Faculty Profiles - Otsuka Motoyuki

Papers - Otsuka Motoyuki

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Myeloid Sarcoma in the Small Intestine. Reviewed

Masaya Iwamuro, Tomohiro Kamio, Shoichiro Hirata, Katsunori Matsueda, Daisuke Kametaka, Takehiro Tanaka, Seiji Kawano, Motoyuki Otsuka

Internal medicine (Tokyo, Japan) 64 ( 14 ) 2155 - 2159 2024.12

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

Myeloid sarcoma is a rare extramedullary tumor of immature myeloid cells that is often associated with acute myeloid leukemia (AML). We herein report an 81-year-old man who presented with intestinal obstruction due to myeloid sarcoma of the small intestine. Diagnostic challenges were overcome using double-balloon enteroscopy and a biopsy, which confirmed the diagnosis of myeloid sarcoma. The patient subsequently developed AML but responded well to chemotherapy. This case underscores the importance of considering myeloid sarcoma in the differential diagnosis of small-bowel tumors. Highlighting the significance of a histological analysis, even in patients presenting with small bowel obstruction, the early diagnosis and treatment are crucial for improving outcomes, particularly in patients without a history of hematologic malignancies.

DOI： 10.2169/internalmedicine.4664-24

WWP1 inhibition suppresses the proliferation of pancreatic cancer cells by regulating the PI3K-AKT pathway. Reviewed

Genso Notoya, Takahiro Kishikawa, Kengo Yasugi, Takuma Iwata, Takahiro Seimiya, Koji Miyabayashi, Ryota Takahashi, Keisuke Yamamoto, Hideaki Ijichi, Motoyuki Otsuka, Mitsuhiro Fujishiro

Journal of gastroenterology 60 ( 3 ) 370 - 384 2024.12

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

BACKGROUND: The proto-oncogene WWP1 is overexpressed in various cancers and contributes to tumor growth and poor prognosis. Recently, WWP1 inhibition was reported to suppress tumor development and cell proliferation by activating the PTEN function. However, the expression profiles and clinical significance of WWP1 in pancreatic ductal adenocarcinoma (PDAC) tissues remain undetermined. Therefore, this study aimed to evaluate the WWP1 expression in PDAC and investigate the therapeutic potential of WWP1 inhibition. METHODS: Cellular proliferation assays were performed using a doxycycline-inducible shWWP1 expression system. Transcriptome analyses were conducted to identify the altered pathways in WWP1-depleted cells. PTEN ubiquitination by WWP1 was confirmed using immunoprecipitation assays. In vivo xenograft and drug screening assays were performed to evaluate the clinical significance of WWP1 inhibition. RESULTS: WWP1 was significantly upregulated in PDAC tissues and associated with poor prognosis. WWP1 depletion significantly reduced the proliferation of PDAC cell lines, correlating with the suppression of the PI3K-AKT pathway. Mechanistically, as reported in other cancer types, PTEN is a target of WWP1 in PDAC cells. PTEN silencing abrogated the growth-inhibitory effects in WWP1-depleted cells, suggesting that the anti-tumor effects of WWP1 inhibition are mediated through PTEN activation. In vivo xenograft studies confirmed that WWP1 depletion substantially inhibited tumor growth. Moreover, drug screening assays revealed that WWP1 depletion had an additive effect with the PI3K-AKT pathway inhibitors on hindering tumor growth. CONCLUSION: WWP1 inhibition enhances the anti-tumor effects of PI3K-AKT pathway inhibitors through PTEN activation. Thus, WWP1 could be a potential therapeutic target in PDAC.

