Faculty Profiles - KAWANO Seiji

Papers - KAWANO Seiji

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Nationwide multicenter prospective study on the usefulness, safety, and acceptability of colon capsule endoscopy in Japan. International journal

Naoki Hotta, Naoki Ohmiya, Hiroto Hiraga, Konosuke Nakaji, Satoshi Osawa, Takafumi Omori, Shoji Mitsufuji, Naoki Hosoe, Sadaharu Nouda, Taku Kobayashi, Masanao Nakamura, Shiro Oka, Koji Nonogaki, Yukiko Baba, Rieko Mukai, Hiroshi Matsumoto, Yuichiro Ikebuchi, Masaaki Shimada, Kazutomo Togashi, Shinichi Katsuki, Yu Sasaki, Ryoichi Sawada, Seiji Kawano, Takahisa Furuta, Hisao Tajiri, Shinji Tanaka

Gastrointestinal endoscopy 2024.11

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

BACKGROUND AND AIMS: We determined the factors influencing total capsule colonoscopy, adequate cleansing, and detectability of second-generation colon capsule endoscopy (CCE) for colorectal polyps or tumors (CRTs), adverse events, and acceptability. METHODS: Among 44 Japanese hospitals, 1,006 patients with suspected or documented colorectal diseases who underwent CCE were enrolled prospectively. RESULTS: The total capsule colonoscopy rate was 86.1%. Age younger than 63 years (adjusted odds ratio [aOR], 1.525), male sex (aOR, 1.496), inflammatory bowel disease (aOR, 1.889), lavage intake on Day -1 (aOR, 1.625), ≥1800 mL lavage intake on Day 0 (aOR, 0.595), prokinetics on Day 0 (aOR, 0.608), and ≥30 mL castor oil booster on Day 0 (aOR, 1.734) were significant independent predictors. The overall adequate cleansing rate was 65.5%. Constipation (aOR, 0.527), lavage intake on Day -1 (aOR, 1.822), laxative intake on Day -1 (aOR, 2.616), and ≥1900 mL lavage intake on Day 0 (aOR, 1.449) were significant independent predictors. The detection rates (95% confidence intervals) for patients with CRTs ≥6 mm and ≥10 mm were 92 (84-97) % and 89 (78-96) %, respectively. Inadequate cleansing in the ascending colon (aOR, 0.184), ≥6 mm CRT in the transverse colon (aOR, 4.703), and ≥6 mm CRT in the left-sided colon (aOR, 32.013) were significant independent predictors. CCE retention occurred in two patients (0.20%) requiring endoscopic and surgical interventions. In total, 63% of patients desired CCE for their next colonoscopy. CONCLUSIONS: CCE was relatively safe, well tolerated, and useful for detecting colorectal lesions when adequate bowel preparation was made.

DOI： 10.1016/j.gie.2024.11.004

Analysis of painful situations during unsedated esophagogastroduodenoscopy. 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

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

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

Vonoprazan-Associated Mucosal Redness: A Report of Two Cases. International journal

Masaya Iwamuro, Yoshiyasu Kono, Takehiro Tanaka, Seiji Kawano, Nobumasa Ikeda

Cureus 16 ( 10 ) e71325 2024.10

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

Vonoprazan, a potassium-competitive acid blocker, is effective at treating acid-related gastrointestinal disorders but has been linked to gastric mucosal redness, a novel condition. This report describes two cases of vonoprazan-associated mucosal redness. Case 1 involved a 73-year-old woman who developed longitudinal erythema and mild mucosal changes after starting vonoprazan seven years ago. Case 2 involved a 70-year-old man who exhibited significant erythema and atrophic gastritis after seven months of treatment. In both cases, the pathological findings included hemorrhage in the superficial mucosa, highlighting that microhemorrhage may be the corresponding pathological finding for vonoprazan-associated mucosal redness.

DOI： 10.7759/cureus.71325

Characteristics of Early Gastric Cancer in a Patient with a History of Helicobacter pylori Infection and No History of Eradication Therapy.

Sakiko Kuraoka, Seiji Kawano, Shoko Ino, Takuya Satomi, Kenta Hamada, Yoshiyasu Kono, Masaya Iwamuro, Yoshiro Kawahara, Takehiro Tanaka, Hiroyuki Okada, Motoyuki Otsuka

Internal medicine (Tokyo, Japan) 2024.7

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

Objective The characteristics of gastric cancer in patients with atrophic mucosa and no apparent history of Helicobacter pylori eradication have not been thoroughly investigated. Therefore, this study examined the clinicopathological characteristics of gastric cancer in these patients. Methods We retrospectively examined the endoscopic and pathological characteristics of gastric cancer in patients who underwent endoscopic submucosal dissection. Patients or Materials We divided the patients into 2 groups: those with gastric atrophy and no history of eradication (group A; n =102) and those with a history of eradication (group B; n =161). In group A, patients were further divided into mild atrophy (group C) and severe atrophy (group D) groups, while group B was further divided into those who underwent eradication treatment >5 years ago (group E) and those who underwent eradication 1-5 years ago (group F). Results Group A comprised significantly older individuals (75±8.0 vs. 71±7.5 years old, p <0.001) with a higher frequency of elevated gastric cancer than group B (32.4% vs. 17.4%, p =0.006). Compared with group E, group A was older and had a greater incidence of elevated gastric cancer. The incidence of gastric cancer in the U or M region was lower in group C than in group D. Conclusion Gastric cancer in patients with gastric atrophy and no history of eradication was associated with an older age and higher frequency of elevated-type morphology than in those with a history of eradication.

DOI： 10.2169/internalmedicine.3617-24

Innovative submucosal injection solution for endoscopic resection with phosphorylated pullulan: a preclinical study. International journal

Takuya Satomi, Yukari Ochi, Takumi Okihara, Hiroki Fujii, Yasuhiro Yoshida, Katsumi Mominoki, Haruko Hirayama, Junki Toyosawa, Yasushi Yamasaki, Seiji Kawano, Yoshiro Kawahara, Hiroyuki Okada, Motoyuki Otsuka, Akihiro Matsukawa

Gastrointestinal endoscopy 99 ( 6 ) 1039 - 1047 2024.6

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

BACKGROUND AND AIMS: A submucosal injection solution is used to assist in endoscopic surgery. The high viscosity of current solutions makes them difficult to inject. In the present study, we developed an extremely low-viscosity, easy-to-use submucosal injection solution using phosphorylated pullulan (PPL). METHODS: The PPL solutions were prepared at different concentrations, and their viscosities were measured. The mucosal elevation capacity was evaluated using excised porcine stomachs. Controls included 0.4% sodium hyaluronate (SH), 0.6% sodium alginate (SA), and saline. To evaluate the practicality, the catheter injectability of 0.7% PPL was measured, and EMR and endoscopic submucosal dissection (ESD) were performed using the stomach and colorectum of live pigs. As controls, 0.4% SH and saline were used. RESULTS: The PPL solutions were of extremely low viscosity compared to the solutions of 0.4% SH and 0.6% SA. Nevertheless, the mucosal elevation capacity of PPL solutions for up to 0.7% concentration was similar to that of 0.4% SH, and 0.7% PPL was less resistant to catheter infusion than 0.4% SH and 0.6% SA. In live pig experiments with endoscopic mucosal resection and ESD, snaring after submucosal injection of 0.7% PPL was easier than with 0.4% SH, ESD with 0.7% PPL produced less bubble formation than with 0.4% SH, and the procedure time tended to be shorter with 0.7% PPL than with 0.4% SH because of the shorter injection time. CONCLUSIONS: The PPL solution is an innovative and easy-to-use submucosal injection solution.

DOI： 10.1016/j.gie.2024.01.015

Association of screening tool scores with overall survival in older patients with unresectable gastrointestinal or biliary pancreatic cancer: A retrospective study. International journal

Shoko Inoo, Yoshiyasu Kono, Hiromitsu Kanzaki, Shigeru Horiguchi, Hironari Kato, Yasushi Yamasaki, Shoichiro Hirata, Sakiko Kuraoka, Katsunori Matsueda, Shotaro Okanoue, Takuya Satomi, Kenta Hamada, Masaya Iwamuro, Seiji Kawano, Yoshiro Kawahara, Hiroyuki Okada, Motoyuki Otsuka

Journal of geriatric oncology 15 ( 4 ) 101714 - 101714 2024.5

Drug-induced mucosal alterations observed during esophagogastroduodenoscopy. International journal

Masaya Iwamuro, Seiji Kawano, Motoyuki Otsuka

World journal of gastroenterology 30 ( 16 ) 2220 - 2232 2024.4

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

Several features of drug-induced mucosal alterations have been observed in the upper gastrointestinal tract, i.e., the esophagus, stomach, and duodenum. These include pill-induced esophagitis, desquamative esophagitis, worsening of gastroesophageal reflux, chemotherapy-induced esophagitis, proton pump inhibitor-induced gastric mucosal changes, medication-induced gastric erosions and ulcers, pseudomelanosis of the stomach, olmesartan-related gastric mucosal inflammation, lanthanum deposition in the stomach, zinc acetate hydrate tablet-induced gastric ulcer, immune-related adverse event gastritis, olmesartan-asso-ciated sprue-like enteropathy, pseudomelanosis of the duodenum, and lanthanum deposition in the duodenum. For endoscopists, acquiring accurate knowledge regarding these diverse drug-induced mucosal alterations is crucial not only for the correct diagnosis of these lesions but also for differential diag-nosis of other conditions. This minireview aims to provide essential information on drug-induced mucosal alterations observed on esophagogastroduodenoscopy, along with representative endoscopic images.

DOI： 10.3748/wjg.v30.i16.2220

Endoscopic and Histological Gastritis in University Students with Helicobacter pylori Infection.

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

Internal medicine (Tokyo, Japan) 2024.3

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

Objective Although the characteristics of Helicobacter pylori infection have been extensively reported, there is a lack of consensus regarding its characteristics in young adults. The present study examined the endoscopic and histological characteristics of young adults who underwent eradication therapy for H. pylori infection. Methods We examined the H. pylori infection status of first-year students at Okayama University School of Medicine and Dentistry between 2014 and 2020. A total of 152 (6.8%) students who were positive for H. pylori antibody or pepsinogen tests were enrolled in the study. Among them, 107 students underwent endoscopy, and their biopsy samples were investigated. Seventy-five students were diagnosed with H. pylori infections. Results Of 75 H. pylori-positive patients, 57 (76.0%) had endoscopic atrophic gastritis, and 42 (56.0%) had histological atrophy. A few patients had severe atrophic gastritis. All 65 patients who underwent an eradication assessment were successfully treated. After successful eradication, 26 patients underwent endoscopic follow-up. The mean follow-up period was 32.9 months. A histological evaluation revealed that gastric antrum atrophy had subsided in 11 of 14 patients, and atrophy in the lesser curvature of the gastric body had subsided in 7 of 8 patients. Conclusion More than half of young adults with H. pylori infection had atrophic gastritis. We found mild atrophy in young adults, which subsided shortly after eradication treatment. This study provides a foundation for future studies to evaluate the validity of eradication therapy in preventing gastric cancer in patients.

DOI： 10.2169/internalmedicine.1851-23

神経線維腫症の消化管合併症に関する検討

本田真奈美, 岩室雅也, 山崎泰史, 田中健大, 川野誠司, 平岡佐規子, 河原祥朗, 大塚基之

日本消化器病学会雑誌 121 ( 臨増総会 ) A349 - A349 2024.3

Clinical significance of gastrointestinal bleeding history in patients who undergo left atrial appendage closure. International journal

Tatsuya Kikuchi, Yoshiyasu Kono, Koji Nakagawa, Hiroyuki Okada, Masakazu Miyamoto, Yoichi Takaya, Shoichiro Hirata, Shoko Inoo, Sakiko Kuraoka, Shotaro Okanoue, Katsunori Matsueda, Takuya Satomi, Kenta Hamada, Masaya Iwamuro, Seiji Kawano, Yoshiro Kawahara

JGH open : an open access journal of gastroenterology and hepatology 8 ( 1 ) e13009 2024.1

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

BACKGROUND AND AIM: Anticoagulant users with nonvalvular atrial fibrillation (NVAF) sometimes suffer from gastrointestinal bleeding (GIB) and have difficulty continuing the medication. Left atrial appendage closure (LAAC) has been developed for such situations. We aimed to clarify the clinical significance of a history of GIB in comparison to other factors in patients who had undergone LAAC. METHODS: From October 2019 to September 2023, patients with NVAF who underwent LAAC at our hospital were enrolled. We investigated the percentage of patients with a history of GIB who underwent LAAC and compared the incidence of post-LAAC bleeding in these patients compared to those with other factors. RESULTS: A total of 45 patients were included. There were 19 patients (42%) with a history of GIB who underwent LAAC. In a Kaplan-Meier analysis, the cumulative incidence of bleeding complications after LAAC was significantly higher in patients with a history of GIB in comparison to patients with other factors. There were eight cases of post-LAAC bleeding in total, and seven cases had GIB. CONCLUSIONS: We need to recognize that GIB is a significant complication in patients who undergo LAAC. The management of GIB by gastroenterologists is essential to the success of LAAC.

DOI： 10.1002/jgh3.13009

小腸疾患治療の最前線小腸疾患を有する先天性心疾患患者における治療の現状と問題点

亀高大介, 川野誠司, 河野吉泰, 井口俊博, 平岡佐規子

日本消化管学会雑誌 8 ( Suppl. ) 207 - 207 2024.1

[Small intestinal perforation manifesting as post-transplant lymphoproliferative disorder occurring 23 years after living lung transplantation: a case report].

Daisuke Kametaka, Masaya Iwamuro, Shoko Inoo, Seiji Kawano, Takehiro Tanaka, Yoshiro Kawahara, Motoyuki Otsuka

Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology 121 ( 11 ) 896 - 903 2024

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

A Japanese female patient underwent a living lung transplant at age 29 and has been on immunomodulatory drug therapy since then. At age 52, she presented with sudden hematochezia. Despite abdominal computed tomography scan, esophagogastroduodenoscopy, and colonoscopy, no definitive source of bleeding was identified. Considering the possibility of small bowel bleeding, video capsule endoscopy was performed, which revealed a suspected ulcerative lesion in the jejunum. Subsequent per-oral double-balloon endoscopy confirmed the presence of an ulcerative lesion in the jejunum. A potential pathological diagnosis of post-transplant lymphoproliferative disorder (PTLD) was considered based on endoscopic biopsy specimens from the jejunal lesion. However, before the pathologic biopsy results were available, the patient experienced small intestinal perforation, necessitating emergency partial resection. Pathologic examination revealed a dense proliferation of medium-to-large atypical lymphocytes with neutrophilic infiltration in the perforated area of the small intestinal wall. Immunostaining showed lymphoid cells positive for CD20 but negative for CD3. Epstein-Barr virus (EBV) -encoded RNA was detected by in situ hybridization, and Ki-67 staining demonstrated a higher percentage of positive cells. Consequently, an EBV-positive diffuse large B-cell lymphoma, developed as PTLD, was diagnosed. Complete remission was achieved with a reduced immunomodulatory drug dosage and rituximab therapy. She has been alive for 8 months postoperatively without recurrence. This case suggests that PTLD should be considered in assessing patients presenting with abdominal symptoms following organ transplantation.

DOI： 10.11405/nisshoshi.121.896

Successful use of dupilumab for egg-induced eosinophilic gastroenteritis with duodenal ulcer: a pediatric case report and review of literature. International journal

Mitsuru Tsuge, Kenji Shigehara, Kazuhiro Uda, Seiji Kawano, Masaya Iwamuro, Yukie Saito, Masato Yashiro, Masanori Ikeda, Hirokazu Tsukahara

Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology 19 ( 1 ) 103 - 103 2023.12

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

BACKGROUND: Non-esophageal eosinophilic gastrointestinal disorder (non-EoE-EGID) is a rare disease in which eosinophils infiltrate parts of the gastrointestinal tract other than the esophagus; however, the number of patients with non-EoE-EGID has been increasing in recent years. Owing to its chronic course with repeated relapses, it can lead to developmental delays due to malnutrition, especially in pediatric patients. No established treatment exists for non-EoE-EGID, necessitating long-term systemic corticosteroid administration. Although the efficacy of dupilumab, an anti-IL-4/13 receptor monoclonal antibody, for eosinophilic esophagitis, has been reported, only few reports have demonstrated its efficacy in non-EoE EGIDs. CASE PRESENTATION: A 13-year-old boy developed non-EoE-EGID with duodenal ulcers, with chicken eggs as the trigger. He was successfully treated with an egg-free diet, proton pump inhibitors, and leukotriene receptor antagonists. However, at age 15, he developed worsening upper abdominal pain and difficulty eating. Blood analysis revealed eosinophilia; elevated erythrocyte sedimentation rate; and elevated levels of C-reactive protein, total immunoglobulin E, and thymic and activation-regulated chemokines. Upper gastrointestinal endoscopy revealed a duodenal ulcer with marked mucosal eosinophilic infiltration. Gastrointestinal symptoms persisted even after starting systemic steroids, making it difficult to reduce the steroid dose. Subcutaneous injection of dupilumab was initiated because of comorbid atopic dermatitis exacerbation. After 3 months, the gastrointestinal symptoms disappeared, and after 5 months, the duodenal ulcer disappeared and the eosinophil count decreased in the mucosa. Six months later, systemic steroids were discontinued, and the duodenal ulcer remained recurrence-free. The egg challenge test result was negative; therefore, the egg-free diet was discontinued. Blood eosinophil count and serum IL-5, IL-13, and eotaxin-3 levels decreased after dupilumab treatment. The serum levels of IL-5 and eotaxin-3 remained within normal ranges, although the blood eosinophil counts increased again after discontinuation of oral prednisolone. CONCLUSIONS: Suppression of IL-4R/IL-13R-mediated signaling by dupilumab may improve abdominal symptoms and endoscopic and histologic findings in patients with non-EoE-EGID, leading to the discontinuation of systemic steroid administration and tolerance of causative foods.

DOI： 10.1186/s13223-023-00859-3

Optimal Bowel Preparation Method to Visualize the Distal Ileum via Small Bowel Capsule Endoscopy. International journal

Daisuke Kametaka, Mamoru Ito, Seiji Kawano, Shuhei Ishiyama, Akiko Fujiwara, Junichirou Nasu, Masao Yoshioka, Junji Shiode, Kazuhide Yamamoto, Masaya Iwamuro, Yoshiro Kawahara, Hiroyuki Okada, Motoyuki Otsuka

Diagnostics (Basel, Switzerland) 13 ( 20 ) 2023.10

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

Small bowel capsule endoscopy (SBCE) is a convenient and minimally invasive method widely used to evaluate the small intestine. However, especially in the distal ileum, visualization of the intestinal mucosa is frequently hampered by the remaining intestinal contents, making it difficult to detect critical lesions. Although several studies have reported on the efficacy of bowel preparation before SBCE, no standardized protocol has been established. Herein, we determined the optimal preparation method for better visualization of the distal ileum using SBCE. We retrospectively analyzed 259 consecutive patients who had undergone SBCE between July 2009 and December 2019, divided into three groups: Group A (no preparation except overnight fasting), Group B (ingestion of 1-2 L polyethylene glycol 4 h before colonoscopy after overnight fasting and performing SBCE immediately after colonoscopy), and Group C (ingestion of 0.9 L magnesium citrate [MC] before SBCE after overnight fasting). The visibility of the intestinal mucosa in the first 10 min and at the last 10 min during the period of observation of the distal ileum was examined using a scoring system and compared. The visibility of the images captured by SBCE was assessed based on the scoring of the degree of bile/chyme staining, residual fluid and debris, brightness, bubble reduction, and visualized mucosa. The status of intestinal collapse was also assessed. In the first 10 min of observation of the distal ileum, no significant differences were detected among the groups. In the last 10 min, significantly better images were acquired in Group C in terms of bile/chyme staining, brightness, bubble reduction, and visualized mucosa. Bowel preparation using a low-dose MC solution 2 h before SBCE provided significantly higher-quality images of the distal ileum. Further optimization, such as the timing of initiating the preparation, is necessary to determine the optimal regimen for bowel preparation prior to SBCE.

