Faculty Profiles - KAWANO Seiji

Papers - KAWANO Seiji

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Primary Localized Esophageal Mucosa-associated Lymphoid Tissue Lymphoma Treated by Endoscopic Submucosal Dissection.

Sayo Kobayashi, Masaya Iwamuro, Kenji Nishida, Takehiro Tanaka, Seiji Kawano, Yoshiro Kawahara, Tadashi Yoshino, Hiroyuki Okada

Internal medicine (Tokyo, Japan) 57 ( 16 ) 2347 - 2352 2018.8

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

A 69-year-old Japanese woman presented to our hospital for the further investigation of an esophageal subepithelial tumor. A diagnosis of extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) was made by an endoscopic biopsy. The patient had no involvement other than the esophagus. The tumor was resected using endoscopic submucosal dissection. Lymphoma recurrence has not been documented in the 57 months since resection. This case suggests that although a detailed preoperative evaluation is required to determine the extent of tumor, endoscopic resection may be an option for the long-term disease control of MALT lymphoma of the esophagus.

DOI： 10.2169/internalmedicine.0487-17

【一歩先を行くクローン病診療】女性特有のイベントへの対応

平岡佐規子, 安富絵里子, 岡昌平, 山崎泰史, 井口俊博, 杉原雄策, 高原政宏, 原田馨太, 川野誠司, 近藤喜太, 岡田裕之

消化器・肝臓内科 4 ( 2 ) 113 - 119 2018.8

CTAPと出血シンチグラフィで診断し、経皮的硬化療法で止血し得た小腸静脈瘤出血の1例

神尾知宏, 川野誠司, 大西秀樹, 大林由佳, 大山淳史, 能祖一裕, 原田馨太, 岡田裕之, 藤原寛康, 金澤右

日本消化器病学会雑誌 115 ( 8 ) 732 - 738 2018.8

Language：Japanese Publisher：(一財)日本消化器病学会

症例は55歳、男性。複数の腹部手術歴や、食道静脈瘤に対して内視鏡的治療歴あり。突然の血便を認め緊急入院。大腸内視鏡を施行するも出血源は同定できず、CT during arterial portography(CTAP)を施行したところ、上腸間膜静脈から流入し腹壁静脈へと排血する小腸静脈瘤を認めた。経皮的に腹壁静脈を直接穿刺することで硬化療法を施行し、良好な止血を得られ、侵襲の高い外科手術を回避することができた。(著者抄録)

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J01118&link_issn=&doc_id=20180817330007&doc_link_id=130007432101&url=https%3A%2F%2Fci.nii.ac.jp%2Fnaid%2F130007432101&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

Lanthanum deposition corresponds to white lesions in the stomach. International journal

Masaya Iwamuro, Haruo Urata, Takehiro Tanaka, Seiji Kawano, Yoshiro Kawahara, Katsuhiko Kimoto, Hiroyuki Okada

Pathology, research and practice 214 ( 7 ) 934 - 939 2018.7

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

OBJECTIVE: Although lanthanum deposition in the stomach has been most frequently reported to occur as white lesions, no study has investigated whether the white lesions observed during esophagogastroduodenoscopy are truly lanthanum-related. Here, we retrospectively investigated the amount of lanthanum in endoscopic biopsy specimens. METHODS: We reviewed four patients showing gastric white spots or annular whitish mucosa in the gastric white lesions (Bw) and peripheral mucosa where the white substance was not endoscopically observed (Bp) during biopsy. We also reviewed three patients with diffuse whitish mucosa and three patients with no whitish lesions. We performed scanning electron microscopy and energy dispersive X-ray spectrometry to quantify the lanthanum elements (wt%) in the biopsy specimens. RESULTS: The amount of lanthanum in the Bw ranged from 0.15-0.31 wt%, whereas that of Bp was 0.00-0.13 wt%. The difference was statistically significant (P < 0.05). The amount of lanthanum in the Bw, endoscopically presented with white spots or annular whitish mucosa, was significantly higher than that of no whitish lesions (0.05-0.14 wt%, P < 0.05). The amount of lanthanum was also higher in the diffuse whitish mucosa (0.21-0.23 wt%) compared with no whitish lesions (P < 0.01). CONCLUSIONS: This study is the first to reveal that pathological lanthanum deposition corresponds to the endoscopically observed white lesions in the gastric mucosa. Therefore, during esophagogastroduodenoscopy, physicians should pay attention to possible presence of white lesions in patients treated with oral lanthanum carbonate to ensure prompt identification of associated issues.