DOI： 10.1007/s00535-024-02192-x

APASL clinical practice guidelines on systemic therapy for hepatocellular carcinoma-2024. Reviewed International journal

George Lau, Shuntaro Obi, Jian Zhou, Ryosuke Tateishi, Shukui Qin, Haitao Zhao, Motoyuki Otsuka, Sadahisa Ogasawara, Jacob George, Pierce K H Chow, Jianqiang Cai, Shuichiro Shiina, Naoya Kato, Osamu Yokosuka, Kyoko Oura, Thomas Yau, Stephen L Chan, Ming Kuang, Yoshiyuki Ueno, Minshan Chen, Ann-Lii Cheng, Gregory Cheng, Wan-Long Chuang, Oidov Baatarkhuu, Feng Bi, Yock Young Dan, Rino A Gani, Atsushi Tanaka, Wasim Jafri, Ji-Dong Jia, Jia-Horng Kao, Kiyoshi Hasegawa, Patrick Lau, Jeong Min Lee, Jun Liang, Zhenwen Liu, Yinying Lu, Hongming Pan, Diana A Payawal, Salimur Rahman, Jinsil Seong, Feng Shen, Gamal Shiha, Tianqiang Song, Hui-Chuan Sun, Tsutomu Masaki, Ekaphop Sirachainan, Lai Wei, Jin Mo Yang, Jose D Sallano, Yanqiao Zhang, Tawesak Tanwandee, AKadir Dokmeci, Shu-Sen Zheng, Jia Fan, Sheung-Tat Fan, Shiv Kumar Sarin, Masao Omata

Hepatology international 18 ( 6 ) 1661 - 1683 2024.11

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

In Asia-Pacific region, hepatocellular carcinoma is a serious health threat attributing to over 600,000 deaths each year and account for over 70% of global cases. Clinically, the major unmet needs are recurrence after curative-intent surgery, liver transplantation or local ablation and disease progression in those with hepatocellular carcinoma not eligible for resection or failed locoregional therapy. In the recent few years, new targeted therapy and immune-checkpoint inhibitors have been registered as systemic therapy to address these issues. Notably, new forms of systemic therapy, either as first-line or second-line therapy for unresectable hepatocellular or those not eligible for locoregional therapy, are now available. New data is also emerging with the use of systemic therapy to prevent hepatocellular carcinoma recurrence after curative-intent resection or local ablation therapy and to retard disease progression after locoregional therapy. In the future, further implementation of immune-checkpoint inhibitors and other forms of immunotherapy are expected to bring a new paradigm to the management of hepatocellular carcinoma. New insight related to immune-related adverse events with the use of immunotherapy has allso enabled optimization of the therapeutic approach to patients with hepatocellular carcinoma. The purpose of this clinical practice guideline is to provide an up-to-date recommendation based on clinical evidence and experience from expert Asia-Pacific key opinion leaders in the field of hepatocellular carcinoma. Three key questions will be addressed, namely: (1) Which patients with hepatocellular carcinoma should be considered for systemic therapy? (2) Which systemic therapy should be used? (3) How should a patient planned for immune checkpoint-based systemic therapy be managed and monitored?

DOI： 10.1007/s12072-024-10732-z

Analysis of painful situations during unsedated esophagogastroduodenoscopy. Reviewed International journal

Hiromitsu Kanzaki, Sakiko Kuraoka, Takuya Satomi, Shotaro Okanoue, Kenta Hamada, Yoshiyasu Kono, Masaya Iwamuro, Seiji Kawano, Yoshiro Kawahara, Hiroyuki Okada, Motoyuki Otsuka

Endoscopy international open 12 ( 11 ) E1267-E1276 2024.11

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

Background and study aims Although esophagogastroduodenoscopy (EGD) is a widely used technique, the procedure is often associated with discomfort. This study aimed to analyze painful situations, their frequency, and factors associated with patient discomfort during EGD. Patients and methods This prospective observational study included patients scheduled to undergo EGD. Seven endoscopists recruited patients scheduled for EGD screening or surveillance. Each endoscopist enrolled 20 patients, performing 10 EGD procedures using ultraslim endoscopes and 10 with standard-sized endoscopes. Data regarding painful situations and frequency were collected using specialized buttons pressed by the patients during EGD. A survey about overall discomfort was conducted after the procedure. Results We analyzed data from 140 patients. Esophageal insertion and duodenal observation were associated with the highest incidence of pressing the pain button, accounting for 59.3% and 40.7% of the cases, respectively. The factor associated with pressing the pain button during esophageal insertion was endoscopist experience (< 10 years). In contrast, younger age and female sex were the factors associated with pressing the pain button during duodenal observation. In the post-procedure survey, 63.6% of patients reported discomfort. Factors associated with patient discomfort included pressing the pain button during esophageal insertion (odds ratio [OR]: 2.84, P = 0.01) and previous painful EGD experience (OR: 2.41, P = 0.03). Concusions This study provides objective data on painful situations, their frequency, and related factors during EGD. Further research and interventions focusing on pain reduction during endoscopic procedures are warranted. The results of this study will help endoscopists manage painful situations and potentially improve skills.