DOI： 10.3390/diagnostics13203269

Nationwide multicenter study on adverse events associated with a patency capsule: Additional survey of appropriate use of patency capsule study. International journal

Teppei Omori, Naoki Ohmiya, Kenji Watanabe, Fumihito Hirai, Masanao Nakamura, Kazuya Kitamura, Keiji Ozeki, Shiro Oka, Seiji Kawano, Osamu Handa, Mikio Kawai, Kazeo Ninomiya, Tamotsu Sagawa, Takahiro Wakamatsu, Akihiro Araki, Yuji Koike, Shingo Kato, Shinichi Hashimoto, Tomohiko Mannami, Konosuke Nakaji, Shinji Tanaka, Toshiyuki Matsui

Journal of gastroenterology and hepatology 2023.10

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

BACKGROUND AND AIM: The PillCam patency capsule (PC) without a radio frequency identification tag was released to preclude retention of the small bowel capsule endoscope (CE) in Japan in 2012. We conducted a multicenter study to determine tag-less PC-related adverse events (AEs). METHODS: We first conducted a retrospective survey using a standardized data collection sheet for the clinical characteristics of PC-related AEs among 1096 patients collected in a prospective survey conducted between January 2013 and May 2014 (Cohort 1). Next, we retrospectively investigated additional AEs that occurred before and after Cohort 1 within the period June 2012 and December 2014 among 1482 patients (Cohort 2). RESULTS: Of the 2578 patients who underwent PC examinations from both cohorts, 74 AEs occurred among 61 patients (2.37%). The main AEs were residual parylene coating in 25 events (0.97%), PC-induced small bowel obstruction, suspicious of impaction, in 23 events (0.89%), and CE retention even after patency confirmation in 10 events (0.39%). Residual parylene coating was significantly associated with Crohn's disease (P < 0.01). Small bowel obstruction was significantly associated with physicians with less than 1 year of experience handling the PC and previous history of postprandial abdominal pain (P < 0.01 and P < 0.03, respectively). CE retention was ascribed to erroneous judgment of PC localization in all cases. CONCLUSIONS: This large-scale multicenter study provides evidence supporting the safety and efficiency of a PC to preclude CE retention. Accurate PC localization in patients without excretion and confirmation of previous history of postprandial abdominal pain before PC examinations is warranted (UMIN000010513).

DOI： 10.1111/jgh.16365

Idiopathic Gastric Antral Ulcers.

Masaya Iwamuro, Takehiro Tanaka, Seiji Kawano, Yoshiro Kawahara, Motoyuki Otsuka

Internal medicine (Tokyo, Japan) 2023.10

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

A Japanese woman presented with gastric antral ulcers accompanied by erosion and edema, demonstrating a chronic pattern of improvement and recurrence for more than six years. The patient had no relevant treatment history, and Helicobacter pylori infection was ruled out. Other potential etiologies contributing to gastric ulcers were eliminated on the basis of endoscopic biopsy and blood laboratory findings. Consequently, the patient was diagnosed with idiopathic gastric antral ulcer. This disease is often overlooked, and the chronological endoscopic images provided in this report can be used as a reference.

DOI： 10.2169/internalmedicine.2554-23

Inverted non-ampullary duodenal adenocarcinoma treated with underwater endoscopic mucosal resection. International journal

Katsunori Matsueda, Seiji Kawano, Takehiro Tanaka

Gastrointestinal endoscopy 2023.10

Endoscopic features of gastric neuroendocrine carcinoma. International journal

Katsunori Matsueda, Noriya Uedo, Masanori Kitamura, Satoki Shichijo, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara, Tomoki Michida, Seiji Kawano, Yoshiro Kawahara

Journal of gastroenterology and hepatology 38 ( 10 ) 1808 - 1817 2023.10

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

BACKGROUND AND AIM: The endoscopic features of gastric neuroendocrine carcinoma (G-NEC) have not been clarified; therefore, they were investigated in relation to clinicopathological findings. METHODS: Consecutive patients with G-NECs who had undergone endoscopic or surgical resection at our institution between January 2005 and March 2022 were included in this retrospective study. The endoscopic and clinicopathological findings of the lesions were analyzed to provide information of diagnostic value. In addition, cases of gastric neuroendocrine tumor (G-NET) and common-type gastric adenocarcinoma treated in the same study period were identified to compare the endoscopic findings between each G-NEC versus G-NET, and G-NEC versus common-type gastric adenocarcinoma. Patients with common-type gastric adenocarcinoma were matched for age, sex, tumor size, and depth of tumor invasion in 1:3 ratio. RESULTS: Among 15 patients with 15 G-NECs, submucosal tumor-like marginal elevation (87%), adherent white coat (67%), and ulceration with a distinct border (60%) were characteristic endoscopic findings in white-light images. Magnifying narrow-band imaging endoscopy revealed an absent microsurface (MS) pattern plus disrupted irregular microvessel (MV) in five (71%) of seven cases with evaluable MS and MV patterns. The area with an absent MS pattern plus disrupted irregular MV corresponded to the histological finding of NEC component in all five cases. These endoscopic features were all significantly more frequent in G-NECs than G-NETs (n = 22) or common-type gastric adenocarcinomas (n = 45). CONCLUSIONS: These endoscopic features should be taken into consideration to increase the index of suspicion and to improve the accuracy of target biopsies for G-NEC.

DOI： 10.1111/jgh.16309

An unusual case of gastric polyposis. International journal

Masaya Iwamuro, Seiji Kawano, Motoyuki Otsuka

Gastroenterology 165 ( 5 ) 1110 - 1113 2023.8

Review of oral and pharyngolaryngeal benign lesions detected during esophagogastroduodenoscopy. International journal

Masaya Iwamuro, Kenta Hamada, Seiji Kawano, Yoshiro Kawahara, Motoyuki Otsuka

World journal of gastrointestinal endoscopy 15 ( 7 ) 496 - 509 2023.7

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

Recent advancements in endoscopy equipment have facilitated endoscopists' detection of neoplasms in the oral cavity and pharyngolaryngeal regions. In particular, image-enhanced endoscopy using narrow band imaging or blue laser imaging play an integral role in the endoscopic diagnosis of oral and pharyngolaryngeal cancers. Despite these advancements, limited studies have focused on benign lesions that can be observed during esophagogastroduodenoscopy in the oral and pharyngolaryngeal regions. Therefore, this mini-review aimed to provide essential information on such benign lesions, along with representative endoscopic images of dental caries, cleft palate, palatal torus, bifid uvula, compression by cervical osteophytes, tonsil hyperplasia, black hairy tongue, oral candidiasis, oral and pharyngolaryngeal ulcers, pharyngeal melanosis, oral tattoos associated with dental alloys, retention cysts, papilloma, radiation-induced changes, skin flaps, vocal cord paresis, and vocal fold leukoplakia. Whilst it is imperative to seek consultation from otolaryngologists or dentists in instances where the diagnosis cannot be definitively ascertained by endoscopists, the merits of attaining foundational expertise pertaining to oral and pharyngolaryngeal lesions are unequivocal. This article will be a valuable resource for endoscopists seeking to enhance their understanding of oral and pharyngolaryngeal lesions.

DOI： 10.4253/wjge.v15.i7.496

免疫関連有害事象(irAE:immune-related adverse events)による胃炎の5例

岩室雅也, 田中健大, 平田翔一郎, 河野吉泰, 川野誠司, 河原祥朗, 大塚基之

日本消化器病学会中国支部例会プログラム・抄録集 119回 70 - 70 2023.6

内反性増殖を示した十二指腸腺癌に対してUnderwater EMRにて切除し得た1例

松枝克典, 川野誠司, 平田翔一郎, 岡上昇太郎, 里見拓也, 稲生祥子, 濱田健太, 河野吉泰, 岩室雅也, 河原祥朗, 田中健大, 大塚基之

日本消化器内視鏡学会中国支部例会 130回 76 - 76 2023.6

希少疾患の内視鏡診断(全体) 稽な消化管腫瘍 gastric adenocarcinoma and proximal polyposis of the stomach(GAPPS)と転移性小腸悪性黒色腫

平井亮佑, 衣笠秀明, 川野誠司

Gastroenterological Endoscopy 65 ( Suppl.1 ) 823 - 823 2023.4

鎮静プロトコールに沿った、上部ESDにおける鎮静内容の検討

神尾知宏, 川野誠司, 平井亮佑, 小橋真由, 倉岡紗樹子, 岡上昇太郎, 里見拓也, 松枝克典, 稲生祥子, 河野吉泰, 濱田健太, 岩室雅也, 河原祥朗

Gastroenterological Endoscopy 65 ( Suppl.1 ) 899 - 899 2023.4

Degree of pharyngeal deformation caused by pharyngeal endoscopic submucosal dissection is associated with the incidence of aspiration pneumonia. International journal

Makoto Abe, Yoshiro Kawahara, Yuka Obayashi, Yuki Baba, Kenta Hamada, Hiroyuki Sakae, Yoshiyasu Kono, Hiromitu Kanzaki, Masaya Iwamuro, Seiji Kawano, Takuma Makino, Yohei Noda, Hidenori Marunaka, Hiroyuki Okada

Endoscopy international open 11 ( 4 ) E351-E357 2023.4

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

Background and study aims Endoscopic submucosal dissection (ESD) is one of the most minimally invasive treatments for superficial squamous cell cancer of the pharynx. However, aspiration pneumonia (AsP) associated with postoperative deformity of the pharynx may occur. The purpose of this study was to investigate the frequency of AsP and the degree of pharyngeal deformity after pharyngeal ESD. Patients and methods This was a retrospective observational study of patients who underwent pharyngeal ESD at Okayama University Hospital between 2006 and 2017. The degree of pharyngeal deformation was assessed using the pharyngeal deformation grade (PDG). The primary endpoint was the frequency of AsP as a long-term adverse event. Results Among the 52 patients enrolled, nine developed aspiration pneumonia, with a 3-year cumulative incidence of 9.0 % (95 % confidence interval [CI], 3.3 %-22.0 %). There were 16, 18, 16, and two patients that had PDG 0, 1, 2, and 3, respectively. Patients with a history of radiotherapy, as a treatment of head and neck cancer (44.4 % vs. 11.6 %; P = 0.02) and the high PDG group (PDG 2 and 3) (77.8 % vs. 25.6 %; P = 0.005) had a significantly higher incidence of AsP. The 3-year cumulative incidence rate of AsP after ESD in the high PDG group was significantly higher than that in the low PDG group (PDG 0 and 1) (23.9 % [95 %CI, 9.2.-49.5%] vs. 0 %; P = 0.03). Conclusions The incidence of aspiration pneumonia in the long-term course after pharyngeal ESD was revealed. The incidence of aspiration pneumonia may be associated with pharyngeal deformity, but further studies are needed.

DOI： 10.1055/a-2033-9707

上部消化管内視鏡検査時の苦痛に関する前向き観察研究

神崎洋光, 倉岡沙樹子, 里見拓也, 岡上昇太郎, 濱田健太, 河野吉泰, 岩室雅也, 川野誠司, 河原祥朗, 岡田裕之

Gastroenterological Endoscopy 65 ( Suppl.1 ) 900 - 900 2023.4

条件付き承認レジメンの意義胃癌二次化学療法における条件付き推奨レジメンの検討

河野吉泰, 神崎洋光, 平田翔一郎, 稲生祥子, 倉岡紗樹子, 岡上昇太郎, 里見拓也, 松枝克典, 濱田健太, 岩室雅也, 川野誠司, 河原祥朗

日本胃癌学会総会記事 95回 218 - 218 2023.2

Scattered Tiny Whitish Protrusions in the Stomach Are a Clue to the Diagnosis of Autoimmune Gastritis.

Masaya Iwamuro, Takehiro Tanaka, Kenta Hamada, Yoshiyasu Kono, Hiromitsu Kanzaki, Seiji Kawano, Yoshiro Kawahara, Hiroyuki Okada

Acta medica Okayama 77 ( 1 ) 75 - 80 2023.2

Language：English

Herein, we report two patients with autoimmune gastritis who had undergone multiple esophagogastroduodenoscopy procedures for 17 and 9 years, respectively, before their diagnosis. Instead, they had been diagnosed with and treated for Helicobacter pylori-associated gastritis. The correct diagnosis was made when scatterings of tiny whitish protrusions in the gastric mucosa were detected on esophagogastroduodenoscopy. Our findings suggest that scattered tiny whitish bumps may be a clue to the diagnosis of autoimmune gastritis.

DOI： 10.18926/AMO/64365

Differences in color between early gastric cancer and cancer-suspected non-cancerous mucosa on linked color imaging. International journal

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

Endoscopy international open 11 ( 1 ) E90-E96 2023.1

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

Background and study aims Linked color imaging (LCI) can enhance the original color of each area and may useful to detect tumorous lesions during esophagogastroduodenoscopy. However, LCI may also enhance cancer-suspected non-cancerous regional color change. We conducted a retrospective image analysis to investigate the color characteristics of early gastric cancer (EGC) and cancer-suspected non-cancerous mucosa (CSM) in LCI. Methods LCI images of both EGC and CSM were retrospectively collected from the database of the institution. Fifteen endoscopists individually judged each image as EGC or CSM. The color difference between the inside and outside of the lesions was measured by CIE-Lab analysis in both groups and compared. Results A total of 245 LCI images of EGC (169) and CSM (76) were extracted and randomly lined for image collection. The test by the endoscopists showed accuracy, sensitivity, and specificity of 64.0 %, 63.7 %, and 64.0 %, respectively. Although the color difference between EGC and CSM was almost the same (12.5 vs. 12.9, not significant), each parameter of ΔL (bright: -0.3 vs. -2.7, P < 0.001), Δa (Reddish: 7.2 vs. 9.6, P = 0.004), and Δb (Yellowish: 6.4 vs. 3.8, P < 0.001) was significantly different in the groups. The color feature of both positive ΔL and Δb to EGC showed accuracy, sensitivity, and specificity of 54.7 %, 39.6 %, 88.2%, respectively. Conclusions The total color difference was almost the same between EGC and CSM; however, their color tones were different on linked color imaging. Although the color characteristics of EGC had high specificity, they also had low sensitivity.

DOI： 10.1055/a-1989-6643

高齢者消化器癌診療における化学療法と外科治療の現状と課題高齢者消化器癌の化学療法開始前における高齢者機能評価と治療内容・予後についての検討

河野吉泰, 稲生祥子, 堀口繁, 加藤博也, 倉岡紗樹子, 岡上昇太郎, 里見拓也, 松枝克典, 濱田健太, 岩室雅也, 川野誠司, 河原祥朗

日本消化管学会雑誌 7 ( Suppl. ) 219 - 219 2023.1

Erratum: Differences in color between early gastric cancer and cancer-suspected non-cancerous mucosa on linked color imaging. International journal

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

Endoscopy international open 11 ( 1 ) C1 2023.1

Safety and efficacy of capsule endoscopy for patients with newly diagnosed Crohn's disease: A multicenter retrospective study. International journal

Seiji Kawano, Shiro Oka, Akiko Shiotani, Shinichi Hashimoto, Sakuma Takahashi, Osamu Handa, Taro Takami, Tomoki Inaba, Hiroyuki Okada, Shinji Tanaka

Medicine 101 ( 50 ) e32424 2022.12

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

Crohn's disease (CD) is a chronic inflammatory disease that develops at a young age and frequently leads to intestinal resection. Capsule endoscopy (CE) can directly and non-invasively inspect the entire small bowel mucosa. We suspected that CE could be a good diagnostic tool for detecting CD in young patients. The aim of this study was to investigate the safety and efficacy of CE in patients with newly diagnosed CD and to evaluate the CE findings, especially in the upper small bowel of young patients. We retrospectively investigated 32 patients with newly diagnosed CD from 5 institutions. Patient characteristics, clinical course, and characteristics of CE findings were analyzed. The total small intestine observation rate was 93%, and the retention rate was 3% (1/32). No abnormality was identified by ileocolonoscopy in 46% (15/32), and transition of small bowel lesions (TSL) was found in 35% (12/34) of the patients. The frequency of longitudinal ulcers and cobblestones in the upper small intestine was significantly higher in younger patients (≤20 years). Moreover, positive findings in the upper small intestine were predominantly observed in younger patients (≤20 years). CE for patients with newly diagnosed CD was safe and useful, especially for the detection of upper small bowel lesions in young patients.

DOI： 10.1097/MD.0000000000032424

Multiple White Plaques in the Esophagus: A Possible Case of Esophageal Mucosal Alteration Associated With Immune-Related Adverse Events of Immune Checkpoint Inhibitors. International journal

Masaya Iwamuro, Takehiro Tanaka, Yoshiyasu Kono, Seiji Kawano, Horoyuki Okada

Cureus 14 ( 12 ) e32710 2022.12

Language：English

We report two cases of multiple white plaques in the esophagus that emerged after the administration of immune checkpoint inhibitors. Both patients developed enterocolitis as immune-related adverse events associated with immune checkpoint inhibitors. Esophagogastroduodenoscopy revealed duodenal involvement and multiple white plaques in the esophagus. A biopsy of the esophagus showed predominant CD3+ lymphocyte infiltration, suggesting that esophageal mucosal alterations were associated with immune-related adverse events. In addition, histopathology showed keratinized stratified squamous epithelium in the first case while increased inflammatory cell infiltration in the intraepithelial and subepithelial layers was observed in the second case. These data suggest a different pathogenesis of the multiple esophageal white plaques between the two cases. Although further investigation is needed to elucidate the significance of these observations, recognition of the esophageal plaques may be important for prompt diagnosis of immune-related adverse events when associated with immune checkpoint inhibitors.

DOI： 10.7759/cureus.32710

H.heilmannii感染胃炎に発症した同時性多発早期胃癌の1例

神尾知宏, 河野吉泰, 稲生祥子, 倉岡紗樹子, 岡上昇太郎, 里見拓也, 濱田健太, 岩室雅也, 川野誠司, 田中健大, 村山そう明, 中村正彦, 河原祥朗

日本消化器病学会中国支部例会・日本消化器内視鏡学会中国支部例会プログラム・抄録集 118回・129回 112 - 112 2022.11

造血幹細胞移植後に酢酸亜鉛二水和物(ノベルジン)の副作用として胃潰瘍を認めた1例

平岡凌河, 岩室雅也, 濱田健太, 河野吉泰, 川野誠司, 河原祥朗

日本消化器病学会中国支部例会・日本消化器内視鏡学会中国支部例会プログラム・抄録集 118回・129回 122 - 122 2022.11

Endoscopic findings of gastric neoplasms in familial adenomatous polyposis are associated with the phenotypic variations and grades of dysplasia. International journal

Mayu Kobashi, Masaya Iwamuro, Sakiko Kuraoka, Shoko Inoo, Shotaro Okanoue, Takuya Satomi, Kenta Hamada, Makoto Abe, Yoshiyasu Kono, Hiromitsu Kanzaki, Seiji Kawano, Takehiro Tanaka, Yoshiro Kawahara, Hiroyuki Okada

Medicine 101 ( 41 ) e30997 2022.10

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

Patients with familial adenomatous polyposis (FAP) are at increased risk of developing gastric neoplasms. However, endoscopic findings have not been sufficiently investigated. We investigated the phenotypic expression of gastric adenoma (low-grade dysplasia) and gastric cancer (high-grade dysplasia or carcinoma) in patients with FAP and clarified their relationships to endoscopic findings. Of 29 patients with FAP who underwent esophagogastroduodenoscopy between 2005 and 2020, 11 (38%) had histologically confirmed gastric neoplasms, including 23 lesions of gastric adenoma and 9 lesions of gastric cancer. The gastric neoplasms were classified into 3 phenotypes (gastric, mixed, or intestinal type) according to the immunostaining results and evaluated for location (U or M region: upper or middle third of the stomach or L region: lower third of the stomach), color (same as the background mucosa, whitish, or reddish), macroscopic type (elevated, flat, or depressed), background mucosal atrophy (present or absent), fundic gland polyps in the surrounding mucosa (present or absent), and morphologic changes in tumor size. Elevated whitish gastric adenomas were further subdivided by macroscopic type (flat elevated, protruded, or elevated with a central depression) and color (milky- or pinkish-white). The gastric adenomas included gastric (11/23, 48%), mixed (4/23, 17%), and intestinal (8/23, 35%) phenotypes. In contrast, no lesions of gastric cancers showed a gastric phenotype (0/9, 0%), while 5 (56%) and 4 (44%) lesions were intestinal and mixed phenotypes, respectively. Gastric cancers were significantly more likely than gastric adenomas to present as reddish depressed lesions with gastric atrophy. All gastric-type adenomas occurred in non-atrophic mucosa, in mucosa with fundic gland polyps in the periphery, in the U or M region, and as flat elevated or protruded lesions with a milky-white color. Half of the lesions increased in size. Meanwhile, the typical endoscopic features of intestinal-type adenomas included occurrence in the L region and elevated pinkish-white lesions with central depression. None of the intestinal-type adenomas increased in size during the observation period. We believe that these endoscopic features will be useful for the prompt diagnosis and appropriate management of gastric neoplasms in patients with FAP.