DOI： 10.1016/j.prp.2018.05.024

Esophageal Granular Cell Tumors Can Be Differentiated from Leiomyomas Using Endoscopic Ultrasonography.

Masaya Iwamuro, Takehiro Tanaka, Hiromitsu Kanzaki, Seiji Kawano, Yoshiro Kawahara, Hiroyuki Okada

Internal medicine (Tokyo, Japan) 57 ( 11 ) 1509 - 1515 2018.6

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

Objective Although esophageal granular cell tumors have been reported to present as hypoechoic tumors, we noticed that their echogenicity is similar to that of the submucosal layer. We investigated the sonographic features of esophageal granular cell tumors and the diagnostic accuracy of the features. Methods Seven patients with esophageal granular cell tumors who underwent endoscopic ultrasonography were retrospectively reviewed. Thirteen patients with esophageal leiomyoma were selected as historical control subjects. The brightness of the tumor on ultrasonography images was measured and the echogenicity was standardized according to the echogenicity of the proper muscle and submucosal layers. Ten board-certified endoscopists then independently evaluated the endoscopic pictures of the 20 patients (Test 1), as well as the endoscopic ultrasonography images together with endoscopic pictures of the same patient set (Test 2). Results The standardized echogenicity in granular cell tumors was significantly higher than that in leiomyomas. The diagnostic accuracy of the 10 evaluators using endoscopic pictures alone (Test 1) was 72.0%. The addition of endoscopic ultrasonography images (Test 2) significantly improved the accuracy to 93.0%. Conclusion The echogenicity of granular cell tumors was similar to that of the submucosal layer, and it was significantly higher than that of leiomyomas. Endoscopic ultrasonography images facilitate the accurate identification of esophageal granular cell tumors.

DOI： 10.2169/internalmedicine.9816-17

A case of small intestinal neuroendocrine carcinoma diagnosed using double-balloon endoscopy with long-term survival.

Seiji Kawano, Yuichi Miyashima, Yoshio Miyabe, Yoshinari Kawai, Toshihiro Murata, Masashi Uda, Toshihiro Inokuchi, Hiroyuki Okada

Clinical journal of gastroenterology 11 ( 3 ) 240 - 244 2018.6

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

Neuroendocrine neoplasms, including neuroendocrine tumors (NETs) and neuroendocrine carcinomas (NECs), are rare epithelial tumors with a predominant neuroendocrine differentiation. Compared with NETs, NECs have been reported to be rarer and have a poorer prognosis. We present a rare case of small bowel NEC diagnosed using double-balloon endoscopy (DBE) and the long-term survival accomplished via intensive therapy. DBE revealed an ulcerative tumor in the deep jejunum, and biopsy specimens showed large and highly dysplastic tumor cells; immuno-histological synaptophysin and chromogranin A tests were positive, and the Ki-67 index was more than 90%. Partial intestinal resection without complete lymph node dissection was performed and, postoperatively, chemotherapy was administered. The patient was observed for 3 years after chemotherapy, and complete remission was maintained.

DOI： 10.1007/s12328-018-0834-8

Lanthanum Deposition in the Stomach in the Absence of Helicobacter pylori Infection.

Masaya Iwamuro, Haruo Urata, Takehiro Tanaka, Seiji Kawano, Yoshiro Kawahara, Katsuhiko Kimoto, Hiroyuki Okada

Internal medicine (Tokyo, Japan) 57 ( 6 ) 801 - 806 2018.3

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

In this case report, we describe two patients who showed a diffusely whitish mucosa in the posterior wall and the lesser curvature of the gastric body. The patients were serologically- and histopathologically-negative for Helicobacter pylori. Random biopsy specimens from the stomach revealed no regenerative changes, intestinal metaplasia, and/or foveolar hyperplasia in either of the patients. Although lanthanum deposition in the gastric mucosa has been reported to occur in close association with H. pylori-associated gastritis, our patients tested negative for H. pylori. These cases suggest that lanthanum deposition presents as whitish lesions in the gastric body in H. pylori-negative patients.

