論文 - 川野　誠司

Narrow-band imaging provides reliable screening for esophageal malignancy in patients with head and neck cancers. 国際誌

Ryuta Takenaka, Yoshiro Kawahara, Hiroyuki Okada, Keisuke Hori, Masafumi Inoue, Seiji Kawano, Daisuke Tanioka, Takao Tsuzuki, Masayuki Uemura, Nobuya Ohara, Susumu Tominaga, Tomoo Onoda, Kazuhide Yamamoto

The American journal of gastroenterology   104 ( 12 )   2942 - 8   2009年12月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: The narrow-band imaging (NBI) system is a novel technology that enhances the visualization of microvasculature and mucosal patterns. The aim of this study was to assess the reliability of the NBI system for esophageal cancer screening in patients with head and neck cancers. METHODS: A total of 142 patients with head and neck squamous cell carcinoma (SCC) were examined by NBI endoscopy, followed by Lugol chromoendoscopy between April 2006 and June 2008 at the Okayama University Hospital, Okayama, Japan. Detection of SCC and high-grade intraepithelial neoplasia (HGIN) was conducted. RESULTS: The median age of the patients was 64 years (range: 29-86 years), and approximately three-fourths of all the patients were male. In total, 21 superficial lesions in 16 patients were detected by NBI endoscopy. Of these, 4 lesions were diagnosed histologically as SCC and 11 lesions as HGIN. An additional 22 Lugol-voiding lesions >or=5 mm were detected in 19 patients by Lugol chromoendoscopy. Although 1 of these lesions was diagnosed as HGIN, 21 lesions were diagnosed as low-grade intraepithelial neoplasia or lesions without atypical findings. The sensitivity of NBI endoscopy for detecting esophageal SCC and HGIN was 90.9% (95% confidence interval (CI), 58.7-99.8), specificity was 95.4% (95% CI, 90.3-98.3), and accuracy was 95.1% (95% CI, 90.1-98.0). CONCLUSIONS: NBI seems to be useful and reliable for screening for esophageal SCC in patients with head and neck cancers.

DOI： 10.1038/ajg.2009.426

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Novel chromoendoscopic method using an acetic acid-indigocarmine mixture for diagnostic accuracy in delineating the margin of early gastric cancers. 国際誌

Yoshiro Kawahara, Ryuta Takenaka, Hiroyuki Okada, Seiji Kawano, Masafumi Inoue, Takao Tsuzuki, Daisuke Tanioka, Keisuke Hori, Kazuhide Yamamoto

Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society   21 ( 1 )   14 - 9   2009年1月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND AND AIM: Recent endoscopic imaging techniques for recognition of unclear lesions in the stomach (e.g. narrow band imaging, magnifying endoscopy) require special equipment and therefore are not commonly used. The aim of the present study was to estimate the accuracy of a new chromoendoscopic method using an acetic acid-indigo carmine mixture (AIM) in diagnosing early gastric cancers (EGC). METHODS: Studied were 108 EGC lesions in 104 patients. EGC were initially observed by white light (WL) after which indigo carmine (IC) solution was sprinkled onto the gastric mucosa. Images by WL and IC observation were recorded by a digital filing system. After washing away IC solution with water, AIM solution was sprinkled onto the gastric mucosa and images were recorded. Margin lines of EGC determined by each observation were drawn on recorded images by graphic software for comparison with resected specimens. After lines were similarly drawn on images of resected specimens, the extent of the lesions was compared with that determined by endoscopic images. RESULTS: Diagnostic accuracy of WL, IC, and AIM observations were 50.0%, 75.9% and 90.7%, respectively. No adverse events occurred with the AIM method. CONCLUSIONS: This chromoendoscopic method can be used to delineate the margin of EGC accurately, easily, safely and inexpensively.