DOI： 10.1097/MD.0000000000030997

手技の解説クローン病におけるダブルバルーン内視鏡下逆行性造影の実際

井口俊博, 川野誠司, 平岡佐規子

Gastroenterological Endoscopy 64 ( 10 ) 2308 - 2316 2022.10

Language：Japanese Publisher：(一社)日本消化器内視鏡学会

クローン病患者の7割以上が小腸病変を有するとされ,小腸病変のモニタリングとその制御は患者のQOLに直結する.従ってクローン病診療では,全小腸を高精度でかつ手軽に,そして低侵襲にモニタリングすることが求められるが,残念ながらすべてを兼ね備えた検査やマーカーは未だ存在しない.ダブルバルーン内視鏡検査は,クローン病小腸病変に対するモニタリング検査の1つとして,また時に内視鏡的拡張術目的に広く使用されている.当科ではダブルバルーン内視鏡検査の際に通常の観察に加えて先端バルーンを拡張させて逆行性造影を行い,それまでは難しかった深部小腸の評価をルーチンで行っている.本稿では,クローン病小腸病変に対するダブルバルーン内視鏡下逆行性造影の手順やコツを解説する.(著者抄録)

手技の解説クローン病におけるダブルバルーン内視鏡下逆行性造影の実際

井口俊博, 川野誠司, 平岡佐規子

Gastroenterological Endoscopy 64 ( 10 ) 2308 - 2316 2022.10

Language：Japanese Publisher：(一社)日本消化器内視鏡学会

クローン病患者の7割以上が小腸病変を有するとされ,小腸病変のモニタリングとその制御は患者のQOLに直結する.従ってクローン病診療では,全小腸を高精度でかつ手軽に,そして低侵襲にモニタリングすることが求められるが,残念ながらすべてを兼ね備えた検査やマーカーは未だ存在しない.ダブルバルーン内視鏡検査は,クローン病小腸病変に対するモニタリング検査の1つとして,また時に内視鏡的拡張術目的に広く使用されている.当科ではダブルバルーン内視鏡検査の際に通常の観察に加えて先端バルーンを拡張させて逆行性造影を行い,それまでは難しかった深部小腸の評価をルーチンで行っている.本稿では,クローン病小腸病変に対するダブルバルーン内視鏡下逆行性造影の手順やコツを解説する.(著者抄録)

Postoperative Bleeding Risk after Gastric Endoscopic Submucosal Dissection in Patients Receiving a P2Y12 Receptor Antagonist. International journal

Ryosuke Hirai, Seiji Kawano, Shoko Inoo, Sakiko Kuraoka, Shotaro Okanoue, Takuya Satomi, Kenta Hamada, Yoshiyasu Kono, Hiromitsu Kanzaki, Masaya Iwamuro, Yoshiro Kawahara, Hiroyuki Okada

Gut and liver 17 ( 3 ) 404 - 411 2022.9

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

BACKGROUND/AIMS: The safety of gastric endoscopic submucosal dissection (ESD) in users of a P2Y12 receptor antagonist (P2Y12RA) under current guidelines has not been verified. METHODS: Patients treated by gastric ESD at Okayama University Hospital between January 2013 and December 2020 were registered. The postoperative bleeding rates of patients (group A) who did not receive any antithrombotic drugs; patients (group B) receiving aspirin or cilostazol monotherapy; and P2Y12RA users (group C) those on including monotherapy or dual antiplatelet therapy were compared. The risk factors for post-ESD bleeding were examined in a multivariate analysis of patient background, tumor factors, and antithrombotic drug management. RESULTS: Ultimately, 1,036 lesions (847 patients) were enrolled. The bleeding rates of group B and C were significantly higher than that of group A (p=0.012 and p<0.001, respectively), but there was no significant difference between group B and C (p=0.11). The postoperative bleeding rate was significantly higher in dual antiplatelet therapy than in P2Y12RA monotherapy (p=0.014). In multivariate analysis, tumor diameter ≥12 mm (odds ratio [OR], 4.30; 95% confidence interval [CI], 1.99 to 9.31), anticoagulant use (OR, 4.03; 95% CI, 1.64 to 9.86), and P2Y12RA use (OR, 3.40; 95% CI, 1.07 to 10.70) were significant risk factors for postoperative bleeding. CONCLUSIONS: P2Y12RA use is a risk factor for postoperative bleeding in patients who undergo ESD even if receiving drug management according to guidelines. Dual antiplatelet therapy carries a higher risk of bleeding than monotherapy.

DOI： 10.5009/gnl220196

酢酸亜鉛起因性胃粘膜傷害の1例

岩室雅也, 河野吉泰, 田中健大, 濱田健太, 神崎洋光, 川野誠司, 河原祥朗, 岡田裕之

日本消化器病学会雑誌 119 ( 9 ) 853 - 857 2022.9

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

82歳男性.食後の胃もたれを主訴に上部消化管内視鏡検査を実施.胃体部小彎に白苔付着をともなうびらんと周囲に発赤を認め,生検で中分化管状腺癌が疑われたため当院紹介となった.初回より3週間後の内視鏡検査では,体部小彎の異なる位置に白苔付着をともなうびらんを認め,生検では非腫瘍であった.酢酸亜鉛起因性胃粘膜傷害を疑い,同薬剤の内服を中止したところ,胃粘膜傷害は改善した.(著者抄録)

Other Link： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J01118&link_issn=&doc_id=20220922450009&doc_link_id=1390574876232671104&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390574876232671104&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_2.gif

Site-specific differences in T lymphocyte composition of the gastric mucosa after Helicobacter pylori eradication. International journal

Masaya Iwamuro, Takahide Takahashi, Natsuki Watanabe, Makoto Abe, Hiroyuki Sakae, Yoshiyasu Kono, Hiromitsu Kanzaki, Takehiro Tanaka, Seiji Kawano, Fumio Otsuka, Yoshiro Kawahara, Hiroyuki Yanai, Hiroyuki Okada

Medicine 101 ( 34 ) e30241 2022.8

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

In our earlier work, we revealed that inflammation of the lesser curvature of the gastric body and antrum could constitute independent risk factors for gastric cancer development, while inflammation of the greater curvature was not. The aims of this study were as follows: first, to reveal the differences between T lymphocyte populations of the gastric antrum and the greater and lesser curvatures of the gastric body in patients after Helicobacter pylori eradication; second, to analyze the correlation between the composition of the stomach-resident T lymphocytes and time from H. pylori eradication; and third, to evaluate the sex differences in T lymphocyte subsets after H. pylori eradication. To investigate site-specific differences in stomach-resident T lymphocytes after H. pylori eradication, we performed flow cytometry analysis on samples taken from the gastric antrum, greater curvature of the gastric body, and lesser curvature of the gastric body of 20 patients. We also analyzed the correlation between the composition of the stomach-resident T lymphocytes and the time from H. pylori eradication. The lymphocyte subsets of the antrum and lesser curvature of the body were similar. In contrast, compared to those in the greater curvature of the gastric body, CD4+/CD3+ lymphocyte subsets (43.8 ± 19.4% vs 31.7 ± 14.6%) were elevated in the lesser curvature of the body, whereas CD8+/CD3+ (67.1 ± 21.3% vs 80.4 ± 12.0%), CD7+/CD3+ (91.2 ± 4.6% vs 93.7 ± 3.8%), CCR4+/CD3+ (7.7 ± 8.1% vs 10.4 ± 7.0%), CD45RA+/CD3+CD4+ (27.2 ± 24.8% vs 39.5 ± 20.8%), and CD45RA+/CD3+CD4- (14.2 ± 11.1% vs 18.7 ± 11.5) were lower. Linear regression analysis showed a negative correlation between the time after H. pylori eradication and CD4+/CD3+ (P < .05, R2 = 0.198). There were no significant differences between men and women with respect to the lymphocyte populations. These results indicate that there are site-specific differences in lymphocyte composition in the stomach after H. pylori eradication.

DOI： 10.1097/MD.0000000000030241

Usefulness of Intestinal Ultrasound to Detect Small Intestinal Stenosis in Patients with Crohn's Disease. International journal

Keiko Takeuchi, Toshihiro Inokuchi, Masahiro Takahara, Masayasu Ohmori, Eriko Yasutomi, Shohei Oka, Shoko Igawa, Kensuke Takei, Yuki Baba, Seiji Kawano, Yasushi Yamasaki, Hideaki Kinugasa, Keita Harada, Sakiko Hiraoka, Hiroyuki Okada

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine 42 ( 2 ) 373 - 383 2022.6

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

OBJECTIVES: Double balloon enteroscopy (DBE) with retrograde contrast is useful as a monitoring tool for small intestinal lesions in Crohn's disease (CD), but these are burdensome for patients. Intestinal ultrasound (IUS) can be used with ease in daily clinical practice, but there is less evidence regarding the accuracy of detection of small intestinal stenosis in CD. This study aimed to examine the diagnostic power of IUS for small intestinal stenosis in patients with CD. METHODS: The findings of DBE and IUS in 86 patients with CD with small intestinal lesions were evaluated. Using DBE as the reference standard, we examined the detection rate of IUS for small intestinal stenosis. We evaluated three parameters: luminal narrowing, prestenotic dilation, and to-and-fro movement for determining stenosis using IUS. In addition, we compared the characteristics between the stenosis-detectable and stenosis-undetectable groups by IUS. RESULTS: Of the 86 patients, 30 had small intestinal stenosis. In IUS findings, when lesions that met two or more of the three parameters were judged as stenosis, the detection rate was 70.0% for sensitivity, 98.2% for specificity, and 88.4% for accuracy. Moreover, there were patients with a younger age at diagnosis (P < 0.05) and more ileocolonic disease location (P < 0.05) in the stenosis-detectable group by IUS. The stenoses detected by IUS were significantly longer than those undetected by IUS (14.1 mm versus 5.2 mm, P < 0.05). CONCLUSIONS: IUS delivered reliable results for clinically important small intestinal stenosis of CD with high diagnostic accuracy.

DOI： 10.1002/jum.16038

Linked Color Imaging (LCI) Emphasizes the Color Changes in the Gastric Mucosa After Helicobacter pylori Eradication. International journal

Hiroyuki Sakae, Hiromitsu Kanzaki, Takuya Satomi, Shotaro Okanoue, Yuka Obayashi, Kenta Hamada, Makoto Abe, Yoshiyasu Kono, Ko Miura, Masaya Iwamuro, Seiji Kawano, Yoshiro Kawahara, Takehiro Tanaka, Hiroyuki Yanai, Hiroyuki Okada

Digestive diseases and sciences 67 ( 6 ) 2375 - 2384 2022.6

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

BACKGROUND: Diffuse redness is a characteristic endoscopic finding that indicates current infection of Helicobacter pylori, which is reduced after successful eradication. Linked color imaging (LCI) has been reported to improve the visibility of diffuse redness compared to white light imaging (WLI); however, quantitative evaluation has not been reported. AIMS: This study aimed to objectively evaluate the color change of the gastric mucosa after H. pylori eradication. METHODS: Images of the greater curvature of the antrum and corpus were captured, and the sites were biopsied during esophagogastroduodenoscopy (EGD) before and 1 year after eradication. The region of interest (ROI) was set around the biopsied area on the images. The color difference (ΔE) before and after eradication was calculated using the CIE L*a*b* color space. The association between the histological evaluation and the color value of the corresponding ROI was determined. RESULTS: At the antrum, there was no significant color change with either mode. At the corpus, the a* value, which reflected redness, decreased significantly after eradication with both modes (WLI: 41.2 to 36.0, LCI: 37.5 to 25.5); the b* value, reflecting yellowish, decreased with WLI, but increased significantly with LCI (WLI: 44.6 to 41.6, LCI: 23.9 to 29.2). The ΔE was significantly larger with LCI than with WLI (16.5 vs. 8.6). The a* values at the corpus were generally associated with histological neutrophil infiltration. CONCLUSIONS: Quantitative evaluation revealed that LCI emphasizes the change in color of the gastric mucosa due to the reduction in diffuse redness.

DOI： 10.1007/s10620-021-07030-1

Erratum: Prospective multicenter study of the efficacy and safety of cold forceps polypectomy for ≤ 6-mm non-ampullary duodenal low-grade adenomas. International journal

Hiromitsu Kanzaki, Joichiro Horii, Ryuta Takenaka, Hiroyuki Nakagawa, Kazuhiro Matsueda, Takao Tsuzuki, Masahide Kita, Yasushi Yamasaki, Takehiro Tanaka, Masaya Iwamuro, Seiji Kawano, Yoshiro Kawahara, Jun Tomoda, Hiroyuki Okada

Endoscopy international open 10 ( 6 ) C6 2022.6

Prospective multicenter study of the efficacy and safety of cold forceps polypectomy for ≤ 6-mm non-ampullary duodenal low-grade adenomas. International journal

Hiromitsu Kanzaki, Joichiro Horii, Ryuta Takenaka, Hiroyuki Nakagawa, Kazuhiro Matsueda, Takao Tsuzuki, Masahide Kita, Yasushi Yamasaki, Takehiro Tanaka, Masaya Iwamuro, Seiji Kawano, Yoshiro Kawahara, Jun Tomoda, Hiroyuki Okada

Endoscopy international open 10 ( 6 ) E712-E718 2022.6

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

Background and study aims Because the endoscopic treatment for non-ampullary duodenal adenoma (NADA) has a non-negligible risk of adverse events (AEs), a safe and easy treatment for NADA is desirable. This was a multicenter prospective trial evaluating the efficacy and safety of cold forceps polypectomy (CFP) for diminutive NADAs. Patients and methods This study was prospectively conducted at six general hospitals and one university hospital. The inclusion criteria were histologic and endoscopic diagnosis of low-grade NADA measuring ≤ 6 mm. A second endoscopy was scheduled for 1 month after CFP. After confirmation of the success of CFP, 6-month and 12-month surveillance endoscopies were scheduled. The primary endpoint was the endoscopic and histologic disease disappearance rates at the 12-month endoscopy. Results Thirty-nine lesions from 38 patients were prospectively included. Median tumor size at enrollment was 5 mm (range 3-6 mm). There were four cases of remnant lesions at the second endoscopy, and the lesion disappearance rate of single CFP was 89.7 % (35 /39; 95 % confidence interval (CI), 76.9 %-97.9 %). In three cases, complete removal of the lesion was achieved with a single re-CFP, but one case required four repeat CFPs. The lesion disappearance rate at 12-month endoscopy was 97.4 % (38 /39; 95 %CI, 86.8 %-99.5 %). During the follow-up period, no AEs related to CFP were observed. Conclusions CFP for NADA ≤ 6 mm was safe and effective in this study. This common endoscopic method to remove lesions may be an option for treatment of diminutive NADAs.

DOI： 10.1055/a-1793-9439

H.pylori未感染胃粘膜を背景に発生したリンパ節転移を伴う低分化型進行胃癌の一例

倉岡紗樹子, 川野誠司, 小橋真由, 岡上昇太郎, 里見拓也, 稲生祥子, 濱田健太, 河野吉泰, 神崎洋光, 岩室雅也, 河原祥朗, 岡田裕之, 垣内慶彦, 黒田新士, 藤原俊義, 田中健大, 池田宣聖

日本消化器病学会中国支部例会プログラム・抄録集 117回 75 - 75 2022.6

Helicobacter suis感染胃炎の一例

稲生祥子, 岩室雅也, 田中健大, 倉岡紗樹子, 岡上昇太郎, 里見拓也, 濱田健太, 河野吉泰, 神崎洋光, 川野誠司, 河原祥朗, 岡田裕之

日本消化器病学会中国支部例会プログラム・抄録集 117回 74 - 74 2022.6

Characterization of Gastric Tissue-Resident T Cells in Autoimmune and Helicobacter pylori-Associated Gastritis. International journal

Daisuke Kametaka, Masaya Iwamuro, Takahide Takahashi, Araki Hirabata, Kenta Hamada, Yoshiyasu Kono, Hiromitsu Kanzaki, Seiji Kawano, Takehiro Tanaka, Fumio Otsuka, Yoshiro Kawahara, Hiroyuki Okada

Current issues in molecular biology 44 ( 6 ) 2443 - 2452 2022.5

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

Data regarding the in-depth surface marker profiles of gastric tissue-resident lymphocytes in autoimmune and Helicobacter pylori-associated gastritis are lacking. In this study, we investigated potential differences in lymphocyte composition between these profiles. We enrolled patients with autoimmune (n = 14), active (current infection of H. pylori in the stomach; n = 10), and inactive gastritis (post-eradication of H. pylori; n = 20). Lymphocytes were isolated from the greater curvature of the stomach and lesser curvature of the body and analyzed using flow cytometry. The CD8+/CD3+ and CD4+/CD3+ ratios differed between the samples. Body CD4+/antrum CD4+, which is calculated by dividing the CD4+/CD3+ ratio in the body by that in the antrum, was significantly higher in autoimmune gastritis (3.54 ± 3.13) than in active (1.47 ± 0.41) and inactive gastritis (1.42 ± 0.77). Antrum CD8+/CD4+ in autoimmune gastritis (7.86 ± 7.23) was also higher than that in active (1.49 ± 0.58) and inactive gastritis (2.84 ± 2.17). The area under the receiver operating characteristic curve of antrum CD8+/CD4+ was 0.842, and the corresponding optimal cutoff point was 4.0, with a sensitivity of 71.4% and a specificity of 93.3%. We propose that an antrum CD8+/CD4+ ratio > 4.0 is a potential diagnostic marker for autoimmune gastritis.

DOI： 10.3390/cimb44060167

A prospective multicenter study of the magnifying endoscopic evaluation of the invasion depth of superficial esophageal cancers. International journal

Tatsuhiro Gotoda, Keisuke Hori, Masahiro Nakagawa, Sayo Kobayashi, Tatsuya Toyokawa, Shuhei Ishiyama, Atsushi Imagawa, Makoto Abe, Yoshiyasu Kono, Hiromitsu Kanzaki, Masaya Iwamuro, Seiji Kawano, Yoshiro Kawahara, Hiroyuki Okada

Surgical endoscopy 36 ( 5 ) 3451 - 3459 2022.5

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

BACKGROUND: Treatment strategies for superficial esophageal squamous cell carcinoma (SESCC) are determined mainly on the basis of the invasion depth. The Japan Esophageal Society (JES) developed a simplified magnifying endoscopic classification for estimating the invasion depth of SESCC. We aimed to evaluate its accuracy. METHODS: We prospectively applied the JES classification for estimating the invasion depth of SESCC to 204 consecutive lesions from 6 hospitals in Japan between April 2016 and October 2018. We analyzed the accuracy of the endoscopic diagnosis by adding the following two categories to the JES classification: ≥ 7 mm lesion in B2 vessels (defined as B2 ≥ 7 mm) and B2 vessels with inflammation (defined as B2i). RESULTS: After applying the exclusion criteria, 201 lesions remained in the analysis. The diagnostic value of type B1, B2, B3 vessels were as follows: sensitivity, 93.9%, 68.0%, 25.0%; specificity, 81.1%, 89.2%, 99.4%; positive predictive value (PPV), 95.6%, 47.2%, 75.0%; negative predictive value (NPV), 75.0%, 95.1%, 95.4%; and accuracy, 91.5%, 86.5%, 95.0%, respectively. A retrospective analysis showed that the diagnostic accuracy was higher in type B2 vessels (86.5% to 92.0%). An avascular area (AVA) was found in 55 (27%) of the 201 lesions, which tended to be associated with a deeper pathological diagnosis of each Type B vessel. In an additional analysis, B2 ≥ 7 mm and B2i improved the diagnostic accuracy of type B2 vessels from 86.5% to 92.0%. CONCLUSIONS: The JES classification is useful for estimating the invasion depth of SESCC. The diagnostic accuracy for type B2 vessels was low, which may be improved by using B2 ≥ 7 mm and B2i.