DOI： 10.2169/internalmedicine.9665-17

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

パテンシーカプセルが回腸に長期滞留したクローン病の1例

岩室雅也, 高嶋志保, 井口俊博, 高原政宏, 川野誠司, 平岡佐規子, 近藤喜太, 田中健大, 岡田裕之

日本消化器病学会雑誌 115 ( 2 ) 203 - 210 2018.2

Language：Japanese Publisher：(一財)日本消化器病学会

40歳男性。21歳時にクローン病と診断され加療中。イレウス症状を繰り返すため当院紹介。CT検査では回腸狭窄および同部位に高吸収の人工物を認めた。ダブルバルーン内視鏡検査では回腸に多発狭窄を認め、小腸部分切除を施行したところ、狭窄部の近位側に異物を認めた。抽出した異物の解析により、30ヵ月前に嚥下したパテンシーカプセルの非溶解性コーティング膜の滞留と診断した。(著者抄録)

Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J01118&link_issn=&doc_id=20180223480008&doc_link_id=1390001206403117184&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390001206403117184&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_3.gif

食道アカラシアの診断と治療戦略 Peroral Endoscopic Myotomy(POEM、経口内視鏡的筋層切開術)の当院導入経緯と治療成績の検討

杉原雄策, 加藤諒, 山内健司, 原田馨太, 高嶋志保, 山崎泰史, 井口俊博, 高原政宏, 川野誠司, 平岡佐規子, 河原祥朗, 眞部紀明, 岡田裕之

日本消化管学会雑誌 2 ( Suppl. ) 136 - 136 2018.2

Efficacy of restarting anti-tumor necrosis factor α agents after surgery in patients with Crohn's disease. International journal

Sakiko Hiraoka, Shiho Takashima, Yoshitaka Kondo, Toshihiro Inokuchi, Yuusaku Sugihara, Masahiro Takahara, Seiji Kawano, Keita Harada, Jun Kato, Hiroyuki Okada

Intestinal research 16 ( 1 ) 75 - 82 2018.1

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

Background/Aims: The efficacy of anti-tumor necrosis factor α (anti-TNFα) antibodies for postoperative Crohn's disease (CD) in patients who were treated with these agents prior to surgery is largely unknown. Methods: CD patients who underwent intestinal resection and received anti-TNFα agents after surgery were divided into 2 groups according to the presence or absence of preoperative anti-TNFα treatment: anti-TNFα restart group or anti-TNFα naïve group. Endoscopic recurrence after surgery was examined according to the preoperative conditions, including administration of anti-TNFα agents before surgery. Results: Thirty-six patients received anti-TNFα antibody after surgery: 22 in the anti-TNFα restart group and 14 in the anti-TNFα naïve group. Endoscopic recurrence after surgery was more frequently observed in the anti-TNFα restart group than in the anti-TNFα naïve group (68% vs. 14%, P<0.001). Multivariate analysis revealed the following significant risk factors of endoscopic recurrence after surgery: anti-TNF restart group (odds ratio [OR], 28.10; 95% CI, 3.08-722.00), age at diagnosis <23 years (OR, 24.30; 95% CI, 1.67-1,312.00), serum albumin concentration at surgery <3.3 g/dL (OR, 34.10; 95% CI, 1.72-2,804.00), and presence of inflammation outside of the surgical site (OR, 21.40; 95% CI, 1.02-2,150.00). Treatment intensification for patients with endoscopic recurrence in the anti-TNFα restart group showed limited responses, with only 1 of 12 patients achieving endoscopic remission. Conclusions: The efficacy of restarting anti-TNFα antibody treatment after surgery was limited, and treatment intensification or a change to different classes of biologics should be considered for those patients.

DOI： 10.5217/ir.2018.16.1.75

Two Cases of White Globe Appearance in Autoimmune Atrophic Gastritis. International journal

Masaya Iwamuro, Takehiro Tanaka, Hiromitsu Kanzaki, Seiji Kawano, Yoshiro Kawahara, Hiroyuki Okada

Case reports in gastrointestinal medicine 2018 7091520 - 7091520 2018

Language：English

In this report, we described two patients with white globe appearance in autoimmune atrophic gastritis. Endoscopy revealed multiple white substances in the stomach in both cases. Biopsied specimens from the lesions contained dilated glands and showed a decrease in parietal cells. Intraglandular necrotic debris and carcinoma were absent. These results confirmed that white globe appearance can be observed in autoimmune atrophic gastritis. Moreover, microscopic features for white globe appearance observed in these cases were different from those reported previously in gastric cancer lesions and were similar to those observed for noncancerous stomach.