DOI： 10.1055/a-2401-6804

Black Hairy Tongue Observed During Esophagogastroduodenoscopy. Reviewed International journal

Masaya Iwamuro, Takehiro Tanaka, Motoyuki Otsuka

Cureus 16 ( 11 ) e74331 2024.11

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

Black hairy tongue, also known as lingua villosa nigra, is a benign oral condition characterized by a dark discoloration and "hairy" appearance on the tongue's dorsal surface, resulting from elongated filiform papillae. This condition is associated with risk factors such as smoking, poor oral hygiene, and diabetes, which increase susceptibility to microbial colonization, particularly by Candida species. Although commonly diagnosed by visual inspection, black hairy tongue is infrequently observed during endoscopic procedures. We report a case of a 69-year-old Japanese man with poorly controlled type 2 diabetes (hemoglobin A1c of 9.7%) and a significant smoking history of 49 pack-years. During a routine esophagogastroduodenoscopy, a dark lesion was detected on the dorsal surface of the tongue. Detailed imaging and biopsy revealed elongated papillae with fungal hyphae, confirming a diagnosis of candidiasis. This case underscores the value of esophagogastroduodenoscopy and histopathological examination in diagnosing black hairy tongue and distinguishing it from other pigmented lesions. Recognizing black hairy tongue as a potential finding during endoscopy may aid in prompt diagnosis, especially in patients with predisposing factors like smoking and diabetes.

DOI： 10.7759/cureus.74331

増大号炎症性腸疾患2024 主題炎症性腸疾患の内科治療基本治療薬(5-ASA製剤,副腎皮質ステロイド,チオプリン製剤)

平岡佐規子, 石黒美佳子, 豊澤惇希, 青山祐樹, 井川翔子, 竹内桂子, 山崎泰史, 井口俊博, 衣笠秀明, 髙原政宏, 大塚基之, 金谷信彦, 近藤喜太, 田中健大

胃と腸 59 ( 10 ) 1453 - 1461 2024.10

Short- and longer-term learning effects from virtual scale endoscopy videos: a useful tool for colorectal lesion size estimation (with video). Reviewed International journal

Ryosuke Hirai, Hideaki Kinugasa, Mikako Ishiguro, Junki Toyosawa, Yuki Aoyama, Shoko Igawa, Yasushi Yamasaki, Toshihiro Inokuchi, Masahiro Takahara, Seiji Kawano, Sakiko Hiraoka, Motoyuki Otsuka