DOI： 10.1007/s00464-021-08666-w

下咽頭ESD後の変形予防にValsalva法が有効であった1例

佐藤大直, 濱田健太, 安部真, 牧野琢丸, 藤澤郁, 岡上昇太郎, 河野吉泰, 神崎洋光, 岩室雅也, 川野誠司, 河原祥朗, 岡田裕之

日本消化器内視鏡学会中国支部例会 128回 101 - 101 2022.5

Heller-Dor術後に残存した胸痛に対し、Peroral Endoscopic Myotomyが有効であった食道アカラシアの一例

平田翔一郎, 里見拓也, 濱田健太, 榮浩行, 杉原雄策, 和田薫, 桑井寿雄, 稲生祥子, 倉岡紗樹子, 岡上昇太郎, 河野吉泰, 神崎洋光, 岩室雅也, 川野誠司, 河原祥朗, 岡田裕之

日本消化器内視鏡学会中国支部例会 128回 110 - 110 2022.5

チエノピリジン服用者における胃内視鏡的粘膜下層剥離術(ESD)の後出血リスクの検討

平井亮佑, 川野誠司, 稲生祥子, 倉岡紗樹子, 岡上昇太郎, 里見拓也, 濱田健太, 河野吉泰, 神崎洋光, 岩室雅也, 河原祥朗, 岡田裕之

Gastroenterological Endoscopy 64 ( Suppl.1 ) 831 - 831 2022.4

Gastric Adenocarcinoma and Proximal Polyposis of the Stomach Occurring With Ball Valve Syndrome. International journal

Soichiro Ako, Seiji Kawano, Hiroyuki Okada

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association 20 ( 2 ) e12-e13 2022.2

胃癌と非癌粘膜の白色球状外観(white globe appearance)の差異に関する検討

岩室雅也, 田中健大, 榮浩行, 安部真, 河野吉泰, 神崎洋光, 川野誠司, 河原祥朗, 岡田裕之

Gastroenterological Endoscopy 64 ( 1 ) 29 - 36 2022.1

Language：Japanese Publisher：(一社)日本消化器内視鏡学会

【背景・目的】胃癌と非癌粘膜の白色球状外観(white globe appearance:WGA)の違いを明らかにする.【方法】胃WGA症例の内視鏡所見と臨床的特徴を後ろ向きに解析した.【結果】胃癌18例,非癌23例にWGAを認めた.胃癌症例は7例(38.9%),非癌症例は17例(73.9%)がプロトンポンプ阻害剤(proton pump inhibitor:PPI)を内服していた.病理学的には,胃癌症例(18例)のうち腺管の嚢胞状拡張は12例(66.7%),腺腔内壊死物質は12例(66.7%),壁細胞の過形成と内腔への鋸歯状の突出(parietal cell protrusion:PCP)は1例(5.6%)でみられた.一方,非癌症例のうち14例で生検が実施され,腺管の嚢胞状拡張は8例(57.1%),PCPは7例(50.0%)でみられたが,腺腔内壊死物質は指摘できなかった.非癌群において,自己免疫性胃炎を2例,内視鏡的粘膜下層剥離術後瘢痕を2例,腺腫を1例,ランタン沈着を1例,胃MALTリンパ腫を1例に認めた.【結論】胃癌粘膜と非癌粘膜ではWGAの成因は異なり,非癌症例ではPPI服用が関与している可能性が示唆された.(著者抄録)

Other Link： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J00192&link_issn=&doc_id=20220125370003&doc_link_id=10.11280%2Fgee.64.29&url=https%3A%2F%2Fdoi.org%2F10.11280%2Fgee.64.29&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

Zinc Acetate Dihydrate Tablet-Associated Gastritis Occurring in a Post-Hematopoietic Stem Cell Transplant Recipient. International journal

Masaya Iwamuro, Takehiro Tanaka, Akifumi Matsumura, Seiji Kawano, Yoshiro Kawahara, Hiroyuki Okada

Case reports in gastrointestinal medicine 2022 4637707 - 4637707 2022

Language：English

A 65-year-old Japanese woman underwent umbilical cord blood transplantation for acute myeloid leukemia. Zinc acetate dihydrate tablets were administered for hypozincemia after transplantation, and vomiting and appetite loss occurred soon thereafter. Esophagogastroduodenoscopy revealed mucosal redness, erosion, white coat adhesion, and ulcers. Although graft-versus-host disease, intestinal transplant-associated microangiopathy, and cytomegalovirus infection were considered as possible causes, we diagnosed the patient with zinc acetate dihydrate tablet-associated gastric mucosal alterations based on the endoscopic features. This case reinforces the notion that medication-associated gastric lesions should be suspected in patients taking zinc acetate dihydrate tablets.

DOI： 10.1155/2022/4637707

[A case of Peutz-Jeghers syndrome that developed triple cancers during the course].

Keishi Fujiwara, Seiji Kawano, Tatsuhiro Yamazaki, Takeshi Tomoda, Masaya Iwamuro, Hironari Kato, Hiroyuki Okada

Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology 119 ( 5 ) 446 - 451 2022

Language：Japanese

At the time of colon polyp follow-up, a 46-year-old Japanese woman with a history of invagination, colon polyps, cervical cancer, and breast cancer was suspected of Peutz-Jeghers syndrome and referred. Multiple polyposes of the jejunum were discovered by capsule endoscopy and double-balloon endoscopy, and the resected specimen was diagnosed with hamartoma. During the follow-up, advanced pancreatic cancer-derived from IPMN developed. It is important to remember that multiple cancers can develop in Peutz-Jeghers syndrome.

DOI： 10.11405/nisshoshi.119.446

Zinc Acetate Dihydrate Tablet-associated Gastric Lesions.

Masaya Iwamuro, Takehiro Tanaka, Sakiko Kuraoka, Kenta Hamada, Makoto Abe, Yoshiyasu Kono, Hiromitsu Kanzaki, Seiji Kawano, Yoshiro Kawahara, Hiroyuki Okada

Internal medicine (Tokyo, Japan) 61 ( 13 ) 1931 - 1938 2022

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

Objective This study aimed to determine the prevalence and endoscopic features of zinc acetate dihydrate tablet-associated gastric lesions. Methods We retrospectively examined the endoscopic features of 47 patients taking zinc acetate dihydrate tablets who underwent esophagogastroduodenoscopy. Results Gastric mucosal alterations, including redness, erosions, ulcers, and adhesion of the white coat, were observed in 29 of 47 patients (61.7%). Among patients with gastric lesions (group A), there was a significantly higher percentage of symptomatic patients in comparison to patients without lesions (group B) (65.5% vs. 22.2%; p<0.01). The background characteristics of the two groups did not differ to a statistically significant extent. On esophagogastroduodenoscopy, mucosal redness (n=27, 93.1%), erosions (n=26, 90.0%), adhesion of the white coat (n=25, 86.2%), and ulcers (n=9, 31.0%) were observed. None of the 19 patients who previously underwent esophagogastroduodenoscopy had gastric lesions before starting zinc acetate dihydrate. Esophagogastroduodenoscopy was performed after the cessation of zinc acetate dihydrate intake in six patients, and revealed the resolution of gastric lesions. Conclusion Gastric lesions were observed in 29 of 47 patients who were taking zinc acetate dihydrate tablets. The most common endoscopic findings were mucosal redness (93.1%), erosions (90.0%), adhesion of the white coat (86.2%), and ulcers (31.0%). Although the exact pathogenesis is uncertain, we believe that understanding the unique manifestations of this gastric lesion will help physicians manage adverse events in patients taking zinc acetate dihydrate tablets.

DOI： 10.2169/internalmedicine.8625-21

[Zinc acetate-associated gastric lesions:a case report].

Masaya Iwamuro, Yoshiyasu Kono, Takehiro Tanaka, Kenta Hamada, Hiromitsu Kanzaki, Seiji Kawano, Yoshiro Kawahara, Hiroyuki Okada

Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology 119 ( 9 ) 853 - 857 2022

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

An 82-year-old Japanese man underwent esophagogastroduodenoscopy for postprandial epigastric discomfort. The patient was diagnosed with hypozincemia with a serum zinc level of 63μg/dL (normal range:80-130μg/dL), and he had commenced oral intake of zinc acetate 1 month before the esophagogastroduodenoscopy. Endoscopy showed erosions with white-coated mucosa surface adhesions and erythema on the lesser curvature of the gastric body. Moderately differentiated tubular adenocarcinoma was suspected based on the biopsy examination findings;therefore, he was referred to our hospital for further examination and treatment. A repeat endoscopy showed two erosions with white-coated mucosa surface adhesion and erythema on the lesser curvature of the gastric body. However, the lesion location was different from that detected in the initial endoscopy. The biopsy showed no neoplastic changes. Therefore, based on the endoscopic findings and history of oral zinc acetate administration, we diagnosed the gastric mucosal injury as zinc acetate-associated gastric lesions. The cessation of zinc acetate intake resulted in the resolution of gastric lesions. Reassessment of the biopsy specimen from the initial endoscopy revealed erosions, epithelial cells showing infarct-like necrosis, degenerative atypical cells, and necrotic substances, which were misdiagnosed as neoplastic changes. This case highlights the importance of recognizing the typical endoscopic features of a zinc acetate-associated gastric lesion to enable its prompt diagnosis during esophagogastroduodenoscopy.

DOI： 10.11405/nisshoshi.119.853

Scoring systems for differentiating gastrointestinal stromal tumors and schwannomas from leiomyomas in the stomach. International journal

Shotaro Okanoue, Masaya Iwamuro, Takehiro Tanaka, Takuya Satomi, Kenta Hamada, Hiroyuki Sakae, Makoto Abe, Yoshiyasu Kono, Hiromitsu Kanzaki, Seiji Kawano, Yoshiro Kawahara, Hiroyuki Okada

Medicine 100 ( 40 ) e27520 2021.10

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

ABSTRACT: There is no practical predictive model for the diagnosis of gastrointestinal stromal tumors (GISTs). To establish a practical predictive model for the diagnosis of subepithelial lesions in the stomach, we reviewed patients with GISTs (n = 89), schwannomas (n = 7), and leiomyomas (n = 28).The tumor was more frequently found along the gastric cardia in the leiomyoma group (57.1%) than in the GIST/schwannoma group (2.1%, P < .01). Contrast enhancement (57.3% vs 0%, P < .01) and intra-tumoral necrosis (34.4% vs 0.0%, P < .01) were more frequently observed in the GIST/schwannoma group than in the leiomyoma group. On endoscopic ultrasonography, 58.3% of GISTs/schwannomas showed uneven echogenicity, whereas the echogenicity was uneven in 21.4% of leiomyomas (P < .01). There were no differences between the tumor color and the presence or absence of ulcer formation, tumor bleeding, irregularity of the tumor margin, cystic spaces, and hyperechoic spots between the 2 groups. Based on these results, we developed a 2-step diagnostic algorithm for GISTs/schwannomas. The first step comprises 1 endoscopic feature: a cardiac or non-cardiac location. Tumors with a cardiac location were judged as leiomyomas and those with a non-cardiac location were judged as GISTs/schwannomas, with 96.9% sensitivity and 57.1% specificity for GIST/schwannoma diagnosis. The second step comprises a combination of endoscopic (non-cardiac location), radiologic (positive contrast enhancement and intra-tumoral necrosis), and endosonographic (uneven echogenicity) features for a total of 4 points. We assigned 1 point to each feature. Tumors with scores of 2 to 4 were judged as GISTs/schwannomas, with 81.3% sensitivity and 92.9% specificity for GIST/schwannoma diagnosis.Our predictive model will be a practical guide for the management of gastric subepithelial lesions.

DOI： 10.1097/MD.0000000000027520

Clinical characteristics and course of sporadic non-ampullary duodenal adenomas: A multicenter retrospective study. International journal

Hiromitsu Kanzaki, Kazuhiro Matsueda, Masahiro Nakagawa, Tomoki Inaba, Masahiro Takatani, Ryuta Takenaka, Masao Yoshioka, Atsushi Imagawa, Masafumi Inoue, Seiyuu Suzuki, Jun Tomoda, Masaya Iwamuro, Seiji Kawano, Yoshiro Kawahara, Takehiro Tanaka, Hiroyuki Okada

Medicine 100 ( 39 ) e27382 2021.10

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

ABSTRACT: Sporadic non-ampullary duodenal adenoma (SNADA) is a rare disease, and therefore, its clinical characteristics have not been comprehensively investigated. Furthermore, owing to the high complication rates and severity of endoscopic resection, treatment strategies vary among facilities. In the present study, we aimed to clarify the clinical characteristics and course of SNADA.We extracted clinical and histological records of SNADA cases diagnosed in 11 hospitals between September 1999 and August 2014. The patients were divided into "no-resection" and "resection" groups based on the initial treatment approach. We investigated the long-term outcome of the "no-resection" group and treatment results of the "resection" group, with particular interest in endoscopic resection.Overall, 299 patients were diagnosed with SNADA. The median age at diagnosis was 67 years (range, 31-88 years), with approximately twice as many men as women. The median tumor size was 8.0 mm (2-60 mm). In total, 161 patients were initially selected for no-resection and 138 underwent resection. Age >70 years and the presence of either severe illness or poor performance status were significantly related to opting for no-resection. In the no-resection group, 101 patients underwent endoscopic follow-up for at least 1 year. During the observational period (2.5 ± 2.2 years), 27 lesions (27%) disappeared following cold forceps biopsy, and 13 lesions (14%) presented lateral growth. Four lesions (4%) changed to mucosal carcinoma, 3 were treated endoscopically, and 1 was surgically resected. Nineteen patients died; however, no one died of duodenal carcinoma. In the endoscopic resection group, en bloc resection was achieved in 78% of patients. However, the complication rate for perforation was 7%, and endoscopic submucosal dissection was associated with a 36% perforation rate.With the low incidence of cancer development and no disease specific death, the strategy of initially not performing resection could be considered especially for the older adults, poor-prognosis patients, or small lesions.

DOI： 10.1097/MD.0000000000027382

家族性大腸腺腫症の胃病変の形質発現と内視鏡的特徴の検討

小橋真由, 岩室雅也, 亀高大介, 岡上昇太郎, 里見拓也, 濱田健太, 榮浩行, 安部真, 河野吉泰, 神崎洋光, 川野誠司, 河原祥朗, 田中健大, 岡田裕之

Gastroenterological Endoscopy 63 ( Suppl.2 ) 2023 - 2023 2021.10

家族性大腸腺腫症の胃病変の形質発現と内視鏡的特徴の検討

小橋真由, 岩室雅也, 亀高大介, 岡上昇太郎, 里見拓也, 濱田健太, 榮浩行, 安部真, 河野吉泰, 神崎洋光, 川野誠司, 河原祥朗, 田中健大, 岡田裕之

Gastroenterological Endoscopy 63 ( Suppl.2 ) 2023 - 2023 2021.10

【消化管の希少疾患-診療の現状】Gastric adenocarcinoma and proximal polyposis of the stomach(GAPPS)の臨床病理学的特徴

川野誠司, 赤穂宗一郎, 倉岡紗樹子, 小橋真由, 岡上昇太郎, 里見拓也, 濱田健太, 安部真, 河野吉泰, 神崎洋光, 岩室雅也, 河原祥朗, 岡田裕之

消化器・肝臓内科 10 ( 3 ) 290 - 295 2021.9

胃気腫症の5例の臨床的特徴に関する検討 Reviewed

岩室雅也, 安部真, 河野吉泰, 神崎洋光, 堀圭介, 川野誠司, 河原祥朗, 岡田裕之

日本消化器病学会雑誌 118 ( 9 ) 851 - 858 2021.9

A prospective multicenter study of the magnifying endoscopic evaluation of the invasion depth of superficial esophageal cancers. International journal

Tatsuhiro Gotoda, Keisuke Hori, Masahiro Nakagawa, Sayo Kobayashi, Tatsuya Toyokawa, Shuhei Ishiyama, Atsushi Imagawa, Makoto Abe, Yoshiyasu Kono, Hiromitsu Kanzaki, Masaya Iwamuro, Seiji Kawano, Yoshiro Kawahara, Hiroyuki Okada

Surgical endoscopy 36 ( 5 ) 3451 - 3459 2021.7

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

BACKGROUND: Treatment strategies for superficial esophageal squamous cell carcinoma (SESCC) are determined mainly on the basis of the invasion depth. The Japan Esophageal Society (JES) developed a simplified magnifying endoscopic classification for estimating the invasion depth of SESCC. We aimed to evaluate its accuracy. METHODS: We prospectively applied the JES classification for estimating the invasion depth of SESCC to 204 consecutive lesions from 6 hospitals in Japan between April 2016 and October 2018. We analyzed the accuracy of the endoscopic diagnosis by adding the following two categories to the JES classification: ≥ 7 mm lesion in B2 vessels (defined as B2 ≥ 7 mm) and B2 vessels with inflammation (defined as B2i). RESULTS: After applying the exclusion criteria, 201 lesions remained in the analysis. The diagnostic value of type B1, B2, B3 vessels were as follows: sensitivity, 93.9%, 68.0%, 25.0%; specificity, 81.1%, 89.2%, 99.4%; positive predictive value (PPV), 95.6%, 47.2%, 75.0%; negative predictive value (NPV), 75.0%, 95.1%, 95.4%; and accuracy, 91.5%, 86.5%, 95.0%, respectively. A retrospective analysis showed that the diagnostic accuracy was higher in type B2 vessels (86.5% to 92.0%). An avascular area (AVA) was found in 55 (27%) of the 201 lesions, which tended to be associated with a deeper pathological diagnosis of each Type B vessel. In an additional analysis, B2 ≥ 7 mm and B2i improved the diagnostic accuracy of type B2 vessels from 86.5% to 92.0%. CONCLUSIONS: The JES classification is useful for estimating the invasion depth of SESCC. The diagnostic accuracy for type B2 vessels was low, which may be improved by using B2 ≥ 7 mm and B2i.

DOI： 10.1007/s00464-021-08666-w

Squamous Metaplasia of the Stomach Associated with Lymphoma Infiltration.

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

Internal medicine (Tokyo, Japan) 60 ( 14 ) 2229 - 2234 2021.7

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

We herein report a patient who presented with follicular lymphoma. Although the stomach was initially intact, mucosal redness and multiple erosions appeared in the gastric body owing to infiltration of the follicular lymphoma cells. Subsequently, a slightly depressed, white area lacking gastric mucosal structure was detected in the lesser curvature of the gastric cardia and body, where lymphoma cell infiltration was also pathologically observed beneath the stratified squamous epithelium. This case indicated that, although infrequent, prolonged mucosal injury owing to lymphoma infiltration can cause squamous metaplasia in the stomach.

DOI： 10.2169/internalmedicine.6271-20

女性に発症した食道扁平上皮癌の臨床病理学的特徴に関する検討

小橋真由, 川野誠司, 倉岡紗樹子, 岡上昇太郎, 里見拓也, 濱田健太, 安部真, 河野吉泰, 神崎洋光, 岩室雅也, 河原祥朗, 田邊俊介, 藤原俊義, 田中健大, 岡田裕之

日本高齢消化器病学会誌 24 ( 1 ) 186 - 186 2021.7

Linked Color Imaging (LCI) Emphasizes the Color Changes in the Gastric Mucosa After Helicobacter pylori Eradication. International journal

Hiroyuki Sakae, Hiromitsu Kanzaki, Takuya Satomi, Shotaro Okanoue, Yuka Obayashi, Kenta Hamada, Makoto Abe, Yoshiyasu Kono, Ko Miura, Masaya Iwamuro, Seiji Kawano, Yoshiro Kawahara, Takehiro Tanaka, Hiroyuki Yanai, Hiroyuki Okada

Digestive diseases and sciences 67 ( 6 ) 2375 - 2384 2021.5

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

BACKGROUND: Diffuse redness is a characteristic endoscopic finding that indicates current infection of Helicobacter pylori, which is reduced after successful eradication. Linked color imaging (LCI) has been reported to improve the visibility of diffuse redness compared to white light imaging (WLI); however, quantitative evaluation has not been reported. AIMS: This study aimed to objectively evaluate the color change of the gastric mucosa after H. pylori eradication. METHODS: Images of the greater curvature of the antrum and corpus were captured, and the sites were biopsied during esophagogastroduodenoscopy (EGD) before and 1 year after eradication. The region of interest (ROI) was set around the biopsied area on the images. The color difference (ΔE) before and after eradication was calculated using the CIE L*a*b* color space. The association between the histological evaluation and the color value of the corresponding ROI was determined. RESULTS: At the antrum, there was no significant color change with either mode. At the corpus, the a* value, which reflected redness, decreased significantly after eradication with both modes (WLI: 41.2 to 36.0, LCI: 37.5 to 25.5); the b* value, reflecting yellowish, decreased with WLI, but increased significantly with LCI (WLI: 44.6 to 41.6, LCI: 23.9 to 29.2). The ΔE was significantly larger with LCI than with WLI (16.5 vs. 8.6). The a* values at the corpus were generally associated with histological neutrophil infiltration. CONCLUSIONS: Quantitative evaluation revealed that LCI emphasizes the change in color of the gastric mucosa due to the reduction in diffuse redness.