DOI： 10.1155/2018/7091520

Two cases of white globe appearance in non-cancerous stomach. International journal

Masaya Iwamuro, Takehiro Tanaka, Hiroyuki Sakae, Yasushi Yamasaki, Hiromitsu Kanzaki, Seiji Kawano, Yoshiro Kawahara, Hiroyuki Okada

Ecancermedicalscience 12 856 - 856 2018

Language：English

In this report, we describe two patients with white globe appearance in the non-cancerous stomach. The patient in Case 1 was an 82-year-old Japanese man who had been taking vonoprazan, dimethicone, acotiamide, sitagliptin, candesartan, dutasteride, etizolam and zolpidem. The patient in Case 2 was a 74-year-old Japanese woman who had been taking esomeprazole, rebamipide, sitagliptin, candesartan, ezetimibe, mirabegron, levocetirizine, zolpidem and lactobacillus preparation. In both cases, endoscopy revealed multiple white spots in the stomach. Magnifying endoscopy and blue laser imaging revealed a slightly elevated, round, white substance. Biopsied specimens from the lesions contained parietal cell protrusions and fundic gland cysts. Intraglandular necrotic debris was absent. Consequently, microscopic features in these cases were different from those reported previously for white globe appearance observed in gastric cancer lesions. These results indicate that white globe appearance can be observed in non-cancerous stomach. Although the macroscopic features could be confusing or misleading, thorough endoscopic observation and pathological analysis of white globe appearance will aid oncologists and endoscopists in differentiating between cancer-related lesions and non-cancerous lesions.

DOI： 10.3332/ecancer.2018.856

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

Gastric MALT Lymphoma with Increased Plasma Cell Differentiation Showing Unique Endoscopic Features. International journal

Masaya Iwamuro, Takehiro Tanaka, Kenji Nishida, Seiji Kawano, Yoshiro Kawahara, Shogen Ohya, Tadashi Yoshino, Hiroyuki Okada

Case reports in gastrointestinal medicine 2018 8054284 - 8054284 2018

Language：English

A 62-year-old woman was diagnosed with extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) with increased plasma cell differentiation of the stomach. Esophagogastroduodenoscopy showed slightly elevated, whitish lesions in the gastric body. Magnifying endoscopic observation revealed that the gastric surface epithelium was swollen, but the structure was not destroyed or diminished. Elongated, tortuous vasculature was observed on the surface of the whitish lesions. The patient underwent eradication treatment for Helicobacter pylori, which resulted in complete remission. Although the appearance of abnormal vessels and the destruction of gastric epithelial structure are the typical features of gastric MALT lymphoma during magnifying endoscopy, the present case showed different features, which were rather similar to those observed in a previously reported case of gastric plasmacytoma. The current case indicates that magnifying endoscopic features are not uniform among gastric MALT lymphomas.

DOI： 10.1155/2018/8054284

[Conservative management of gastric emphysema and hepatic portal venous gas: a case report].

Masaya Iwamuro, Yuki Okamoto, Hiromitsu Kanzaki, Seiji Kawano, Shunsuke Tanabe, Hiromasa Yamamoto, Yoshiro Kawahara, Hiroyuki Okada

Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology 115 ( 7 ) 655 - 661 2018

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

A 69-year-old Japanese man underwent successful percutaneous endoscopic gastrostomy (PEG) without any intra-procedural adverse event. However, 3 days postoperatively, he presented with melena and bloody discharge from the gastrostomy tube. Computed tomography revealed gastric emphysema, hepatic portal venous gas, portal vein thrombosis, and swelling of the ascending colon. We administered antibiotics and discontinued enteral feeding; this resulted in resolution of gastric emphysema, hepatic portal venous gas, and portal vein thrombosis and an improvement in the swelling of the ascending colon. To the best of our knowledge, till date, only three patients have been reported to develop gastric emphysema and hepatic portal venous gas after PEG. All previously reported patients were treated with antibiotics and/or discontinuation of enteral feeding, exhibiting recovery within 6-14 days. Although the occurrence of gastric emphysema and hepatic portal venous gas after a PEG procedure is rare, conservative management can ensure recovery in such patients.