Gastrointestinal endoscopy 101 ( 5 ) 1030 - 1037 2024.10

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

BACKGROUND AND AIMS: Accurate assessment of colorectal polyp size is crucial for determining treatment and surveillance policies. However, visual estimation of lesion diameter is often inaccurate, making simple and effective educational tools essential. We aimed to evaluate the learning effects of virtual scale endoscopy (VSE). METHODS: Thirty-three endoscopists first watched pre-learning videos for SET1. They then estimated the diameters of 20 lesions and referred to instructional videos with VSE for self-study. Subsequently, they watched the post-learning videos for SET2 and estimated the lesion diameters. The error between the estimated and correct lesion sizes of both sets was compared. To evaluate longer-term learning effects, participants answered SET3 and SET4, which consisted of the same questions as SET2 and SET1, respectively, 2-3 months later without watching the instructional video for SET2. RESULTS: The error in the participants' estimation of the correct lesion diameter improved from SET1 to SET2 (34.7 mm ± 6.6 vs. 30.7 mm ± 7.7; p = 0.048), with a significant learning effect and error improvement specifically among non-experts (35.2 mm ± 5.3 vs. 30 mm ± 6.8; p = 0.028). In the SET3 and SET4, participants' errors indicated that the learning effect was well maintained (SET2 vs. SET3; 30.7 mm ± 7.7 vs. 28.6 mm ± 7.2; p = 0.1, and SET1 and SET4: 34.7 mm ± 6.6 vs. 31.7 mm ± 7.1; p = 0.025). CONCLUSIONS: VSE videos are a valuable learning tool for estimating lesion diameter, particularly for novice endoscopists, both in the short- and longer-term.

DOI： 10.1016/j.gie.2024.10.038

Characteristics of diabetes mellitus patients with nonviral chronic liver disease who developed hepatocellular carcinoma. Reviewed International journal

Kyo Sasaki, Miwa Kawanaka, Yasuyuki Tomiyama, Akinobu Takaki, Motoyuki Otsuka, Fusao Ikeda, Naoko Yoshioka, Hideaki Kaneto, Jun Wada, Tetsuya Fukuda, Keisuke Hino, Sohji Nishina

Hepatology research : the official journal of the Japan Society of Hepatology 2024.10

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

AIM: Type 2 diabetes mellitus (T2DM) is a well-known risk factor for hepatocellular carcinoma (HCC). However, HCC is often diagnosed at an advanced stage in patients with diabetes because of the lack of the best criteria for surveillance candidates. The aim of this study was to identify risk factors for HCC development in patients with diabetes with nonviral chronic liver disease. METHOD: Three hundred thirty T2DM patients with nonviral chronic liver disease who underwent surveillance for HCC by imaging techniques between 2009 and 2020 were enrolled in this multicenter cross-sectional retrospective study. The clinical and laboratory parameters of patients with and without HCC were compared. RESULTS: Age ≥65 years, alcohol intake, lack of hepatic steatosis, triglyceride level <111 mg/dL, Mac2 binding protein glycosylation isomer (M2BPGi) ≥0.9 cut-off index (COI), α-fetoprotein concentration ≥5 ng/mL, and des-γ-carboxy prothrombin concentration ≥26 mAU/mL were independently associated with HCC development. When stratified by age, only alcohol intake (odds ratio [OR] 114.19, p < 0.001) was associated with HCC development in patients aged <65 years, and medication for diabetes mellitus (OR 5.72, p = 0.001), lack of hepatic steatosis (OR 4.47, p = 0.002), lactate dehydrogenase ≥198 IU/L (OR 2.751, p = 0.031), M2BPGi ≥1.18 COI (OR 9.05, p < 0.001), and FIB-4 index ≥2.59 (OR 3.22, p = 0.017) were associated with HCC development in patients aged ≥65 years. CONCLUSIONS: In addition to age and advanced liver fibrosis, alcohol intake in younger T2DM patients and medication for DM and lack of hepatic steatosis in older T2DM patients should be considered for HCC surveillance by imaging.

DOI： 10.1111/hepr.14124

Clinical Significance of Prior Ramucirumab Use on the Effectiveness of Nivolumab as the Third-Line Regimen in Gastric Cancer: A Multicenter Retrospective Study. Reviewed International journal

Yuka Obayashi, Shoichiro Hirata, Yoshiyasu Kono, Makoto Abe, Koji Miyahara, Masahiro Nakagawa, Michihiro Ishida, Yasuhiro Choda, Kenta Hamada, Masaya Iwamuro, Seiji Kawano, Yoshiro Kawahara, Motoyuki Otsuka