DOI： 10.1007/s10620-021-07030-1

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

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

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

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

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

DOI： 10.2169/internalmedicine.5486-20

Peutz-Jeghers症候群の11例における胃病変に関する検討

里見拓也, 岩室雅也, 豊川達也, 森藤由記, 松枝和宏, 堀伸一郎, 吉岡正雄, 田中健大, 川野誠司, 岡田裕之

Gastroenterological Endoscopy 63 ( Suppl.1 ) 936 - 936 2021.4

Peutz-Jeghers症候群の11例における胃病変に関する検討

里見拓也, 岩室雅也, 豊川達也, 森藤由記, 松枝和宏, 堀伸一郎, 吉岡正雄, 田中健大, 川野誠司, 岡田裕之

Gastroenterological Endoscopy 63 ( Suppl.1 ) 936 - 936 2021.4

Efficacy and safety of endoscopic submucosal dissection for gastric tube cancer: A multicenter retrospective study. International journal

Takuya Satomi, Seiji Kawano, Tomoki Inaba, Masahiro Nakagawa, Hirokazu Mouri, Masao Yoshioka, Shoichi Tanaka, Tatsuya Toyokawa, Sayo Kobayashi, Takehiro Tanaka, Hiromitsu Kanzaki, Masaya Iwamuro, Yoshiro Kawahara, Hiroyuki Okada

World journal of gastroenterology 27 ( 11 ) 1043 - 1054 2021.3

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

BACKGROUND: Recent improvements in the prognosis of patients with esophageal cancer have led to the increased occurrence of gastric tube cancer (GTC) in the reconstructed gastric tube. However, there are few reports on the treatment results of endoscopic submucosal dissection (ESD) for GTC. AIM: To evaluate the efficacy and safety of ESD for GTC after esophagectomy in a multicenter trial. METHODS: We retrospectively investigated 48 GTC lesions in 38 consecutive patients with GTC in the reconstructed gastric tube after esophagectomy who had undergone ESD between January 2005 and December 2019 at 8 institutions participating in the Okayama Gut Study group. The clinical indications of ESD for early gastric cancer were similarly applied for GTC after esophagectomy. ESD specimens were evaluated in 2-mm slices according to the Japanese Classification of Gastric Carcinoma with curability assessments divided into curative and non-curative resection based on the Gastric Cancer Treatment Guidelines. Patient characteristics, treatment results, clinical course, and treatment outcomes were analyzed. RESULTS: The median age of patients was 71.5 years (range, 57-84years), and there were 34 men and 4 women. The median observation period after ESD was 884 d (range, 8-4040 d). The median procedure time was 81 min (range, 29-334 min), the en bloc resection rate was 91.7% (44/48), and the curative resection rate was 79% (38/48). Complications during ESD were seen in 4% (2/48) of case, and those after ESD were seen in 10% (5/48) of case. The survival rate at 5 years was 59.5%. During the observation period after ESD, 10 patients died of other diseases. Although there were differences in the procedure time between institutions, a multivariate analysis showed that tumor size was the only factor associated with prolonged procedure time. CONCLUSION: ESD for GTC after esophagectomy was shown to be safe and effective.

DOI： 10.3748/wjg.v27.i11.1043

Long-term outcomes of endoscopic versus surgical resection for MM-SM1 esophageal squamous cell carcinoma using propensity score analysis.

Kenji Yamauchi, Masaya Iwamuro, Masahiro Nakagawa, Ryuta Takenaka, Kazuhiro Matsueda, Tomoki Inaba, Masao Yoshioka, Tatsuya Toyokawa, Shouichi Tanaka, Hiromitsu Kanzaki, Seiji Kawano, Yoshiro Kawahara, Yasuhiro Shirakawa, Hiroyuki Okada

Esophagus : official journal of the Japan Esophageal Society 18 ( 1 ) 72 - 80 2021.1

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

BACKGROUND: Esophageal squamous cell carcinoma (ESCC) confined to the muscularis mucosae (MM) or up to 200 µm of the submucosa (SM1) confers the risk for lymph node metastasis, and is defined as relative indication for endoscopic submucosal dissection (ESD) by the Japan Esophageal Society guidelines. Although additional surgical treatment after ESD is recommended, long-term outcomes of ESD compared with those of surgery have not been clarified. This study aimed to evaluate the long-term outcomes of ESD and surgery for cN0M0 relative indication lesions of ESCC. METHODS: Between 2006 and 2016, patients with relative indication lesions of ESCC who underwent ESD or surgery at nine participating hospitals were examined retrospectively. Using propensity score matching, we evaluated survival curves for and hazard ratios associated with endoscopic submucosal dissection and surgery. RESULTS: In total, 155 lesions in the ESD group and 106 lesions in the surgery group met the pathological criteria of relative indication for endoscopic resection. After matching, 50 matched pairs of patients who underwent ESD or surgery were selected. The 5-year overall survival rates were 84.5% [95% confidence interval (CI) 68-93] in the ESD group and 79% [95% CI 60-90] in the surgery group. The hazard ratio of mortality for ESD compared with that for surgery estimated by Cox regression analysis was 0.79 (95% CI 0.3-2.06, p = 0.63). CONCLUSIONS: Compared with surgery, ESD does not compromise long-term outcomes. ESD alone or ESD with chemotherapy and/or radiotherapy may be an option for the treatment of MM and SM1 ESCC.

DOI： 10.1007/s10388-020-00775-0

クローン病小腸狭窄病変に対するダブルバルーン内視鏡下バルーン拡張術の有効性の検討

井口俊博, 井川翔子, 安富絵里子, 岡昌平, 川野誠司, 平岡佐規子, 岡田裕之

日本消化管学会雑誌 5 ( Suppl. ) 129 - 129 2021.1

Gastric Adenoma: A High Incidence Rate of Developing Carcinoma and Risk of Metachronous Gastric Cancer according to Long-Term Follow-Up. International journal

Yuki Okamoto, Hiromitsu Kanzaki, Takehiro Tanaka, Hiroyuki Sakae, Makoto Abe, Masaya Iwamuro, Seiji Kawano, Yoshiro Kawahara, Hiroyuki Okada

Digestion 102 ( 6 ) 878 - 886 2021

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

INTRODUCTION: Gastric adenomas are histologically defined as benign epithelial tumors. While some of them remain adenomas for a long time, others progress to carcinomas. However, long-term outcomes of such cases are not entirely clear. Here, we explored the risk factors and incidence of developing carcinoma from gastric adenoma as well as metachronous gastric cancer. METHODS: This study was conducted at a facility that adopted a follow-up strategy for gastric adenoma. Lesions histologically diagnosed as gastric intestinal-type adenomas between January 2004 and December 2016 were analyzed. Clinicopathological data were collected from patients' medical records, and histological changes from adenoma to carcinoma during endoscopic follow-up and risk factors of cancer development were evaluated. RESULTS: This study involved 409 lesions from 376 patients. The analysis of the development of gastric cancer from adenoma and metachronous gastric cancer was ultimately performed for 282 lesions from 258 patients and 269 lesions from 246 patients, respectively, due to different follow-up periods. The 5-year rate of carcinoma development was 34.0%. Risk factors for carcinoma development upon multivariate analysis were lesion size ≥15 mm and morphological depression. All cases with both factors developed gastric carcinoma, and 50.5% of those with either factor developed carcinoma within 5 years. Gastric adenoma was accompanied by metachronous gastric cancer in 1.5% of the patients annually. The only risk factor for metachronous gastric carcinoma was primary adenoma progressing to carcinoma during the follow-up period. DISCUSSION/CONCLUSION: Given the high rate of carcinoma development in patients with risk factors, resection of gastric adenoma should be considered during the initial examination. Careful observation and follow-up should also be conducted to detect not only changes in the primary adenoma but also the occurrence of metachronous carcinoma, especially in cases of adenoma progressing to carcinoma.

DOI： 10.1159/000515213

[Clinical characteristics of five patients with gastric emphysema].

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

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

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

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

DOI： 10.11405/nisshoshi.118.851

Clinical and phenotypical characteristics of submucosal invasive carcinoma in non-ampullary duodenal cancer. International journal

Katsunori Matsueda, Hiromitsu Kanzaki, Ryuta Takenaka, Masahiro Nakagawa, Kazuhiro Matsueda, Masaya Iwamuro, Seiji Kawano, Yoshiro Kawahara, Tomohiro Toji, Takehiro Tanaka, Takahito Yagi, Toshiyoshi Fujiwara, Hiroyuki Okada

PloS one 16 ( 8 ) e0256797 2021

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

OBJECTIVE: The rare incidence of submucosal invasive non-ampullary duodenal carcinoma has led to scant information in literature; therefore, we compared the clinicopathological features between submucosal invasive carcinoma (SM-Ca), mucosal carcinoma (M-Ca), and advanced carcinoma (Ad-Ca). MATERIALS: We retrospectively analyzed 165 patients with sporadic non-ampullary duodenal carcinomas (SNADCs) from four institutions between January 2003 and December 2018. The SNADCs were divided to three groups according to histological diagnosis: SM-Ca, M-Ca, and Ad-Ca. The clinicopathological characteristics and mucin phenotypes were compared between groups. RESULTS: Among the 165 SNADCs, 11 (7%) were classified as SM-Ca, 70 (42%) as M-Ca, and 84 (51%) as Ad-Ca. We found that all SM-Ca (P = 0.013) and most Ad-Ca (P = 0.020) lesions were located on the oral-Vater; however, an almost equal distribution of M-Ca lesions was found between the oral- and anal-Vater. No significant difference was observed between the tumor diameter of M-Ca and SM-Ca; however, 45% (5/11) of SM-Ca were ≤10 mm. A total of 73% (8/11) of SM-Ca were classified as gastric phenotype and no lesions were classified as intestinal phenotype; whereas most M-Ca were classified as intestinal phenotype (67%, 8/12). CONCLUSIONS: SM-Ca lesions were all located on the oral-Vater and were highly associated with the gastric mucin phenotype, which were different from the features of most M-Ca.

DOI： 10.1371/journal.pone.0256797

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

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

Acta medica Okayama 74 ( 6 ) 461 - 466 2020.12

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

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

DOI： 10.18926/AMO/61204

POEMが有効であったJackhammer esophagusの2例

榮浩行, 杉原雄策, 里見拓也, 岡上昇太郎, 濱田健太, 安部真, 河野吉泰, 神崎洋光, 岩室雅也, 川野誠司, 河原祥朗, 眞部紀明, 岡田裕之

日本消化器病学会中国支部例会プログラム・抄録集 114回 114 - 114 2020.11

びまん性大細胞型B細胞性リンパ腫の無治療経過観察中に胃病変の自然退縮が認められた1例

長岡寛和, 岩室雅也, 田中健大, 遠西大輔, 榮浩行, 安部真, 河野吉泰, 神崎洋光, 川野誠司, 河原祥朗, 岡田裕之

日本消化器病学会中国支部例会・日本消化器内視鏡学会中国支部例会プログラム・抄録集 114回・125回 92 - 92 2020.11

咽頭癌CRT後の局所再発病変に対してサルベージESDを施行した一例

織田崇志, 安部真, 濱田健太, 榮浩行, 河野吉泰, 神崎洋光, 岩室雅也, 川野誠司, 河原祥朗, 岡田裕之, 丸中秀格

日本消化器病学会中国支部例会プログラム・抄録集 114回 114 - 114 2020.11

胃癌術後11年目にKrukenberg腫瘍及び骨髄癌腫症を発症した一例

吉田遥, 川野誠司, 河原聡一郎, 岡上昇太郎, 里見拓也, 濱田健太, 榮浩行, 安部真, 河野吉泰, 神崎洋光, 岩室雅也, 河原祥朗, 岡田裕之

日本消化器病学会中国支部例会プログラム・抄録集 114回 55 - 55 2020.11

Ballvalve syndromeを契機に診断されたGAPPS (Gastric Adenocarcinoma and Proximal Polyposis of the Stomach)一例とその家系の検討

赤穂宗一郎, 川野誠司, 岡上昇太郎, 里見拓也, 岡本雄貴, 大林由佳, 馬場雄己, 濱田健太, 榮浩行, 安部真, 神崎洋光, 岩室雅也, 河原祥朗, 田中健太, 岡田裕之

Gastroenterological Endoscopy 62 ( Suppl.2 ) 2101 - 2101 2020.10

Ballvalve syndromeを契機に診断されたGAPPS (Gastric Adenocarcinoma and Proximal Polyposis of the Stomach)一例とその家系の検討

赤穂宗一郎, 川野誠司, 岡上昇太郎, 里見拓也, 岡本雄貴, 大林由佳, 馬場雄己, 濱田健太, 榮浩行, 安部真, 神崎洋光, 岩室雅也, 河原祥朗, 田中健太, 岡田裕之

Gastroenterological Endoscopy 62 ( Suppl.2 ) 2101 - 2101 2020.10

Factors Predicting a Favorable Disease Course Without Anti-TNF Therapy in Crohn's Disease Patients.

Toshihiro Inokuchi, Sakiko Hiraoka, Eriko Yasutomi, Shohei Oka, Yasushi Yamasaki, Hideaki Kinugasa, Masahiro Takahara, Seiji Kawano, Keita Harada, Hiroyuki Okada, Jun Kato

Acta medica Okayama 74 ( 4 ) 265 - 274 2020.8

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

Determining factors that predict a favorable disease course without anti-tumor necrosis factor (TNF) agents would help establish a more cost-effective strategy for Crohn's disease (CD). A retrospective chart review was performed for CD patients with disease durations > 10 years who had not received anti-TNF agents as first-line therapy. Patients were divided into 2 groups: those who received neither anti-TNF agents nor bowel resection (G1), and those who had received an anti-TNF agent and/or bowel resection (G2). The patient backgrounds, therapies and clinical courses were compared between the groups. A total of 62 CD patients met the inclusion criteria (males: 71%; median duration of follow-up: 19 years). Six patients were included in G1; they were significantly less likely to have upper gastrointestinal lesions than G2 (p=0.007). A multivariate analysis revealed that the significant factors for avoidance of bowel resection without anti-TNF treatment were non-stricturing and non-penetrating behaviors, and absence of upper gastrointestinal lesions at the diagnosis (hazard ratios 0.41 and 0.52; p=0.004 and 0.04, respectively). In consideration of the long treatment course of CD, patients with non-stricturing and non-penetrating behaviors and no upper gastrointestinal lesions should not be treated with anti-TNF agents as first-line therapy.

DOI： 10.18926/AMO/60363

Gastric Adenocarcinoma and Proximal Polyposis of the Stomach Occurring With Ball Valve Syndrome. International journal

Soichiro Ako, Seiji Kawano, Hiroyuki Okada

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association 20 ( 2 ) e12-e13 2020.7

Peutz-Jeghers症候群の14例における悪性腫瘍の合併に関する検討

里見拓也, 岩室雅也, 豊川達也, 森藤由記, 松枝和宏, 堀伸一郎, 吉岡正雄, 田中健大, 川野誠司, 岡田裕之

日本消化器病学会雑誌 117 ( 臨増総会 ) A275 - A275 2020.7

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

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

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

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

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

DOI： 10.2169/internalmedicine.3628-19

Pattern of gastric lanthanum deposition based on the presence or absence of mucosal atrophy

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

Gastroenterological Endoscopy 62 ( 6 ) 684 - 690 2020.6

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

Aim: This study aimed to investigate the relationship between the pattern of gastric lanthanum deposition and gastric mucosal atrophy. Methods: We retrospectively reviewed 4 patients with gastric lanthanum deposition who tested negative for Helicobacter pylori infection (non-atrophy group) and 10 patients with gastric lanthanum deposition with gastric atrophy (atrophy group). The endoscopic features of gastric lanthanum deposition were retrospectively analyzed in both groups. Results: Although gastric lanthanum deposition appears as white lesions, this presentation was not observed in 1 of the 4 patients in the non-atrophy group. The remaining 3 patients (75%) had diffuse white lesions in the gastric body that were predominantly distributed in the posterior wall and lesser curvature. In the atrophy group, white lesions were found in 9 of the 10 cases. In the areas with atrophic mucosa, white lesions were most frequently found in the gastric antrum (n = 5) and angle (n = 5). The white lesions appeared in an annular and/or granular pattern. White lesions were also found in the gastric body with mucosal atrophy and presented in an annular pattern (n = 1) or as diffuse whitish lesions (n = 1). Based on these findings, we speculate that in patients without gastric mucosal atrophy, gastric lanthanum deposition appears as diffuse white lesions in the posterior wall and lesser curvature of the gastric body. In the gastric mucosa with atrophy, lanthanum-related lesions likely appear as annular or granular white lesions. Moreover, these white lesions are probably more frequently observed in the gastric antrum and angle since atrophy begins at the lower part of the stomach. Conclusions: These findings suggest that the localization and macroscopic findings of gastric lanthanum deposition differ depending on the presence or absence of gastric atrophy.

DOI： 10.11280/gee.62.684

悪性黒色腫の遅発性転移により小腸重積をきたした1例

林里美, 衣笠秀明, 山本峻平, 大森正泰, 安富絵里子, 岡昌平, 山崎泰史, 井口俊博, 川野誠司, 原田馨太, 平岡佐規子, 田中健大, 寺石文則, 山崎修, 岡田裕之

日本消化器内視鏡学会中国支部例会 124回 41 - 41 2020.6

胃濾胞性リンパ腫に胃扁平上皮化生を合併した1例

岩室雅也, 田中健大, 榮浩行, 安部真, 神崎洋光, 川野誠司, 河原祥朗, 岡田裕之

日本消化器病学会中国支部例会プログラム・抄録集 113回 96 - 96 2020.5

Esophageal Papilloma Detected by Positron Emission Tomography.

Masaya Iwamuro, Yuki Okamoto, Seiji Kawano, Hiroyuki Okada

Internal medicine (Tokyo, Japan) 59 ( 7 ) 1003 - 1004 2020.4

Tolerability and efficacy of the concentration of iodine solution during esophageal chromoendoscopy: a double-blind randomized controlled trial. International journal

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

Gastrointestinal endoscopy 91 ( 4 ) 763 - 770 2020.4

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

BACKGROUND AND AIMS: Esophageal chromoendoscopy with iodine solution is an important diagnostic method for the detection of superficial esophageal cancer. However, the concentration of iodine solution has differed among reports. This study aimed to evaluate patient discomfort with different iodine concentrations. METHODS: We performed a prospective, double-blind, randomized study. We prospectively enrolled and analyzed 77 patients who were at high risk for esophageal carcinoma and scheduled to undergo EGD from March 2018 to January 2019. All patients were divided into 2 groups before the procedure to compare pain measurements: a 1% iodine solution group (group A) and a 2% iodine solution group (group B). The primary endpoint of this study was the difference in pain measurement between 1% and 2% iodine solution chromoendoscopy. Secondary endpoints were safety, detection yield, and color evaluation based on both the endoscopist's survey and color values, as determined using the Commission Internationale de l'Eclairage (CIELAB, Vienna, Austria) color evaluation system, in the iodine-faded and iodine-stained area of each group. RESULTS: Heartburn and retrosternal pain in group A were significantly lower than those in group B (P = .02). Eleven patients reported heartburn and retrosternal pain (group A, 2; group B, 9). Four patients reported pain above the sternal angle and 7 below the sternal angle. There was no significant difference between the 2 groups with regard to detection yield, color evaluation by the endoscopist's assessment, or color values. No patients had any adverse events, and all safely completed this study. CONCLUSIONS: The 2% iodine solution resulted in significantly greater pain than the 1% iodine solution, and the color of the stained esophageal images of each group was the same from this study. Therefore, the 1% iodine solution is recommended for esophageal chromoendoscopy. (Clinical trial registration number: UMIN 000029796.).

DOI： 10.1016/j.gie.2019.10.022

Primary localized amyloidosis of the stomach mimicking healing gastric ulcer. International journal

Katsunori Matsueda, Seiji Kawano, Hiroyuki Okada

Gastrointestinal endoscopy 91 ( 4 ) 947 - 948 2020.4

Efficacy and safety of scheduled early endoscopic ultrasonography-guided ethanol reinjection for patients with pancreatic neuroendocrine tumors: Prospective pilot study. International journal

Kazuyuki Matsumoto, Hironari Kato, Seiji Kawano, Hiroyasu Fujiwara, Kenji Nishida, Ryo Harada, Masakuni Fujii, Ryuichi Yoshida, Yuzo Umeda, Shiro Hinotsu, Takahito Yagi, Hiroyuki Okada

Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 32 ( 3 ) 425 - 430 2020.3

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

Endoscopic ultrasonography (EUS)-guided ethanol injection was recently proposed for treatment of patients with small pancreatic neuroendocrine tumors (p-NET); however, tips on how to carry out safe and effective procedures are unclear. We launched a pilot study for scheduled early EUS-guided ethanol reinjection for small p-NET. Major eligibility criteria were presence of pathologically diagnosed grade (G) 1 or G2, tumor size ≤2 cm and being a poor or rejected candidate for surgery. For the treatment, we used a 25-gauge needle and pure ethanol. Contrast-enhanced computed tomography (CE-CT) was carried out on postoperative day 3, and if enhanced areas of the tumor were still apparent, an additional session was scheduled during the same hospitalization period. Primary endpoint was complete ablation rate at 1 month after treatment, and secondary endpoint was procedure-related adverse events. A total of five patients were treated. Median size of the tumor was 10 (range: 7-14) mm. Of the five patients, three underwent an additional session. Median volume of ethanol injection per session was 0.8 (range: 0.3-1.0) mL, and the total was 1.0 (0.9-1.8) mL. Complete ablation was achieved in four of the five tumors (80%) with no adverse events. During 1 year of follow up, none of the patients reported any procedure-related adverse events, and no recurrence of tumor. Scheduled early EUS-guided ethanol reinjection appears to be safe and effective for treating small p-NET (UMIN number: 000018834).