DOI： 10.11405/nisshoshi.115.655

[Retention of patency capsule in a patient with Crohn's disease].

Masaya Iwamuro, Shiho Takashima, Toshihiro Inokuchi, Masahiro Takahara, Seiji Kawano, Sakiko Hiraoka, Yoshitaka Kondo, Takehiro Tanaka, Hiroyuki Okada

Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology 115 ( 2 ) 203 - 210 2018

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

A 40-year-old Japanese man with abdominal pain was referred to our hospital. The patient had been diagnosed with Crohn's disease at the age of 21 years and had since then received treatment with mesalazine and had been advocated an elemental diet. About 30 months before his visit to the hospital, he had swallowed a patency capsule, the retention of which in the ileum was subsequently detected on abdominal ultrasonography. The patient was advised to undergo the evaluation of stenosis, but he refused further investigation at that time. Computed tomography scanning performed at our institution revealed stenosis of the ileum and the presence of a high-density material in the proximal side of the stenosis. Double-balloon enteroscopy and enterography with contrast media revealed multiple stenoses of the ileum. The stenotic ileum was surgically resected, and a foreign body was removed. Electron microscopy analysis revealed that the foreign body was the cellophane wall of the PillCamTM patency capsule. Thus, the retention of the cellophane wall of a patency capsule after consumption was diagnosed for the current case on the basis of the study findings.

DOI： 10.11405/nisshoshi.115.203

[Rupture of small intestinal varices diagnosed by CTAP and gastrointestinal bleeding scintigraphy and treated by percutaneous phlebosclerozation angioembolization]. Reviewed

Kamio T, Kawano S, Onishi H, Obayashi Y, Oyama A, Nouso K, Harada K, Okada H, Fujiwara H, Kanazawa Y

Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology 115 ( 8 ) 732 - 738 2018

Findings of Retrograde Contrast Study Through Double-balloon Enteroscopy Predict the Risk of Bowel Resections in Patients with Crohn's Disease with Small Bowel Stenosis. International journal

Noriko Okazaki, Toshihiro Inokuchi, Sakiko Hiraoka, Masayasu Ohmori, Shiho Takashima, Daisuke Takei, Yuusaku Sugihara, Masahiro Takahara, Keita Harada, Seiji Kawano, Hiroyuki Okada, Jun Kato

Inflammatory bowel diseases 23 ( 12 ) 2097 - 2103 2017.12

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

BACKGROUND: Patients with Crohn's disease (CD) with small bowel strictures are at risk of surgery. Double-balloon enteroscopy (DBE) can evaluate the status of the small intestine, and retrograde contrast through the scope enables the surgeon to obtain information beyond the reach of the scope. This study aimed to examine whether a retrograde contrast study through DBE could be used as a predictor of subsequent surgery in patients with CD with small intestinal strictures. METHODS: The findings of DBE with retrograde contrast in 48 patients CD with small bowel strictures were examined. RESULTS: Of the 48 patients, 14 (29%) underwent surgery for small intestinal strictures during a median observation period of 2.4 years (interquartile range: 1.4-3.7 yr). According to the results of the multivariate analysis, a maximum length of strictures ≥20 mm and the ratio of the maximum diameter of prestenotic dilations to the diameter of the normal small intestine ≥1.4 were independent risk factors of surgery for small intestinal strictures (risk ratio = 7.6 [95% confidence interval, 1.8-42.0], P = 0.006; and risk ratio = 52.0 [95% confidence interval, 3.5-2485.1], P = 0.002, respectively). The latter predicted subsequent surgery with 92% sensitivity and 88% specificity. Cumulative surgery-free rates were discriminated significantly according to the presence or absence of these 2 risk factors (log-rank test: P < 0.001). CONCLUSIONS: Findings of retrograde contrast through DBE are helpful to predict risk of surgery in patients with CD with small intestinal strictures.

DOI： 10.1097/MIB.0000000000001175

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

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