Drugs - real world outcomes 11 ( 4 ) 557 - 564 2024.10

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

BACKGROUND AND OBJECTIVE: Because vascular endothelial growth factor inhibition has been suggested to improve immune cell function in the cancer microenvironment, we examined whether using ramucirumab (RAM) before nivolumab usage is more effective in advanced gastric cancer. METHODS: This was a multicenter retrospective observational study. We analyzed patients who received nivolumab monotherapy as the third-line regimen for unresectable advanced or recurrent gastric cancer between October 2017 and December 2022. They were divided into the RAM (RAM-treated) group and the non-RAM (non-treated) group according to the RAM usage in the second-line regimen. The primary outcome was to compare the overall survival after nivolumab administration in the third-line regimen between the RAM and non-RAM groups. RESULTS: Fifty-two patients were included in the present study: 42 patients in the RAM group and ten patients in the non-RAM group. The median overall survival was significantly longer in the RAM group than in the non-RAM group (8.5 months vs 6.9 months, p < 0.05). In the RAM group, patients without peritoneal metastasis had significantly better median overall survival than those with peritoneal metastasis (23.8 months vs 7.7 months, p = 0.0033). Multivariate Cox-proportional hazards analyses showed that the presence of peritoneal metastasis (hazard ratio, 2.4; 95% confidence interval 1.0-5.7) alone was significantly associated with overall survival in the RAM group. CONCLUSIONS: The use of RAM prior to nivolumab monotherapy may contribute to prolonged survival in patients with gastric cancer, especially those without peritoneal metastasis.

DOI： 10.1007/s40801-024-00460-z

Long-term outcomes of endoscopic resection of superficial esophageal squamous cell carcinoma in late-elderly patients. Reviewed International journal

Katsunori Matsueda, Seiji Kawano, Keisuke Fukui, Shoichiro Hirata, Takuya Satomi, Shoko Inoo, Kenta Hamada, Yoshiyasu Kono, Masaya Iwamuro, Yoshiro Kawahara, Motoyuki Otsuka

Journal of gastroenterology and hepatology 39 ( 12 ) 2664 - 2671 2024.10

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

BACKGROUND AND AIM: As the population ages, the number of elderly patients with superficial esophageal squamous cell carcinoma (ESCC) is increasing. We aimed to clarify the indications for endoscopic resection (ER) in late-elderly patients with ESCC in terms of life expectancy. METHODS: Patients aged ≥75 years who underwent ER for ESCC at our institution from January 2005 to December 2018 were enrolled. Clinical data, including the Eastern Cooperative Oncology Group performance status, American Society of Anesthesiologists physical status (ASA-PS), Charlson comorbidity index, and prognostic nutritional index (PNI), were collected at the time of ER. The main outcome measure was overall survival (OS). RESULTS: Two hundred eight consecutive patients were enrolled. The patients' median age was 78 years (range, 75-89 years). The 5-year follow-up rate was 88.5% (median follow-up period, 6.6 years). The 5-year OS rate was 79.2% (95% confidence interval [CI], 72.2-84.8), and 5-year net survival standardized for age, sex, and calendar year was 1.04 (95% CI, 0.98-1.09). In the multivariate analysis, an ASA-PS of 3 (hazard ratio, 2.45; 95% CI, 1.16-5.17) and PNI of <44.0 (hazard ratio, 2.73; 95% CI, 1.38-5.40) were independent prognostic factors. When neither of these factors was met, the 5-year OS rate was 87.8% (95% CI, 80.0-92.9), and 5-year net survival was 1.08 (95% CI, 1.02-1.14). CONCLUSIONS: ER for ESCC in late-elderly patients may improve life expectancy. ER is recommended in patients with a good ASA-PS and PNI.

