internal Medicine 54 ( 18 ) 2395 - 2399 2015.9

Publishing type：Research paper (scientific journal)

Polycythemia vera (PV) is a chronic myeloproliferative neoplasm that leads to hyperviscosity and the risk of thrombosis. We encountered the case of a young male Filipino patient diagnosed with PV after the rupture of esophageal varices. The complete blood cell count showed a slight increase in white blood cells. An abdominal computed tomography scan disclosed splenomegaly and occlusion of the portal vein and collateral vessels. A blood examination demonstrated an increase in all three blood cell lines within three months. Based on the presence of severe hypercellularity of the bone marrow and positivity for the JAK2V617F mutation, we finally diagnosed the patient with PV.

DOI： 10.2169/internalmedicine.54.4687

A Randomized Trial of Monopolar Soft-mode Coagulation Versus Heater Probe Thermocoagulation for Peptic Ulcer Bleeding. International journal

Tomokazu Nunoue, Ryuta Takenaka, Keisuke Hori, Noriko Okazaki, Kenta Hamada, Yuki Baba, Yasushi Yamasaki, Yoshiyasu Kono, Hiroyuki Seki, Toshihiro Inokuchi, Koji Takemoto, Akihiko Taira, Hirofumi Tsugeno, Shigeatsu Fujiki, Yoshiro Kawahara, Hiroyuki Okada

Journal of clinical gastroenterology 49 ( 6 ) 472 - 6 2015.7

Language：English Publishing type：Research paper (scientific journal) Publisher：LIPPINCOTT WILLIAMS & WILKINS

BACKGROUND AND AIM: Endoscopic therapy has been demonstrated to be effective in achieving hemostasis for bleeding peptic ulcers. Thermal coagulation is one of the most commonly used methods, with a high success rate. Recently, endoscopic submucosal dissection for early gastric carcinoma was developed and hemostasis with soft coagulation using hemostatic forceps was introduced. The aim of this study was to compare the hemostatic efficacy of soft coagulation with heater probe thermocoagulation for peptic ulcer bleeding. METHODS: Patients who visited our hospital with hematemesis or melena underwent emergency endoscopy. Inclusion criteria were presentation with an actively bleeding ulcer, a nonbleeding visible vessel, or an adherent clot. Patients were excluded if they were unwilling to give written informed consent or had a bleeding gastric malignancy. Patients were randomized to receive endoscopic hemostasis with soft coagulation (Group S) or heater probe thermocoagulation (Group H). The primary endpoint was the primary hemostasis rate and secondary endpoints were rebleeding rate, complications, and the procedure time. RESULTS: Between May 2010 and February 2012, a total of 111 patients (89 gastric ulcers and 22 duodenal ulcers) were enrolled. Primary hemostasis was achieved in 54 patients (96%) in Group S and 37 (67%) in Group H (P<0.0001). Rebleeding occurred in 7 patients in Group H and none in Group S. Of these 7 patients, urgent surgery was performed in 1. Perforation occurred in 2 patients in Group H, which was managed conservatively. CONCLUSIONS: For patients with gastroduodenal ulcer bleeding, soft coagulation using monopolar hemostatic forceps is more effective than heater probe thermocoagulation for achieving hemostasis.

DOI： 10.1097/MCG.0000000000000190

Intramucosal gastric mixed adenoneuroendocrine carcinoma completely resected with endoscopic submucosal dissection.

Yasushi Yamasaki, Junichiro Nasu, Kou Miura, Yoshiyasu Kono, Hiromitsu Kanzaki, Keisuke Hori, Takehiro Tanaka, Masahide Kita, Takao Tsuzuki, Minoru Matsubara, Seiji Kawano, Yoshiro Kawahara, Masahiro Tabata, Hiroyuki Okada, Kazuhide Yamamoto

Internal medicine (Tokyo, Japan) 54 ( 8 ) 917 - 20 2015

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

Composite tumors in the stomach composed of adenocarcinoma and neuroendocrine carcinoma are rare. We herein report a case of intramucosal gastric mixed adenoneuroendocrine carcinoma (MANEC) that was treated with endoscopic submucosal dissection (ESD). A 77-year-old man who had previously received ESD for early gastric adenocarcinoma underwent esophagogastroduodenoscopy for screening, which showed a depressed lesion on the lesser curvature of the antrum. The tumor was removed en bloc via ESD and pathologically diagnosed as MANEC. The tumor was located within the mucosal layer, and no lymphovascular invasion was evident. Seven months after the ESD procedure, the patient is currently feeling well without recurrence or metastasis.