DOI： 10.1111/den.13552

肝細胞癌に対するシスプラチン肝動注化学療法後に大腸炎を発症した一例

山本峻平, 大西秀樹, 衣笠秀明, 神崎洋光, 岩室雅也, 原田馨太, 川野誠司, 平岡佐規子, 河原祥朗, 岡田裕之

日本消化管学会雑誌 4 ( Suppl. ) 291 - 291 2020.1

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

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

Digestion 101 ( 6 ) 771 - 778 2020

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

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

DOI： 10.1159/000502573

Intestinal Diffuse Large B-Cell Lymphoma in a Patient with Systemic Lupus Erythematosus. International journal

Masaya Iwamuro, Takahide Takahashi, Yoko Ota, Takehiro Tanaka, Noboru Asada, Shuya Yano, Mayu Uka, Rei Nakamura, Yuki Baba, Seiji Kawano, Yoshiro Kawahara, Hiroyuki Okada

Case reports in gastrointestinal medicine 2020 7947540 - 7947540 2020

Language：English

A 44-year-old Japanese woman with systemic lupus erythematosus (SLE) presented to our hospital with abdominal pain. Radiological and endoscopic examinations led to the diagnosis of diffuse large B-cell lymphoma of the jejunum, which was subsequently resected. Patients with SLE reportedly have an increased risk of non-Hodgkin lymphoma, as demonstrated by our patient. Hence, lymphoma should be considered in the differential diagnosis of neoplastic lesions emerging in SLE patients. In addition, flow cytometry using endoscopically biopsied fragments is useful for the immediate diagnosis of lymphoma, leading to timely and accurate preoperative staging.

DOI： 10.1155/2020/7947540

Appendiceal Orifice Inflammation in Ulcerative Colitis Mimicking Mucosa-Associated Lymphoid Tissue Lymphoma in the Cecum. International journal

Masaya Iwamuro, Takahide Takahashi, Takehiro Tanaka, Tomohiro Toji, Sakiko Hiraoka, Seiji Kawano, Yoshiro Kawahara, Hiroyuki Okada

Case reports in gastrointestinal medicine 2020 8893604 - 8893604 2020

Language：English

A 55-year-old Japanese woman, who had been diagnosed with ulcerative colitis at 18 years of age, underwent screening endoscopy examinations. Esophagogastroduodenoscopy revealed an extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) of the stomach. Colonoscopy showed a slightly elevated reddish lesion with dilated microvessels but no erosions or ulcers. Although MALT lymphoma in the cecum was endoscopically suspected, flow cytometry and pathological analyses led to the diagnosis of appendiceal orifice inflammation in ulcerative colitis. This case highlights the diversity of the endoscopic appearance of appendiceal orifice inflammation in ulcerative colitis.

DOI： 10.1155/2020/8893604

[IgA vasculitis with massive hemorrhage from the jejunum after steroid administration].

Nao Yamauchi, Masaya Iwamuro, Seiji Kawano, Tatsuhiro Yamazaki, Yuki Baba, Tomoko Tsumura, Yuta Hara, Junro Kataoka, Tatsuya Toyokawa, Hiroyuki Okada

Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology 117 ( 1 ) 64 - 71 2020

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

A 45-year-old Japanese man presenting with leg purpura, abdominal pain, and arthralgia was diagnosed with IgA vasculitis. His symptoms resolved after the intravenous administration of prednisolone. However, on day 20 of admission, he experienced bloody discharge and hypovolemic shock. The bleeding point was not identified on contrast-enhanced computed tomography scanning. The blood loss was approximately 10800ml and the patient received transfusions of 48 units of concentrated red blood cells, 18 units of fresh frozen plasma, and 30 units of concentrated platelets. Laparotomy and enteroscopy were performed through the incision of the jejunum to detect the bleeding source. Spurting bleeding was observed during the enteroscopy and partial resection of the jejunum was performed. Histopathological examination of the resected specimen revealed large vessels beneath the jejunal ulcer scar, suggesting bleeding from a Dieulafoy's lesion. Leukocytoclastic vasculitis or cytomegalovirus infection was not observed in the resected specimen. Gastrointestinal symptoms in patients with IgA vasculitis usually improve with bowel rest and conservative treatment. Administration of steroids or factor XIII is recommended for patients with severe abdominal pain refractory to conservative management. Rarely, massive bleeding, perforation, intussusception, and/or intestinal obstruction occur in the gastrointestinal tract and these complications affect patients' prognoses. The clinical course in the present patient indicated that severe bleeding from the gastrointestinal tract can occur even after symptom remission in patients with IgA vasculitis. In such cases, prompt treatment, including laparotomy and/or enteroscopy, is essential.

DOI： 10.11405/nisshoshi.117.64

Eosinophilic Gastritis in a Patient Previously Treated with Dupilumab. International journal

Masaya Iwamuro, Toshi Murakami, Takehiro Tanaka, Shohei Oka, Seiji Kawano, Yoshiro Kawahara, Hiroyuki Okada

Case reports in gastrointestinal medicine 2020 6381670 - 6381670 2020

Language：English

A 77-year-old Japanese man with bronchial asthma was treated with dupilumab. Dupilumab treatment was discontinued at the patient's request after two injections separated by a 2-week interval. The blood eosinophil count was elevated, and an esophagogastroduodenoscopy performed 3 months after dupilumab treatment revealed gastric ulcers; subsequently, eosinophilic gastritis was diagnosed from biopsy examinations. The gastric lesions were resolved by steroid administration. This case report underscores that eosinophil-associated gastrointestinal diseases should be considered in the differential diagnosis of gastric lesions occurring in patients who were treated with dupilumab.

DOI： 10.1155/2020/6381670

蘇生後にサイトメガロウイルス腸炎を発症し、胃気腫症と腸管偽リポマトーシスを合併した一例

山内菜緒, 岩室雅也, 田中健大, 中島有理, 和田嵩平, 高原政宏, 川野誠司, 平岡佐規子, 河原祥朗, 岡田裕之

日本消化器病学会中国支部例会プログラム・抄録集 112回 83 - 83 2019.11

クローン病の内視鏡スコア変化予測には血清Alb値が有用である

井口俊博, 平岡佐規子, 安富絵里子, 平井麻美, 岡昌平, 山崎泰史, 杉原雄策, 衣笠秀明, 高原政宏, 原田馨太, 川野誠司, 岡田裕之

Gastroenterological Endoscopy 61 ( Suppl.2 ) 2181 - 2181 2019.10

咽頭ESD後の下咽頭変形と誤嚥性肺炎についての検討

馬場雄己, 安部真, 河原祥朗, 岡本雄貴, 大林由佳, 榮浩行, 濱田健太, 神崎洋光, 岩室雅也, 川野誠司, 津村宗近, 牧野琢丸, 野田洋平, 丸中秀格, 岡田裕之

耳鼻咽喉科展望 62 ( 5 ) 239 - 239 2019.10

Frequent Involvement of the Duodenum with Lanthanum Deposition: A Retrospective Observational Study.

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

Internal medicine (Tokyo, Japan) 58 ( 16 ) 2283 - 2289 2019.8

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

Objective This study aimed to investigate the endoscopic features of lanthanum-associated duodenal lesions and the prevalence of duodenal involvement among patients with pathologically proven lanthanum deposition in the gastrointestinal tract. Methods We retrospectively reviewed 24 patients with pathologically proven lanthanum deposition in the gastrointestinal tract. Patients were subdivided into three groups: Group A, patients with pathologically-proven lanthanum deposition in the duodenum; Group B, patients without lanthanum deposition in the duodenum; and Group C, patients without a biopsy of the duodenum. Results A biopsy examination of the duodenum was performed in 19 patients, and lanthanum deposition was detected in 17 patients (17/19, 89.5%). In group A (n=17), whitish duodenal villi were detected in 15 patients during esophagogastroduodenoscopy (15/17, 88.2%). While the other two patients showed no whitish villi, a biopsy of the duodenal mucosa revealed lanthanum deposition. The deposition of a white substance showing a clear margin was visible within multiple villi under magnified observation in some patients of group A. Group B patients (n=2) also showed whitish villi. However, the whitish color was faint in one case and sparse in the other case. Conclusion Lanthanum deposits in the duodenum may resemble white villi. However, in some cases, these deposits may be unrecognizable during esophagogastroduodenoscopy due to the subtle degree of deposition. Endoscopists should biopsy the duodenum as well as the stomach, regardless of the presence or absence of white villi, for an accurate determination of lanthanum deposition in the gastrointestinal tract.

DOI： 10.2169/internalmedicine.2398-18

【IBD類縁疾患を考える】8番染色体異常(trisomy 8)を伴う骨髄異形成症候群(MDS)に合併する腸炎

川野誠司, 平岡佐規子, 井口俊博, 岡田裕之

消化器・肝臓内科 6 ( 2 ) 115 - 120 2019.8

男女別に見たHelicobacter pylori除菌前後での組織学的胃炎の変化

榮浩行, 岡上昇太郎, 大林由佳, 神崎洋光, 岩室雅也, 川野誠司, 河原祥朗, 田中健大, 岡田裕之

日本高齢消化器病学会誌 22 ( 1 ) 136 - 136 2019.7

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

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

Journal of gastroenterology 54 ( 5 ) 419 - 426 2019.5

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

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

DOI： 10.1007/s00535-018-1525-4

Clinicopathological Features and Outcomes of Endoscopic Submucosal Dissection for Superficial Cancer of the Pharynx.

Makoto Abe, Masaya Iwamuro, Yoshiro Kawahara, Hiromitsu Kanzaki, Seiji Kawano, Takehiro Tanaka, Munechika Tsumura, Takuma Makino, Yohei Noda, Hidenori Marunaka, Kazunori Nishizaki, Hiroyuki Okada

Acta medica Okayama 73 ( 2 ) 109 - 115 2019.4

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

The efficacy and safety of endoscopic submucosal dissection (ESD) for superficial cancer of the pharynx are still unclear. To identify clinicopathological features of superficial pharyngeal cancer, and the efficacy and safety of ESD, we retrospectively assessed 70 pharyngeal cancers in 59 patients who underwent ESD. Of these patients, 61.0% and 50.8% had a history of esophageal cancer and head and neck cancer, respectively. The median tumor size was 15 mm, and 75.7% of the lesions were located at the piriform sinus. The en bloc resection rate was 94.9%. Treatment-related adverse events occurred in 8 cases, but there was no treatment-related death. The lateral margin was positive for neoplasm in 3 lesions (4.3%) and inconclusive in 27 lesions (38.6%), but no local recurrence was observed. Cervical lymph node metastasis was observed in 6 patients, and was successfully treated by cervical lymph node dissection. The three-year overall survival rate was 91.5% (95%CI: 76.6-97.3%) and the cause-specific survival rate was 97.6% (95%CI: 84.9-99.7%). In conclusion, ESD for superficial pharyngeal cancer was safe and effective. "Resect and watch" is probably a feasible and rational strategy for treatment of patients with superficial pharyngeal cancer.

DOI： 10.18926/AMO/56646

Paradoxical Roles of Oxidative Stress Response in the Digestive System before and after Carcinogenesis. International journal

Akinobu Takaki, Seiji Kawano, Daisuke Uchida, Masahiro Takahara, Sakiko Hiraoka, Hiroyuki Okada

Cancers 11 ( 2 ) 2019.2

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

Oxidative stress is recognized as a cancer-initiating stress response in the digestive system. It is produced through mitochondrial respiration and induces DNA damage, resulting in cancer cell transformation. However, recent findings indicate that oxidative stress is also a necessary anticancer response for destroying cancer cells. The oxidative stress response has also been reported to be an important step in increasing the anticancer response of newly developed molecular targeted agents. Oxidative stress might therefore be a cancer-initiating response that should be downregulated in the precancerous stage in patients at risk of cancer but an anticancer cell response that should not be downregulated in the postcancerous stage when cancer cells are still present. Many commercial antioxidant agents are marketed as "cancer-eliminating agents" or as products to improve one's health, so cancer patients often take these antioxidant agents. However, care should be taken to avoid harming the anticancerous oxidative stress response. In this review, we will highlight the paradoxical effects of oxidative stress and antioxidant agents in the digestive system before and after carcinogenesis.

DOI： 10.3390/cancers11020213

咽頭ESD後の下咽頭の変形と誤嚥性肺炎の発症に関する検討

安部真, 河原祥朗, 岡本雄貴, 大林由佳, 馬場雄己, 榮浩行, 後藤田達洋, 神崎洋光, 岩室雅也, 川野誠司, 津村宗近, 牧野琢丸, 野田洋平, 丸中秀格, 岡田裕之

耳鼻咽喉科展望 62 ( 1 ) 51 - 51 2019.2

[Peutz-Jeghers syndrome and cancer:a retrospective study in 14 Japanese patients with Peutz-Jeghers syndrome].

Masaya Iwamuro, Tatsuya Toyokawa, Yuki Moritou, Kazuhiro Matsueda, Shinichiro Hori, Masao Yoshioka, Takehiro Tanaka, Seiji Kawano, Hiroyuki Okada

Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology 116 ( 12 ) 1015 - 1021 2019

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

We retrospectively investigated 14 Japanese patients with Peutz-Jeghers (PJ) syndrome who were treated in six hospitals to determine the prevalence of cancer in Japanese patients with PJ syndrome. The study included seven males and seven females. The mean age at the time of diagnosis of PJ syndrome was 28.1 years (range 2-60 years). Hamartomatous polyps were observed in 13 (92.9%) patients, mucocutaneous pigmentation in 11 (78.6%), and positive family history in six patients (42.9%). The mean observation period after the diagnosis of PJ syndrome was 10.1 years (range 0-34 years). Although one patient died of cancer of unknown primary origin, the remaining 13 patients included in the study completed their last follow-up at each hospital. Cancers were detected in six patients (42.9%), including cancer of the uterine cervix (N=3), breast cancer (N=1), duodenal cancer (N=1), transverse colon cancer (N=1), and cancer of unknown primary origin (N=1). One patient presented with both cervical cancer and breast cancer. No patient presented with pancreatic cancer. This study highlights that patients with PJ syndrome are at high risk for intestinal and extra-intestinal cancers, such as uterine and breast cancer. Routine surveillance for intestinal and extra-intestinal malignancies is warranted in patients with PJ syndrome.

DOI： 10.11405/nisshoshi.116.1015

Two cases of gastric mucosa-associated lymphoid tissue (MALT) lymphoma masquerading as follicular gastritis. International journal

Masaya Iwamuro, Takehiro Tanaka, Kenji Nishida, Hiromitsu Kanzaki, Seiji Kawano, Yoshiro Kawahara, Tadashi Yoshino, Hiroyuki Okada

Ecancermedicalscience 13 933 - 933 2019

Language：English

In this report, we describe two cases of extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) of the stomach, which presented with multiple small, whitish nodules in the gastric body. The endoscopic appearance was similar to that of lymphoid follicular hyperplasia found in follicular gastritis or nodular gastritis. Both patients were positive for Helicobacter pylori, and the eradication treatment resulted in complete remission of the lymphoma. However, recurrence was noted in one patient. These cases indicate that, although infrequent, gastric MALT lymphoma can show a nodular appearance resembling that of follicular gastritis.

DOI： 10.3332/ecancer.2019.933

Detection of activated neutrophils by reactive oxygen species production using a hematology analyzer. International journal

Mari Kono, Katsuyasu Saigo, Shiori Matsuhiroya, Takayuki Takahashi, Makoto Hashimoto, Ayako Obuchi, Shion Imoto, Takashi Nishiyama, Seiji Kawano

Journal of immunological methods 463 122 - 126 2018.12

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

Neutrophils are recruited to infection sites and kill bacteria by phagocytosis and reactive oxygen species (ROS) production. It has been reported that vacuoles are present in neutrophils that produce ROS and are present in large numbers in blood smears of patients with bacterial infections. The leukocyte differentiation function on the Sysmex automated hematology analyzer classifies leukocytes by flow cytometry. Particularly, side-scattered light is known to reflect the quantity of organelles. This study investigated the possibility of detecting vacuoles or invagination of cell membrane in neutrophils producing ROS using a hematology analyzer. Whole blood and polymorphonuclear (PMN) cell fractions were activated with phorbol myristate acetate (PMA) or formylmethionylleucylphenylalanine (fMLP) and analyzed using the Sysmex XE-2100 automated hematology analyzer. PMN fractions were morphologically analyzed with a confocal laser scanning microscope (CLSM), electron microscope (EM), and general-purpose conventional flow cytometer. In the white blood cell differentiation scattergram obtained in this analysis, a new cluster separate from the original neutrophil cluster appeared in the eosinophil area in an area of higher side-scattering (SSC) intensity. Flow cytometry analysis of the PMN fractions revealed that the cells in this new cluster were CD16b- and APF-positive, indicating that the cells were activated neutrophils that produced ROS. CLSM and EM findings revealed that ROS production occurred in the cytoplasm and that the activated neutrophils contained some vacuole-like structures of vacuoles or invagination of cell membrane. Vacuole-like Sstructures were found within the cytoplasm of neutrophils producing ROS. These neutrophils were detected as an independent cluster in the eosinophil area with higher SSC intensity than that shown by neutrophils in the traditional cluster on the white blood cell differentiation scattergram, likely because the vacuole-like structures increased the SSC intensity.

DOI： 10.1016/j.jim.2018.10.004

A Case of Diffuse Esophageal Spasm Treated with Peroral Endoscopic Myotomy.

Yuusaku Sugihara, Keita Harada, Ryo Kato, Kenji Yamauchi, Hiroyuki Sakae, Seiji Kawano, Sakiko Hiraoka, Yoshiro Kawahara, Fumio Otsuka, Hiroyuki Okada

Acta medica Okayama 72 ( 6 ) 595 - 600 2018.12

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

The indications for peroral endoscopic myotomy (POEM) have been expanded to include diffuse esophageal spasm (DES). A 67-year-old Japanese man presented with a 4-year history of dysphagia. Endoscopy and upper gastrography revealed abnormal peristaltic movements involving interruption of normal peristalsis, and a diverticulum located at the 2 o'clock esophageal position. High-resolution manometry indicated DES. POEM with a long (15 cm) myotomy was performed for the abnormal contractions, which subsequently disappeared along with dysphagia improvement. Our results suggest that esophageal motility disorders accompanying a diverticulum may be eliminated by POEM without treating the diverticulum itself. We speculate that POEM ameliorates esophageal diverticulum by reducing internal esophageal pressure.

DOI： 10.18926/AMO/56378

適応拡大前後における院内紹介例からみた小腸カプセル内視鏡施行内容の検討院内への啓発活動にむけて

川野誠司, 岩室雅也, 井口俊博, 杉原雄策, 原田馨太, 平岡佐規子, 岡田裕之

岡山医学会雑誌 130 ( 3 ) 155 - 159 2018.12

Language：Japanese Publisher：岡山医学会

当院でのカプセル内視鏡(VCE)施行症例のうち、院内紹介症例の特徴をそれ以外の症例と比較した。さらにVCE適応拡大前後におけるVCEの使用目的の推移、特に院内紹介例の推移を比較検討した。適応拡大前(2009年1月から2012年6月:A群)122例と拡大後(2012年7月から2016年2月:B群)292例を対象とした。VCE施行件数は2009年1月の導入以降緩やかに増加していたが、2012年の適応拡大に伴い著明に増加を認めた。原因不明消化管出血(OGIB)症例の頻度は57%から41%へと有意に低下を認める一方、overt OGIBやoccult OGIBは相対的に増加していた。院内紹介例99例の検討では、総数においては循環器内科が最も多く、次いで総合内科、血液内科など各内科系からの紹介症例が大多数を占めていた。適応拡大後に限っては総合内科が最も多くを占めていた。

Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J00175&link_issn=&doc_id=20181205110006&doc_link_id=https%3A%2F%2Fousar.lib.okayama-u.ac.jp%2F56635&url=https%3A%2F%2Fousar.lib.okayama-u.ac.jp%2F56635&type=%89%AA%8ER%91%E5%8Aw%81F%89%AA%8ER%91%E5%8Aw%8Aw%8Fp%90%AC%89%CA%83%8A%83%7C%83W%83g%83%8A&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F80034_3.gif

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

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

Gastroenterological Endoscopy 60 ( 10 ) 2297 - 2302 2018.10

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

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

DOI： 10.11280/gee.60.2297

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

The Usefulness of Colonoscopy for the Detection of Ileal Involvement in Intestinal Follicular Lymphoma Patients.