DOI： 10.1111/j.1443-1661.2008.00824.x

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腹腔鏡補助下手術を施行した大腸内視鏡検査で発見された回腸カルチノイド腫瘍の一例

小林直哉, 香川俊輔, 近藤喜太, 楳田祐三, 西谷正史, 山辻知樹, 白川靖博, 田辺俊介, 藤原康宏, 宇野 太, 猶本良夫, 田中紀章, 堀井城一朗, 川野誠司, 浦岡俊夫, 平岡佐規子, 加藤 順, 岡田裕之, 山本和秀, 大原信哉, 市村浩一, 大森昌子, 森谷行利

外科治療   100 ( 2 )   212 - 215   2009年

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記述言語：日本語   出版者・発行元：(株)永井書店  

症例は61歳男性で検診にて便潜血反応を指摘され、精検の大腸内視鏡では大腸に特記すべき所見は認めなかったが、回腸終末部(バウヒン弁から3cm口側)に10mm大の粘膜下腫瘍様突起を認め、生検所見から回腸カルチノイド腫瘍と診断された。入院時、血液・生化学試験は正常範囲で、腹部CTでは造影にて回腸末端部位に造影効果を有する10mm大の腫瘍像を認め、小腸内視鏡では多発病変は認めなかった。治療は腹腔鏡補助下に第2群リンパ節郭清D2+回盲部切除術を施行、切除標本は10×10mm大で漿膜への露出は認めず、術後経過良好で10日目に退院となった。病理組織学的所見では腫瘍は粘膜下層を主座に増生し、表層は一部粘膜内、深部は固有筋層から一部漿膜下層への浸潤を認め、深達度SSで第1群リンパ節転移陽性、脈管侵襲陽性(ly1・v1)であった。主体は異型を伴うカルチノイド腫瘍像で、最近の分類では高分化神経内分泌癌(well differentiated neuroendocrine carcinoma、G2、T3、N1、Stage IIIBに相当した。

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2009&ichushi_jid=J00396&link_issn=&doc_id=20090206220018&doc_link_id=%2Faf2gktye%2F2009%2F010002%2F018%2F0212-0215%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faf2gktye%2F2009%2F010002%2F018%2F0212-0215%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Risk factors associated with local recurrence of early gastric cancers after endoscopic submucosal dissection. 国際誌

Ryuta Takenaka, Yoshiro Kawahara, Hiroyuki Okada, Keisuke Hori, Masafumi Inoue, Seiji Kawano, Daisuke Tanioka, Takao Tsuzuki, Satoru Yagi, Jun Kato, Masayuki Uemura, Nobuya Ohara, Tadashi Yoshino, Atsushi Imagawa, Shigeatsu Fujiki, Rie Takata, Kazuhide Yamamoto

Gastrointestinal endoscopy   68 ( 5 )   887 - 94   2008年11月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Although endoscopic submucosal dissection (ESD) is expected to reduce the local recurrence of gastric cancers, we still experience cases of recurrence after an ESD. OBJECTIVE: To characterize clinical and pathologic features of cases with local recurrence of early gastric cancer after an ESD. DESIGN: A prospective cohort study. SETTING AND PATIENTS: A total of 306 patients with gastric cancers removed by ESD at Okayama University Hospital and Tsuyama Central Hospital between March 2001 and December 2005 were enrolled. INTERVENTION: ESD. MAIN OUTCOME MEASUREMENT: Local recurrence. RESULTS: The incidence of a complete en bloc resection was 80.4% when pathologically evaluated. Within a median follow-up period of 26 months (12-64 months), a local recurrence was found in 7 cases, all of which had been declared incomplete resections. One patient underwent a second ESD, and the remaining 6 underwent a surgical resection. All removed lesions were mucosal cancers. No lymph-node metastases were found in patients with a surgical resection. There was a significant correlation between the incidence of an incomplete resection and that of a local recurrence (P < .0001). Among the clinical characteristics, tumor size (>30 mm vs <20 mm; odds ratio [OR] 16 mm [95% CI, 2.0-130 mm]) and tumor location (upper vs middle or lower; OR 7.6 [95% CI, 1.3-45]) were identified as factors that were significantly associated with the incidence of a local recurrence. LIMITATION: Short follow-up duration. CONCLUSIONS: The incidence of a local recurrence was strongly associated with that of an incomplete resection. The frequency of a local recurrence also showed significant correlations with the tumor size and location within the stomach.

DOI： 10.1016/j.gie.2008.03.1089

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