DOI： 10.2169/internalmedicine.54.3469

Monopolar Soft-Mode Coagulation Using Hemostatic Forceps for Peptic Ulcer Bleeding

Yasushi Yamasaki, Ryuta Takenaka, Tomokazu Nunoue, Yoshiyasu Kono, Koji Takemoto, Akihiko Taira, Hirofumi Tsugeno, Shigeatsu Fujiki

HEPATO-GASTROENTEROLOGY 61 ( 136 ) 2272 - 2276 2014.11

Language：English Publishing type：Research paper (scientific journal) Publisher：H G E UPDATE MEDICAL PUBLISHING S A

Background/Aims: Upper gastrointestinal hemorrhage from bleeding peptic ulcer is sometimes difficult to treat by conventional endoscopic methods. Recently, monopolar electrocoagulation using a soft-coagulation system and hemostatic forceps (soft coagulation) has been used to prevent bleeding during endoscopic submucosal dissection. The aim of this study was to assess the safety and efficacy of soft coagulation in the treatment of bleeding peptic ulcer. Methodology: A total of 39 patients with peptic ulcers were treated using soft coagulation at our hospital between January 2005 and March 2010. Emergency treatment employed an ERBE soft-mode coagulation system using hemostatic forceps. Second-look endoscopy was performed to evaluate the efficacy of prior therapy. Initial hemostasis was defined as accomplished by soft coagulation, with or without other endoscopic therapy prior to soft coagulation. The rate of initial hemostasis, rebleeding, and ultimate hemostasis were retrospectively analyzed. Results: The study subjects were 31 men and 8 women with a mean age of 68.3 +/- 13.7 years, with 29 gastric ulcers and 10 duodenal ulcers. Initial hemostasis was achieved in 37 patients (95%). During follow-up, bleeding recurred in two patients, who were retreated with soft coagulation. Conclusions: The monopolar soft coagulation is feasible and safe for treating bleeding peptic ulcers.

DOI： 10.5754/hge13780

Chromoendoscopy of gastric adenoma using an acetic acid indigocarmine mixture. International journal

Yoshiyasu Kono, Ryuta Takenaka, Yoshiro Kawahara, Hiroyuki Okada, Keisuke Hori, Seiji Kawano, Yasushi Yamasaki, Koji Takemoto, Takayoshi Miyake, Shigeatsu Fujiki, Kazuhide Yamamoto

World journal of gastroenterology 20 ( 17 ) 5092 - 7 2014.5

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

AIM: To investigate the usefulness of chromoendoscopy, using an acetic acid indigocarmine mixture (AIM), for gastric adenoma diagnosed by forceps biopsy. METHODS: A total of 54 lesions in 45 patients diagnosed as gastric adenoma by forceps biopsy were prospectively enrolled in this study and treated by endoscopic submucosal dissection (ESD) between January 2011 and January 2012. AIM-chromoendoscopy (AIM-CE) was performed followed by ESD. AIM solution was sprinkled and images were recorded every 30 s for 3 min. Clinical characteristics such as tumor size (< 2 cm, ≥ 2 cm), surface color in white light endoscopy (WLE) (whitish, normochromic or reddish), macroscopic appearance (flat or elevated, depressed), and reddish change in AIM-CE were selected as valuables. RESULTS: En bloc resection was achieved in all 54 cases, with curative resection of fifty two lesions (96.3%). Twenty three lesions (42.6%) were diagnosed as well-differentiated adenocarcinoma and the remaining 31 lesions (57.4%) were gastric adenoma. All adenocarcinoma lesions were well-differentiated tubular adenocarcinomas and were restricted within the mucosal layer. The sensitivity of reddish color change in AIM-CE is significantly higher than that in WLE (vs tumor size ≥ 2 cm, P = 0.016, vs normochromic or reddish surface color, P = 0.046, vs depressed macroscopic type, P = 0.0030). On the other hand, no significant differences were found in the specificity and accuracy. In univariate analysis, normochromic or reddish surface color in WLE (OR = 3.7, 95%CI: 1.2-12, P = 0.022) and reddish change in AIM-CE (OR = 14, 95%CI: 3.8-70, P < 0.001) were significantly related to diagnosis of early gastric cancer (EGC). In multivariate analysis, only reddish change in AIM-CE (OR = 11, 95%CI: 2.3-66, P = 0.0022) was a significant factor associated with diagnosis of EGC. CONCLUSION: AIM-CE may have potential for screening EGC in patients initially diagnosed as gastric adenoma by forceps biopsy.

DOI： 10.3748/wjg.v20.i17.5092

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