DOI： 10.1111/jgh.16764

Rates and risk factors of bleeding after gastric endoscopic submucosal dissection with continuous warfarin or 1-day withdrawal of direct oral anticoagulants. Reviewed International journal

Shoichiro Hirata, Kenta Hamada, Masaya Iwamuro, Hirokazu Mouri, Koji Miyahara, Takao Tsuzuki, Kenji Yamauchi, Sayo Kobayashi, Sakuma Takahashi, Ryuta Takenaka, Shinichiro Hori, Masafumi Inoue, Tatsuya Toyokawa, Mamoru Nishimura, Shuhei Ishiyama, Jiro Miyaike, Ryo Kato, Minoru Matsubara, Naoko Yunoki, Hiromitsu Kanzaki, Yoshiro Kawahara, Hiroyuki Okada, Hideki Ishikawa, Motoyuki Otsuka

Journal of gastroenterology and hepatology 39 ( 12 ) 2760 - 2766 2024.10

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

BACKGROUND AND AIM: The 2017 Japanese guidelines recommend continuing warfarin therapy during the perioperative period or discontinuing direct oral anticoagulants (DOACs) only on the day of endoscopic submucosal dissection for early gastric cancer. However, their safety has not been sufficiently explored. This study aimed to validate this management method. METHODS: This retrospective, multicenter study analyzed the characteristics and outcomes of patients who underwent gastric endoscopic submucosal dissection between July 2017 and June 2019. The patients were categorized according to the use of warfarin or DOACs. RESULTS: Among the 62 eligible patients, 53 (85%) were male (median age, 76 years). Warfarin was used in 10 patients (16%) and DOACs in 52 patients (84%). Fourteen patients taking DOACs (27%) used concomitant antiplatelet agents, with seven patients (13%) continuing treatment at the time of the endoscopic procedure. No postprocedural bleeding occurred in patients receiving warfarin (0%), whereas 10 cases (19%) of bleeding occurred in patients receiving DOACs: rivaroxaban, 0% (0/22); dabigatran, 0% (0/2); edoxaban, 43% (6/14); and apixaban, 29% (4/14). The type of anticoagulant (P < 0.01) and continuation of antiplatelet therapy (P = 0.02) were risk factors for postprocedural bleeding in patients receiving DOACs. Intraprocedural bleeding requiring transfusion or symptomatic thromboembolic events were not reported. CONCLUSIONS: Continuous warfarin therapy is preferred. DOAC withdrawal 1 day before a procedure is associated with a high bleeding rate, which may differ for different types of anticoagulants. The continuation of antiplatelet medications in patients receiving DOACs carries a high risk of bleeding and is a future challenge.

DOI： 10.1111/jgh.16757

A Case of Esophageal Squamous Cell Carcinoma Detected After Peroral Endoscopic Myotomy in a Patient With Achalasia. International journal

Tomohiro Kamio, Shoichiro Hirata, Kenta Hamada, Masaya Iwamuro, Motoyuki Otsuka

Cureus 16 ( 10 ) e71604 2024.10

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

Achalasia, a chronic esophageal motility disorder, increases the risk of esophageal squamous cell carcinoma. Despite effective treatment with peroral endoscopic myotomy (POEM), patients remain at risk of malignancy. We present the case of a 75-year-old Japanese woman diagnosed with achalasia who was found to have esophageal squamous cell carcinoma three months after POEM. Early detection through endoscopic surveillance and biopsy led to successful endoscopic submucosal dissection. This case underscores the need for ongoing surveillance of patients with achalasia post-POEM to ensure early identification and treatment of potential malignancies.

DOI： 10.7759/cureus.71604

Gingival Bleeding in a Heavy Drinker. Reviewed International journal

Masaya Iwamuro, Tomohiro Kamio, Motoyuki Otsuka

Cureus 16 ( 10 ) e71133 2024.10

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

This case report presents a 34-year-old Japanese man with hematemesis who was ultimately diagnosed with gingival bleeding due to periodontitis via esophagogastroduodenoscopy. Although endoscopic examination revealed no gastrointestinal lesions, persistent bleeding from the gums was observed, highlighting the need to consider non-gastrointestinal sources of bleeding in such scenarios. Heavy alcohol consumption likely contributed to poor oral health and increased the risk of oral bleeding. This case emphasizes the importance of thorough endoscopic evaluation of the oral and pharyngolaryngeal regions, particularly when common gastrointestinal sources of bleeding are excluded. A comprehensive diagnostic approach is essential to avoid overlooking less common causes of bleeding.