Masaya Iwamuro, Katsuyoshi Takata, Eiko Hayashi, Seiji Kawano, Sakiko Hiraoka, Yoshiro Kawahara, Tadashi Yoshino, Hiroyuki Okada

Acta medica Okayama 71 ( 5 ) 391 - 398 2017.10

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

To evaluate the usefulness of colonoscopy for the detection of ileal involvement in patients with intestinal follicular lymphoma, seventeen patients with intestinal follicular lymphoma who underwent colonoscopy and biopsy sampling from the terminal ileum were enrolled. The patients were divided into 2 groups: cases with ileal involvement (n=6) and cases without ileal involvement (n=11). Patients' clinical backgrounds were compared between the two groups. Subsequently, 10 board-certified endoscopists independently evaluated the endoscopic pictures and determined whether the ileum was involved with follicular lymphoma. Infiltration of follicular lymphoma cells were identified in 6 patients (35.3%). Cases with positive ileal involvement were diagnosed with follicular lymphoma at a younger age than were cases without ileal involvement (55.4±7.4 vs. 68.1±10.3 years, p=0.011). Macroscopically, in patients with ileal involvement, there were multiple polypoid elevations smaller than 5 mm in 4 cases, single polypoid elevation smaller than 5 mm in 1 case, and single polypoid elevation larger than 5 mm in 1 case. In patients without ileal involvement, there were no lesions in the terminal ileum in 7 cases, and multiple polypoid elevations smaller than 5 mm were seen in 4 cases. The accuracy of the macroscopic evaluation by 10 board-certified endoscopists was 68.8%. Colonoscopy is particularly recommended during the initial workup of patients with follicular lymphoma diagnosed at age ≤ 60 years. The diagnosis of ileal involvement based on morphology alone is difficult; thus, biopsy and pathologic diagnosis are required for accurate diagnosis.

DOI： 10.18926/AMO/55436

POEM(Per-Oral Endoscopic Myotomy)を施行した食道アカラシアの1例

杉原雄策, 原田馨太, 加藤諒, 山内健司, 高嶋志保, 竹井大介, 井口俊博, 高原政宏, 川野誠司, 平岡佐規子, 田辺俊介, 野間和宏, 白川靖博, 眞部紀明, 井上晴洋, 岡田裕之

岡山医学会雑誌 129 ( 2 ) 115 - 121 2017.8

Language：Japanese Publisher：岡山医学会

39歳男。食事摂取後の嚥下困難を主訴に近医受診し、上部消化管内視鏡検査で食道アカラシアと診断され、精査加療目的に当院紹介となった。食道X線造影検査(バリウム50ml内服)で食道内に5分間以上のバリウム停滞を認め、異常蠕動を認めた。高解像度食道内圧検査(嚥下試験)で下部食道の収縮圧は24mmHgであり、胃食道接合部の弛緩は認めなかった。これらの所見から、食道アカラシアのシカゴ分類type Iと診断し、POEMを施行した。翌日の食道X線造影検査でバリウムは速やかに胃内へ流入することが確認され、その後の経過も良好で、術後4日目に退院となり、1年後の現在まで症状の再燃は認めていない。

Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J00175&link_issn=&doc_id=20170817260005&doc_link_id=10.4044%2Fjoma.129.115&url=https%3A%2F%2Fdoi.org%2F10.4044%2Fjoma.129.115&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

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

十二指腸偽メラノーシスの1例

岩室雅也, 岡昌平, 神崎洋光, 田中健大, 川野誠司, 河原祥朗, 岡田裕之

日本消化器病学会雑誌 114 ( 7 ) 1264 - 1268 2017.7

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

83歳男性。クエン酸第一鉄、β遮断薬、利尿剤(フロセミド、スピロノラクトン、トルバプタン)などを内服中、スクリーニングで実施した上部消化管内視鏡検査にて、十二指腸球部に点状の暗褐色の色素沈着をびまん性に認めた。生検では絨毛内に褐色色素を貪食したマクロファージを認め、褐色色素は鉄染色陽性であり、偽メラノーシスと診断した。エネルギー分散型X線による解析では沈着部位に鉄およびイオウ元素が検出された。(著者抄録)

Other Link： https://search.jamas.or.jp/default/link?pub_year=2017&ichushi_jid=J01118&link_issn=&doc_id=20170720090008&doc_link_id=1390282681380288384&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390282681380288384&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_3.gif

Endoscopic features of lanthanum deposition in the gastroduodenal mucosa

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

Gastroenterological Endoscopy 59 ( 6 ) 1428 - 1434 2017.6

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

The purpose of this study was to investigate the endoscopic features of lanthanum deposition in the gastrointestinal mucosa. We retrospectively reviewed the endoscopic images of 10 patients who had received a histological diagnosis of lanthanum deposition in the gastroduodenal mucosa. The patients were 9 men and 1 woman with an average age of 64.3 years( range: 42 to 77 years). All patients were undergoing hemodialysis for chronic renal failure, and had been receiving lanthanum carbonate for 12 to 86 months. All patients had lanthanum deposition in the stomach, which presented as white lesions. Magnifying endoscopic observation, which was performed in six patients, also demonstrated the deposition of white microgranules. Three patients had lanthanum deposition in the duodenum, which manifested as white duodenal mucosa. In conclusion, lanthanum deposition in the gastroduodenal mucosa typically manifests as white lesions. Endoscopists should suspect lanthanum deposition when they detect white lesions in the gastroduodenal mucosa of patients who are taking lanthanum carbonate.

胃・十二指腸粘膜へのランタン沈着症における内視鏡像の検討

岩室雅也, 神崎洋光, 川野誠司, 河原祥朗, 田中健大, 岡田裕之

Gastroenterological Endoscopy 59 ( 6 ) 1428 - 1434 2017.6

Language：Japanese Publisher：(一社)日本消化器内視鏡学会

当院で胃・十二指腸へのランタン沈着症と診断した10症例について、内視鏡所見および臨床背景を後ろ向きに検討した。10例(男性9例、女性1例)の平均年齢は64.3歳(42歳～77歳)であり、全例が慢性腎不全のため血液透析中であった。炭酸ランタンの服用期間は12～86ヵ月。全例で胃にランタン沈着があり、通常観察にて白色病変として観察された。拡大観察を行った6例では微細顆粒状の白色沈着物がみられた。3例では十二指腸にもランタン沈着があり、いずれも白色の粘膜を呈した。これらの所見がみられた場合には、ランタン沈着症として経過を追跡する必要があると考えられた。(著者抄録)

Other Link： https://search.jamas.or.jp/default/link?pub_year=2017&ichushi_jid=J00192&link_issn=&doc_id=20170713320006&doc_link_id=10.11280%2Fgee.59.1428&url=https%3A%2F%2Fdoi.org%2F10.11280%2Fgee.59.1428&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

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

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

Endoscopic Manifestations and Clinical Characteristics of Cytomegalovirus Infection in the Upper Gastrointestinal Tract.

Masaya Iwamuro, Eisei Kondo, Takehiro Tanaka, Hideharu Hagiya, Seiji Kawano, Yoshiro Kawahara, Fumio Otsuka, Hiroyuki Okada

Acta medica Okayama 71 ( 2 ) 97 - 104 2017.4

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

We retrospectively analyzed the cases of 14 patients (9 women, 5 men, mean age: 51.6 years) with cytomegalovirus (CMV) involvement in the esophagus, stomach, and/or duodenum diagnosed at a single center, to determine their endoscopic features and clinical backgrounds. Thirteen patients (92.9%) had hematologic disease; the other had rheumatoid arthritis. Of the former, 12 patients underwent allogeneic hematopoietic stem cell transplantation, and 9 of these patients had graft-versus-host disease (GVHD) before undergoing esophagogastroduodenoscopy (EGD). All 14 patients had been taking one or more immunosuppressive agents including cyclosporine (n=10), corticosteroids (n=9), mycophenolic acid (n=6), tacrolimus (n=3), and methotrexate (n=1). Tests for CMV antigenemia were positive in 11 patients (78.6%). EGD examinations revealed esophageal (n=3), gastric (n=9), and duodenal involvement (n=6). Macroscopically, esophageal lesions by CMV infection presented as redness (n=1), erosions (n=1), and ulcers (n=1). Gastric lesions manifested as redness (n=7), erosions (n=3), exfoliated mucosa (n=2), and verrucous erosions (n=1). Mucosal appearances in the duodenum varied: redness (n=2), ulcers (n=2), multiple erosions (n=2), single erosion (n=1), edema (n=1). CMV was detected even in the intact duodenal mucosa (n=1). In conclusion, physicians must recall the relevance of CMV infection when any mucosal alterations exist in the upper gastrointestinal tract of immunosuppressed patients.

DOI： 10.18926/AMO/54977

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

クローン病小腸狭窄病変に対するダブルバルーン小腸内視鏡逆行性造影の有用性の検討

岡崎倫子, 井口俊博, 平岡佐規子, 竹井大介, 高嶋志保, 原田馨太, 川野誠司, 岡田裕之

Gastroenterological Endoscopy 59 ( Suppl.1 ) 1093 - 1093 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

【腸炎まるわかり】腸管Behcet病と単純性潰瘍

平岡佐規子, 井口俊博, 川野誠司, 原田馨太, 岡田裕之

消化器内視鏡 29 ( 1 ) 55 - 59 2017.1

Language：Japanese Publisher：(株)東京医学社

腸管Behcet病および単純性潰瘍は、内視鏡像は酷似しているが、前者はBehcet徴候を有する全身性疾患で、後者は腸管に限局した疾患である。基本的には別の疾患と考えられるが、鑑別が難しい場合もある。両疾患の定型病変は回盲部の円形または類円形の深掘れ潰瘍である。その特徴的な形態から診断は容易なこともあるが、特に単純性潰瘍は他疾患との鑑別も必要である。(著者抄録)

Deterioration of duodenal lymphangiectasia after radiotherapy for gastric MALT lymphoma. International journal

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

Ecancermedicalscience 11 752 - 752 2017

Language：English

A 68-year-old Japanese woman underwent radiotherapy for gastric lymphoma. Although lymphangiectasia was sparsely observed in the second portion of the duodenum before radiotherapy, the number of pinpoint white spots obviously increased after the treatment. Although the duodenal lymphangiectasia gradually progressed, the patient had no features of protein-losing enteropathy. This case highlights the importance of endoscopic observation of the duodenum after irradiation to the abdomen as radiotherapy may secondarily cause intestinal lymphangiectasia.

DOI： 10.3332/ecancer.2017.752

Pseudomelanosis duodeni:a case report.

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

Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology 114 ( 7 ) 1264 - 1268 2017

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

An 83-year-old Japanese man underwent esophagogastroduodenoscopy for screening purposes. He had a medical history of hypertension, chronic kidney disease, chronic heart failure, and chronic myeloid leukemia, and he had been taking the following medications:ferrous citrate, furosemide, spironolactone, tolvaptan, bisoprolol, nicorandil, warfarin, nilotinib, febuxostat, esomeprazole, digestive enzyme complex, ambroxol, carbocysteine, and potassium L-aspartate. Esophagogastroduodenoscopy revealed a brownish speckled pigmentation in the duodenal bulb. Biopsy specimens from the duodenal villi revealed a brown pigment deposition, which appeared bright on scanning electron microscopy. Energy dispersive X-ray spectroscopy and elemental mapping revealed the presence of iron and sulfur in the duodenal villi. Consequently, pseudomelanosis duodeni was diagnosed based on these findings.

DOI： 10.11405/nisshoshi.114.1264

Adenocarcinoma In Situ Arising from Brunner's Gland Treated by Endoscopic Mucosal Resection. International journal

Masaya Iwamuro, Sayo Kobayashi, Nobuya Ohara, Seiji Kawano, Yoshiro Kawahara, Hiroyuki Okada

Case reports in gastrointestinal medicine 2017 7916976 - 7916976 2017

Language：English

An 86-year-old Japanese man was presented to our hospital for further investigation of duodenal adenocarcinoma. The tumor was endoscopically resected. Pathological analysis revealed coexistence of gastric foveolar metaplasia and a surrounding hyperplastic Brunner's gland, in addition to an adenocarcinoma component. Immunostaining for MUC5AC and MUC6 confirmed the diagnosis of adenocarcinoma in situ arising from Brunner's gland hyperplasia. This case suggests that although detailed preoperative evaluation is required to determine the depth of tumor invasion, endoscopic resection may be a promising option for the treatment of adenocarcinomas arising from Brunner's gland hyperplasia.

DOI： 10.1155/2017/7916976

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)

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

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

Achalasia treated with per-oral endoscopic myotomy (POEM)

Sugihara Yuusaku, Harada Keita, Kato Ryo, Yamauchi Kenji, Takashima Shiho, Takei Daisuke, Inokuchia Toshihiro, Takahara Masahiro, Kawano Seiji, Hiraoka Sakiko, Tanabe Shunsuke, Noma Kazuhiro, Shirakawa Yasuhiro, Manabe Noriaki, Inoue Haruhiro, Okada Hiroyuki

Okayama Igakkai Zasshi (Journal of Okayama Medical Association) 129 ( 2 ) 115 - 121 2017

Language：Japanese Publisher：Okayama Medical Association

&emsp;Esophageal achalasia is a disorder of the lower esophageal sphincter muscle. Patients present with dysphagia, chest pain, vomiting, and aspiration. Esophageal achalasia had traditionally been treated with esophageal achalasia balloon dilatation and the Heller-Dor method, but in recent years, the use of per-oral endoscopic myotomy (POEM) has increased. Our patient, a 39-yr-old male, began experiencing dysphagia 4 years prior to his referral to our hospital. Based on the results of esophagogastroduodenoscopy, esophageal radiography and high-resolution manometry, we made the diagnosis of esophageal achalasia (Chicago classification type I) . After informed consent from the patient and his family and approval from our hospital's ethics committee were obtained, we performed a POEM. The patient was discharged on the 4th day post-surgery. At the 1-year post-operative examination, no worsening of symptoms and no relapse were observed. POEM is an excellent treatment method for esophageal achalasia from the perspective of therapeutic effect and prevention of invasion. We recommend that it be considered as the first-choice treatment for achalasia. However, accessibility to the procedure itself is limited due to the few adequately trained operators worldwide. POEM should thus be performed by an expert operator at a high-volume center.

DOI： 10.4044/joma.129.115

Other Link： http://search.jamas.or.jp/link/ui/2017339773

Adenocarcinoma in the jejunum 20 years after surgery for familial adenomatous polyposis

Sugihara Yuusaku, Kawano Seiji, Harada Keita, Takashima Shiho, Takei Daisuke, Inokuchi Toshihiro, Takahara Masahiro, Hiraoka Sakiko, Mori Yoshiko, Kishimoto Hiroyuki, Nagasaka Takeshi, Okada Hiroyuki

Okayama Igakkai Zasshi (Journal of Okayama Medical Association) 129 ( 2 ) 111 - 114 2017

Language：Japanese Publisher：Okayama Medical Association

A 58-year-old Japanese man visited a local clinic for the evaluation of a stomachache. He was diagnosed with intestinal obstruction. His medical history included a proctocolectomy at the age of 38 years, due to familial adenomatous polyposis (FAP). He was referred to our institution, where he underwent a computed tomography examination and endoscopy of the small intestine. The pathological diagnosis was adenocarcinoma. No invasive or metastatic lesions were observed. Therefore, partial resection of the ileum with lymphadenectomy and reconstruction of the ileostomy were performed. Pathological examination revealed that the tumor was type 2, pT3 (SS) , pN1, pPM0, pDM0, pRM0, INFb, ly1, v1, pEX0, PN0. Twenty-nine days after the surgery, the patient was diagnosed with lung metastasis and he underwent lung radiofrequency ablation. We suggest that long-term follow-up is necessary for patients after surgery for FAP, because of the risk of malignant disease developing in other organs.

DOI： 10.4044/joma.129.111

Other Link： https://www.jstage.jst.go.jp/article/joma/129/2/129_111/_pdf

Clinical Outcomes of Endoscopic Hemostasis in Marginal Ulcer Bleeding.

Yasushi Yamasaki, Ryuta Takenaka, Keisuke Hori, Koji Takemoto, Seiji Kawano, Yoshiro Kawahara, Shigeatsu Fujiki, Hiroyuki Okada

Acta medica Okayama 70 ( 6 ) 469 - 475 2016.12

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

The usefulness of endoscopy in marginal ulcer bleeding has rarely been studied, and the optimal method for preventing rebleeding is unclear. Here we assessed the efficacy of endoscopy in marginal ulcer bleeding and examined the efficacy of proton pump inhibitors (PPIs) in the prevention of rebleeding. A total of 28 patients with marginal ulcer bleeding (21 men, 7 women; median age 58.5 years) were treated by endoscopy. We analyzed the clinical characteristics, results of endoscopic therapy, characteristics of rebleeding patients, and relation between the use of PPIs and the duration of rebleeding. Sixteen patients had active bleeding. Initial hemostasis was achieved in all patients. There were no procedure-related adverse events. Rebleeding occurred in one patient within the first month and in 7 patients thereafter. There was a significant difference in the rebleeding rate between the patients who received a PPI and those who did not. In a multivariate analysis, the non-use of PPIs was a risk factor for rebleeding (hazard ratio, 6.22). Therapeutic endoscopy is effective in achieving hemostasis from marginal ulcer bleeding. PPIs may prevent rebleeding from marginal ulcers.

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

Lanthanum phosphate deposition in the gastric mucosa of patients with chronic renal failure.

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

Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology 113 ( 7 ) 1216 - 22 2016.7

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

A 77-year-old Japanese man underwent endoscopic submucosal dissection twice over a 5-year period for the treatment of two separate early gastric cancers. He had been taking lanthanum carbonate, an orally administered phosphate binder, for 3 years. Esophagogastroduodenoscopy revealed reddish mucosa in the greater curvature and anterior wall of the gastric angle, while granular, white deposits were also observed in some areas of this reddish mucosa. Additionally, biopsy specimens from the gastric mucosa revealed the deposition of fine, amorphous, eosinophilic material, which appeared bright on scanning electron microscopy. Energy dispersive X-ray spectroscopy revealed the presence of lanthanum and phosphate in these bright areas, and elemental mapping confirmed that their distribution was identical to that seen in the bright areas. Based on these findings, the diagnosis of lanthanum phosphate deposition in the gastric mucosa was determined.

DOI： 10.11405/nisshoshi.113.1216

Randomized study of lafutidine vs lansoprazole in patients with mild gastroesophageal reflux disease. International journal

Ryuta Takenaka, Hiroyuki Okada, Seiji Kawano, Yoshinori Komazawa, Fumiya Yoshinaga, Shinji Nagata, Masafumi Inoue, Hirohisa Komatsu, Seiji Onogawa, Yoshinori Kushiyama, Shinichi Mukai, Hiroko Todo, Hideharu Okanobu, Noriaki Manabe, Shinji Tanaka, Ken Haruma, Yoshikazu Kinoshita

World journal of gastroenterology 22 ( 23 ) 5430 - 5 2016.6

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

AIM: To compare the clinical efficacy of the second-generation H2RA lafutidine with that of lansoprazole in Japanese patients with mild gastroesophageal reflux disease (GERD). METHODS: Patients with symptoms of GERD and a diagnosis of grade A reflux esophagitis (according to the Los Angeles classification) were randomized to receive lafutidine (10 mg, twice daily) or lansoprazole (30 mg, once daily) for an initial 8 wk, followed by maintenance treatment comprising half-doses of the assigned drug for 24 wk. The primary endpoint was the frequency and severity of heartburn during initial and maintenance treatment. The secondary endpoints were the sum score of questions 2 and 3 in the Gastrointestinal Symptom Rating Scale (GSRS), and the satisfaction score. RESULTS: Between April 2012 and March 2013, a total of 53 patients were enrolled, of whom 24 and 29 received lafutidine and lansoprazole, respectively. After 8 wk, the frequency and severity of heartburn was significantly reduced in both groups. However, lafutidine was significantly inferior to lansoprazole with regard to the severity of heartburn during initial and maintenance treatment (P = 0.016). The sum score of questions 2 and 3 in the GSRS, and satisfaction scores were also significantly worse in the lafutidine group than the lansoprazole group (P = 0.0068 and P = 0.0048, respectively). CONCLUSION: The clinical efficacy of lafutidine was inferior to that of lansoprazole, even in Japanese patients with mild GERD.