DOI： 10.7759/cureus.71133

Effectiveness of data-augmentation on deep learning in evaluating rapid on-site cytopathology at endoscopic ultrasound-guided fine needle aspiration. Reviewed International journal

Yuki Fujii, Daisuke Uchida, Ryosuke Sato, Taisuke Obata, Matsumi Akihiro, Kazuya Miyamoto, Kosaku Morimoto, Hiroyuki Terasawa, Tatsuhiro Yamazaki, Kazuyuki Matsumoto, Shigeru Horiguchi, Koichiro Tsutsumi, Hironari Kato, Hirofumi Inoue, Ten Cho, Takayoshi Tanimoto, Akimitsu Ohto, Yoshiro Kawahara, Motoyuki Otsuka

Scientific reports 14 ( 1 ) 22441 - 22441 2024.9

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

Rapid on-site cytopathology evaluation (ROSE) has been considered an effective method to increase the diagnostic ability of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA); however, ROSE is unavailable in most institutes worldwide due to the shortage of cytopathologists. To overcome this situation, we created an artificial intelligence (AI)-based system (the ROSE-AI system), which was trained with the augmented data to evaluate the slide images acquired by EUS-FNA. This study aimed to clarify the effects of such data-augmentation on establishing an effective ROSE-AI system by comparing the efficacy of various data-augmentation techniques. The ROSE-AI system was trained with increased data obtained by the various data-augmentation techniques, including geometric transformation, color space transformation, and kernel filtering. By performing five-fold cross-validation, we compared the efficacy of each data-augmentation technique on the increasing diagnostic abilities of the ROSE-AI system. We collected 4059 divided EUS-FNA slide images from 36 patients with pancreatic cancer and nine patients with non-pancreatic cancer. The diagnostic ability of the ROSE-AI system without data augmentation had a sensitivity, specificity, and accuracy of 87.5%, 79.7%, and 83.7%, respectively. While, some data-augmentation techniques decreased diagnostic ability, the ROSE-AI system trained only with the augmented data using the geometric transformation technique had the highest diagnostic accuracy (88.2%). We successfully developed a prototype ROSE-AI system with high diagnostic ability. Each data-augmentation technique may have various compatibilities with AI-mediated diagnostics, and the geometric transformation was the most effective for the ROSE-AI system.

DOI： 10.1038/s41598-024-72312-3

Gastric adenocarcinoma and proximal polyposis of the stomachに対する内視鏡診療の現状と今後の課題

川野誠司, 田中健大, 大塚基之

Gastroenterological Endoscopy 66 ( 9 ) 1663 - 1671 2024.9

Adverse events after different endoscopic resection procedures for small and intermediate-sized colorectal polyps. Reviewed International journal

Junki Toyosawa, Yasushi Yamasaki, Yuki Aoyama, Kensuke Takei, Shoko Igawa, Toshihiro Inokuchi, Hideaki Kinugasa, Masahiro Takahara, Sakiko Hiraoka, Hiroyuki Okada, Motoyuki Otsuka

Digestive diseases (Basel, Switzerland) 42 ( 6 ) 1 - 9 2024.8

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

BACKGROUND AND STUDY AIMS: Cold snare polypectomy (CSP) and underwater endoscopic mucosal resection (UEMR) have been developed recently, in addition to conventional methods, but adverse events of each method have not been fully clarified. We compared outcomes of each method for the appropriate choice. PATIENTS AND METHODS: Patients who underwent CSP, endoscopic mucosal resection (EMR)/hot snare polypectomy (HSP) or UEMR for small and intermediate-sized colorectal polyps between April 2017 and June 2020 were retrospectively examined. The rate of adverse events and recurrences due to each method were determined as main outcomes. Clinical factors related with adverse events were examined. RESULTS: A total of 1,025 patients with 3,163 polyps underwent polypectomy using any of the methods. CSP, EMR/HSP and UEMR were performed for 704 (22.2%), 2,145 (67.8%) and 314 polyps (9.9%), and median size for each method was 4, 6 and 7 mm, respectively. Delayed bleeding for CSP, EMR/HSP and UEMR was 0%, 0.2% and 0.6% (P = 0.15), and perforation was 0%, 0.1% and 0%, respectively (P = 0.62). Recurrence after CSP, EMR/HSP and UEMR was 0.1%, 0.04% and 1.0%, respectively (P < 0.01). Recurrence for UEMR was significantly higher in the early stage of procedure introduction (P = 0.001). Oral anticoagulants were the risk factor for delayed bleeding (P < 0.01, respectively). CONCLUSIONS: There was no significant difference regarding adverse events among each method for small and intermediate-sized polyps, although recurrence rate after UEMR was higher than other methods.

DOI： 10.1159/000540365

Initial clinical experience with durvalumab plus tremelimumab in patients with unresectable hepatocellular carcinoma in real‑world practice. Reviewed International journal

Shigeo Shimose, Issei Saeki, Tetsu Tomonari, Takanori Ito, Joji Tani, Yasuto Takeuchi, Naoki Yoshioka, Takehito Naito, Mamiko Takeuchi, Satoru Kakizaki, Takeshi Hatanaka, Kyo Sasaki, Tetsuya Yasunaka, Masahiro Sakata, Hideki Iwamoto, Satoshi Itano, Tomotake Shirono, Norikazu Tanabe, Takafumi Yamamoto, Atsushi Naganuma, Soji Nishina, Motoyuki Otsuka, Hiroki Kawashima, Tetsuji Takayama, Taro Takami, Takumi Kawaguchi

Oncology letters 28 ( 2 ) 397 - 397 2024.8

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

Although durvalumab plus tremelimumab (Dur/Tre) has been approved as first-line therapy for patients with unresectable hepatocellular carcinoma (u-HCC), its outcomes in real-world clinical practice are unclear. The present study aimed to evaluate the efficacy and safety of Dur/Tre treatment. This multicenter study was conducted between March 2023 and January 2024, and included 120 patients with u-HCC treated with Dur/Tre. Among the patients, 44 had no history of systemic treatment. Progression-free survival (PFS), therapeutic response and adverse events (AEs) were assessed. The objective response rate (ORR) and disease control rates (DCR) were 15.8 and 53.3%, respectively. The median PFS was 3.9 months. The incidence rates of AEs of any grade and those grade 3 or higher were 83.3 and 36.7%, respectively. Liver injury was the most frequent AE of any grade and grade 3 or higher. Although there was no significant difference in ORR and PFS between the first and later line groups (ORR 15.8 vs. 15.7%, P=0.986; PFS 4.5 vs. 3.6 months, P=0.213), there was a significant difference in DCR between the two groups (65.8 vs. 45.9%, P=0.034). No significant differences were noted between the first- and later-line treatment groups regarding the incidence rate of AEs. Decision tree analysis revealed that poor liver function and advanced age were significant variables for discontinuation owing to AEs. In conclusion, Dur/Tre as first-line therapy had better disease control responses compared with later-line therapy; however, this regimen should be carefully administered to patients with deteriorating hepatic function or advanced age.

DOI： 10.3892/ol.2024.14530

Gastric syphilis displaying multiple annular lesions. Reviewed International journal

Masaya Iwamuro, Takehiro Tanaka, Motoyuki Otsuka

Gastrointestinal endoscopy 100 ( 2 ) 332 - 333 2024.8

【膵・胆道癌の発生・進展メカニズムを探る】胆道癌の薬剤耐性メカニズム

堤康一郎, 小幡泰介, 織田崇志, 松三明宏, 宮本和也, 寺澤裕之, 藤井佑樹, 内田大輔, 松本和幸, 堀口繁, 大塚基之

胆と膵 45 ( 8 ) 857 - 862 2024.8

【今推しの肝胆膵研究手法と疾患モデル】新規モデルによる肝胆膵研究胆嚢オルガノイドを用いた新規治療の開発

織田崇志, 堤康一郎, 大塚基之

肝胆膵 89 ( 2 ) 249 - 254 2024.8

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