DOI： 10.3748/wjg.v22.i23.5430

Fecal Immunochemical Test Versus Fecal Calprotectin for Prediction of Mucosal Healing in Crohn's Disease. International journal

Toshihiro Inokuchi, Jun Kato, Sakiko Hiraoka, Shiho Takashima, Asuka Nakarai, Daisuke Takei, Yuusaku Sugihara, Masahiro Takahara, Seiji Kawano, Keita Harada, Hiroyuki Okada

Inflammatory bowel diseases 22 ( 5 ) 1078 - 85 2016.5

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

BACKGROUND: Mucosal healing (MH) has been proposed as a treatment goal of inflammatory bowel disease patients. We reported recently that not only fecal calprotectin (Fcal) but also the fecal immunochemical test (FIT) can predict MH in ulcerative colitis. However, the predictive power of the fecal markers for MH in Crohn's disease (CD), particularly with small bowel lesions, has not been reported in detail. The aim of this study was to evaluate the predictability of FIT versus Fcal for MH in CD. METHODS: Consecutive CD patients underwent colonoscopy or balloon-assisted enteroscopy according to the disease location. FIT and Fcal were examined using stool samples collected the day before endoscopy. RESULTS: Seventy-one CD patients were analyzed, of whom 42 (59%) underwent balloon-assisted enteroscopy because of the presence of affected lesions in the small intestine. Both the Fcal and the FIT results were significantly correlated with endoscopic activity (r = 0.67 and 0.54, respectively). However, the FIT results did not correlate with the activity in patients with small bowel lesions alone, whereas Fcal did (r = 0.42 versus 0.78). Fcal predicted MH in CD with 87% sensitivity and 71% specificity, whereas the values for FIT were 96% and 48%, respectively. The specificity for MH among patients with small bowel lesions alone was low for FIT (40%) compared with Fcal (80%). CONCLUSIONS: Both FIT and Fcal were correlated with the mucosal status of CD. However, the specificity of FIT was not satisfactory, particularly for small bowel lesions.

DOI： 10.1097/MIB.0000000000000728

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

Lymphoid hyperplasia of the colon and its association with underlying allergic airway diseases. International journal

Masaya Iwamuro, Sakiko Hiraoka, Hiroyuki Okada, Yoshinari Kawai, Yoshio Miyabe, Katsuyoshi Takata, Seiji Kawano, Kazuhide Yamamoto

International journal of colorectal disease 31 ( 2 ) 313 - 7 2016.2

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

PURPOSE: The purpose of this study was to determine the prevalence of lymphoid hyperplasia in the lower gastrointestinal tract and its role in patients undergoing colonoscopic examinations, particularly focusing on any allergic predisposition. METHODS: A database search performed at the Department of Gastroenterology at Onomichi Municipal Hospital identified seven patients with lymphoid hyperplasia in the large intestine (i.e., cecum, colon, and/or rectum). Data regarding the endoscopic, biological, and pathological examinations performed and the allergic histories for each patient were retrospectively reviewed from the clinical records. RESULTS: Median age of the patients (four males, three females) was 50 years. Lymphoid hyperplasia was seen in the cecum (n = 5), ascending colon (n = 2), and transverse colon (n = 1). Six patients (85.7%) had one of the allergic airway diseases: allergic rhinoconjunctivitis for pollen (n = 3), bronchial asthma (n = 1), infantile asthma (n = 1), or allergic bronchitis (n = 1). Drug allergy (n = 3) and urticaria (n = 2) were also found. All seven patients had one or more allergic diseases; however, none had a history of food allergy. Blood tests for allergens revealed that six patients (85.7%) had positive reactions to inherent allergens, whereas only one patient had a positive reaction to food allergens. CONCLUSIONS: Our results indicate that lymphoid hyperplasia in the large intestine may be associated with allergic airway diseases rather than with food allergies; thus, its presence may be useful to detect patients with underlying airway hyperreactivity.

DOI： 10.1007/s00384-015-2392-6

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

Endoscopic Resection of a Pedunculated Brunner's Gland Hamartoma of the Duodenum. International journal

Masaya Iwamuro, Takehiro Tanaka, Satoko Ando, Tatsuhiro Gotoda, Hiromitsu Kanzaki, Seiji Kawano, Yoshiro Kawahara, Hiroyuki Okada

Case reports in gastrointestinal medicine 2016 6707235 - 6707235 2016

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

A 68-year-old Japanese woman presented with a solitary pedunculated polyp in the duodenum. Endoscopic ultrasonography showed multiple cystic structures in the polyp. The polyp was successfully resected by endoscopic snare polypectomy and pathologically diagnosed as Brunner's gland hamartoma. Because hamartomatous components were not identified in the stalk of the polyp, we speculate that the stalk developed from traction of the normal duodenal mucosa. When a solitary, pedunculated polyp with cystic structure within the submucosa is found in the duodenum, Brunner's gland hamartoma should be considered in the differential diagnosis, despite the rarity of the disease. This case underscores the usefulness of endoscopic ultrasonography for the diagnosis of duodenal subepithelial tumors.

DOI： 10.1155/2016/6707235

Magnifying Endoscopic Features of Follicular Lymphoma Involving the Stomach: A Report of Two Cases. International journal

Masaya Iwamuro, Katsuyoshi Takata, Seiji Kawano, Nobuharu Fujii, Yoshiro Kawahara, Tadashi Yoshino, Hiroyuki Okada

Case reports in gastrointestinal medicine 2016 2082698 - 2082698 2016

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

A 70-year-old woman presented with follicular lymphoma involving the stomach, duodenum, jejunum, bone, and lymph nodes. Esophagogastroduodenoscopy revealed multiple depressed lesions in the stomach. Examination with magnifying endoscopy showed branched abnormal vessels along with gastric pits, which were irregularly shaped but were preserved. The second case was a 45-year-old man diagnosed with stage II1 follicular lymphoma with duodenal, ileal, and colorectal involvement, as well as lymphadenopathy of the mesenteric lymph nodes. Esophagogastroduodenoscopy performed six years after the diagnosis revealed multiple erosions in the gastric body and angle. Magnifying endoscopic observation with narrow-band imaging showed that the gastric pits were only partially preserved and were destroyed in most of the stomach. Branched abnormal vessels were also seen. Pathological features were consistent with follicular lymphoma in both cases. The structural differences reported between the two cases appear to reflect distinct pathologies. Disappearance of gastric pits in the latter case seems to result from loss of epithelial cells, probably due to chronic inflammation. In both cases, branched abnormal vasculature was observed. These two cases suggest that magnified observations of abnormal branched microvasculature may facilitate endoscopic detection and recognition of the extent of gastric involvement in patients with follicular lymphoma.

Actual Status of Involvement of Helicobacter pylori Infection That Developed Gastric Cancer from Group A of ABC (D) Stratification - Study of Early Gastric Cancer Cases That Underwent Endoscopic Submucosal Dissection. International journal

Ko Miura, Hiroyuki Okada, Yoshiyasu Kouno, Hiromitsu Kanzaki, Masaya Iwamuro, Keisuke Hori, Masahide Kita, Seiji Kawano, Yoshiro Kawahara, Takehiro Tanaka, Hiroyuki Yanai

Digestion 94 ( 1 ) 17 - 23 2016

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

BACKGROUND/AIMS: Patients who are Helicobacter pylori antibody negative and have normal pepsinogen (PG) levels (group A of ABC (D) stratification) are considered unlikely to develop gastric cancer. This study aimed to clarify the involvement (uninfection, present infection or previous infection) of H. pylori in group A patients with early gastric cancer who underwent endoscopic submucosal dissection (ESD) by examining their background gastric mucosa endoscopically and histologically. METHODS: This study included 166 patients with gastric cancer who were treated by ESD. Patients were classified according to PG levels and H. pylori antibody titers. Three biopsies (greater curvature of the antrum, lesser curvature of the middle corpus and greater curvature of the middle corpus) from group A were histologically analyzed and compared with those of groups B, C, D and after eradication). RESULTS: In group A (34 patients), 32 patients had endoscopic atrophy (group A'). Histological neutrophil activity, chronic inflammation and atrophy scores were lower in group A' than in other groups. Group A' scores were similar to those of the after eradication group. CONCLUSION: Most of the group A patients with early gastric cancer were not uninfected with H. pylori, but had previous infections, thus carrying carcinogenic risk.

DOI： 10.1159/000446771

Magnified observation of spontaneous morphological changes of duodenal follicular lymphoma Reviewed

Iwamuro Masaya, Takata Katsuyoshi, Kawano Seiji, Kawahara Yoshiro, Yoshino Tadashi, Okada Hiroyuki

Okayama Igakkai Zasshi (Journal of Okayama Medical Association) 128 ( 2 ) 111 - 116 2016

Language：Japanese Publisher：Okayama Medical Association

A 63-year-old Japanese woman was diagnosed with duodenal follicular lymphoma. The initial esophagogastroduodenoscopic examination with magnifying observation revealed opaque white spots and enlarged whitish villi. Nine months later, esophagogastroduodenoscopy showed that the size of the lymphoma lesion decreased, and only opaque white spots were visible. The histological analysis of biopsy samples obtained during the initial endoscopy examination showed both neoplastic follicles and an inter-follicular infiltration of lymphoma cells, whereas the biopsy samples obtained at the endoscopy performed 9 months later showed only neoplastic follicle formation. These results suggest that the magnifying endoscopic features may reflect the underlying pathological mechanisms : enlarged whitish villi are probably due to lymphoma cell infiltration in the inter-follicular area, and opaque white spots are probably caused by neoplastic follicle formation.

DOI： 10.4044/joma.128.111

Ectopic sebaceous glands in the esophagus that became evident over a three-year span

Iwamuro Masaya, Okada Hiroyuki, Harada Keita, Kanzaki Hiromitsu, Hori Keisuke, Kita Masahide, Kawano Seiji, Kawahara Yoshiro, Tanaka Takehiro, Yamamoto Kazuhide

Okayama Igakkai Zasshi (Journal of Okayama Medical Association) 128 ( 3 ) 201 - 205 2016

Language：Japanese Publisher：Okayama Medical Association

A 43-year-old Japanese woman was diagnosed with ectopic sebaceous glands in the esophagus by esophagogastroduodenoscopy and biopsy. At the age of 46, typical ectopic sebaceous glands were recognized in the upper esophagus, whereas yellowish white granules were faintly observed in the lower esophagus. Esophagogastroduodenoscopy examinations were repeated when she was 47 and again at 50 years old, and the lesions in the lower esophagus had become more evident over the ensuing 3 years. Esophageal ectopic sebaceous glands are relatively infrequent, and there have been few case reports describing the progression of the endoscopic features. We also report the clinical and endoscopic features of the five similar cases with pathologically proven ectopic sebaceous glands in the esophagus.

DOI： 10.4044/joma.128.201

A multicenter survey of enteroscopy for the diagnosis of intestinal follicular lymphoma. International journal

Masaya Iwamuro, Hiroyuki Okada, Seiji Kawano, Junji Shiode, Ryuta Takenaka, Atsushi Imagawa, Tomoki Inaba, Seiyu Suzuki, Mamoru Nishimura, Motowo Mizuno, Masashi Araki, Tomohiko Mannami, Toru Ueki, Haruhiko Kobashi, Haruka Fukatsu, Shouichi Tanaka, Akiyoshi Omoto, Yoshinari Kawai, Takashi Kitagawa, Tatsuya Toyokawa, Katsuyoshi Takata, Tadashi Yoshino, Akinobu Takaki, Kazuhide Yamamoto

Oncology letters 10 ( 1 ) 131 - 136 2015.7

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

The importance of enteroscopy examinations to investigate the entire length of the small intestines has been emphasized in follicular lymphoma patients with intestinal involvement. The aim of the present study was to determine the current state of enteroscopy examinations, including the performance rate, and the prevalence of small intestinal lesions in a patient population in Japan. A retrospective multicenter survey of 17 institutions collected the case information of 110 follicular lymphoma patients with gastrointestinal involvement. The results of the enteroscopy examinations were reviewed, and in order to identify potential factors affecting the performance rate of enteroscopy, patient gender, age at lymphoma diagnosis, histopathological grade, clinical stage, the date of the initial diagnosis and the annual volume of enteroscopy at the institution were compared between the patients who underwent one or more enteroscopy procedures and the patients who did not undergo enteroscopy. A total of 34 patients (30.9%) underwent enteroscopy, and 24 of these (70.6%) presented with involvement in the jejunum and/or ileum. It was found that more patients diagnosed in recent years and more patients treated at an ultra-high volume institution (≥101 enteroscopy examinations/year) underwent an enteroscopy. In conclusion, although the prevalence of small intestinal lesions was high (70.6%) in the follicular lymphoma patients presenting with intestinal involvement, the performance rate of enteroscopy was only 30.9%, and thus the majority of the patients have not undergone enteroscopy examinations. Further investigation is required to define the clinical significance of enteroscopy at the initial diagnostic work-up and during the follow-up period of these patients.

直腸肛門部腫瘍の術後吻合部狭窄に対する、内視鏡的新規治療RIC法応用の試み

原田馨太, 岡田裕之, 高嶋志保, 竹井大介, 井口俊博, 半井明日香, 杉原雄策, 高原政宏, 川野誠司, 平岡佐規子, 河原祥朗, 近藤喜太, 山本和秀

Gastroenterological Endoscopy 57 ( Suppl.1 ) 927 - 927 2015.4

Tolerability of magnifying narrow band imaging endoscopy for esophageal cancer screening. International journal

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

World journal of gastroenterology 21 ( 9 ) 2793 - 9 2015.3

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

AIM: To compare the tolerability of magnifying narrow band imaging endoscopy for esophageal cancer screening with that of lugol chromoendoscopy. METHODS: We prospectively enrolled and analyzed 51 patients who were at high risk for esophageal cancer. All patients were divided into two groups: a magnifying narrow band imaging group, and a lugol chromoendoscopy group, for comparison of adverse symptoms. Esophageal cancer screening was performed on withdrawal of the endoscope. The primary endpoint was a score on a visual analogue scale for heartburn after the examination. The secondary endpoints were scale scores for retrosternal pain and dyspnea after the examinations, change in vital signs, total procedure time, and esophageal observation time. RESULTS: The scores for heartburn and retrosternal pain in the magnifying narrow band imaging group were significantly better than those in the lugol chromoendoscopy group (P = 0.004, 0.024, respectively, ANOVA for repeated measures). The increase in heart rate after the procedure was significantly greater in the lugol chromoendoscopy group. There was no significant difference between the two groups with respect to other vital sign. The total procedure time and esophageal observation time in the magnifying narrow band imaging group were significantly shorter than those in the lugol chromoendoscopy group (450 ± 116 vs 565 ± 174, P = 0.004, 44 ± 26 vs 151 ± 72, P < 0.001, respectively). CONCLUSION: Magnifying narrow band imaging endoscopy reduced the adverse symptoms compared with lugol chromoendoscopy. Narrow band imaging endoscopy is useful and suitable for esophageal cancer screening periodically.

DOI： 10.3748/wjg.v21.i9.2793

潰瘍性大腸炎患者における大腸腫瘍性病変の内視鏡治療当院の現況

原田馨太, 平岡佐規子, 高嶋志保, 竹井大介, 井口俊博, 半井明日香, 杉原雄策, 高原政宏, 衣笠秀明, 川野誠司, 河原祥朗, 岡田裕之, 山本和秀

日本消化器病学会雑誌 112 ( 臨増総会 ) A496 - A496 2015.3

Magnifying Endoscopic Observation of Duodenal Involvement of Follicular Lymphoma before and after Chemotherapy.

Masaya Iwamuro, Hiroyuki Okada, Katsuyoshi Takata, Nobuharu Fujii, Seiji Kawano, Yoshiro Kawahara, Tadashi Yoshino, Kazuhide Yamamoto

Internal medicine (Tokyo, Japan) 54 ( 14 ) 1741 - 5 2015

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

A 60-year-old Japanese man was diagnosed with systemic follicular lymphoma with duodenal, jejunal, and ileal involvement. The duodenal lesion showed typical endoscopic features with multiple whitish granules. Chemotherapy with bendamustine and rituximab was administered, and complete remission was confirmed by CT scanning and positron emission tomography scanning. Although the duodenal granular lesions did not completely disappear, magnifying observation for the remaining lesions showed no evidence of residual lymphoma. Complete remission was pathologically confirmed by biopsy examinations. This case suggests the usefulness of magnifying observation in evaluating the effects of treatment for duodenal follicular lymphoma lesions.

DOI： 10.2169/internalmedicine.54.4390

Endoscopic radial incision and cutting method for refractory stricture of a rectal anastomosis after surgery. International journal

Keita Harada, Seiji Kawano, Sakiko Hiraoka, Yoshiro Kawahara, Yoshitaka Kondo, Hiroyuki Okada

Endoscopy 47 Suppl 1 E552-3 2015

Clinical Features of Intestinal Behçet's Disease Associated with Myelodysplastic Syndrome and Trisomy 8.

Seiji Kawano, Sakiko Hiraoka, Hiroyuki Okada, Mitsuhiro Akita, Masaya Iwamuro, Kazuhide Yamamoto

Acta medica Okayama 69 ( 6 ) 365 - 9 2015

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

Several studies have identified a relationship between myelodysplastic syndrome and Behçet's disease (BD), especially intestinal BD, and trisomy 8 appears to play an important role in these disorders. Despite this, only few case reports or series have been reported in gastroenterology, meaning that endoscopic findings and characteristics of intestinal BD have not been clarified yet. In this report, we describe three cases of intestinal BD associated with myelodysplastic syndrome and trisomy 8, and discuss the clinical features and problems of these disorders from a gastroenterology perspective.

Morphological Changes in a Pyogenic Granuloma of the Esophagus Observed over Three Years.

Masaya Iwamuro, Hiroyuki Okada, Takehiro Tanaka, Keisuke Hori, Masahide Kita, Seiji Kawano, Yoshiro Kawahara, Kazuhide Yamamoto

Internal medicine (Tokyo, Japan) 54 ( 14 ) 1737 - 40 2015

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

A 78-year-old Japanese man underwent routine esophagogastroduodenoscopy, during which a reddish, flat elevated lesion was observed in the middle third of the esophagus. A bright red area of protrusion appeared in the center of the elevated lesion three months later, and the protruded nodule grew to be a blood blister six months after the initial endoscopy examination. The morphology of the lesion changed from a protruded nodule to a mass with two humps that subsequently returned to a single hump during the three-year observation period. A histological diagnosis of pyogenic granuloma was made based on a biopsy performed at six months. This report illustrates a rare case of an esophageal pyogenic granuloma presenting with a unique endoscopic appearance and morphologic changes. Endoscopic ultrasonography images are also presented.

DOI： 10.2169/internalmedicine.54.4265

Magnified endoscopic features of duodenal follicular lymphoma and other whitish lesions.

Masaya Iwamuro, Hiroyuki Okada, Katsuyoshi Takata, Yoshinari Kawai, Seiji Kawano, Junichiro Nasu, Yoshiro Kawahara, Takehiro Tanaka, Tadashi Yoshino, Kazuhide Yamamoto

Acta medica Okayama 69 ( 1 ) 37 - 44 2015

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

The sensitivity and specificity of magnified endoscopic features for differentiating follicular lymphoma from other diseases with duodenal whitish lesions have never been investigated. Here we compared the magnified endoscopic features of duodenal follicular lymphoma with those of other whitish lesions. We retrospectively reviewed the cases of patients with follicular lymphoma (n＝9), lymphangiectasia (n＝7), adenoma (n＝10), duodenitis (n＝4), erosion (n＝1), lymphangioma (n＝1), and hyperplastic polyp (n＝1). The magnified features of the nine follicular lymphomas included enlarged villi (n＝8), dilated microvessels (n＝5), and opaque white spots of various sizes (n＝9). The lymphangiectasias showed enlarged villi, dilated microvessels, and white spots, but the sizes of the white spots were relatively homogeneous and their margin was clear. Observation of the adenoma and duodenitis revealed only whitish villi. Although the lymphangioma was indistinguishable from the follicular lymphomas by magnified features, it was easily diagnosed based on the macroscopic morphology. In conclusion, magnified endoscopic features, in combination with macroscopic features, are useful for differentiating follicular lymphomas from other duodenal diseases presenting whitish lesions.

An effective and safe sedation technique combining target-controlled infusion pump with propofol, intravenous pentazocine, and bispectral index monitoring for peroral double-balloon endoscopy. International journal

Seiji Kawano, Hiroyuki Okada, Masaya Iwamuro, Yoshiyasu Kouno, Kou Miura, Toshihiro Inokuchi, Hiromitsu Kanzaki, Keisuke Hori, Keita Harada, Sakiko Hiraoka, Yoshiro Kawahara, Kazuhide Yamamoto

Digestion 91 ( 2 ) 112 - 6 2015

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

BACKGROUND/AIMS: Because peroral double-balloon endoscopy (DBE) is a time-consuming, painful procedure, sedation with analgesics, and/or anesthetics is generally required. The aim of this prospective study was to investigate the safety and efficacy of our sedation protocol for peroral DBE, which consisted of target-controlled infusion (TCI) anesthesia with propofol, an intravenous bolus of pentazocine, and bispectral index (BIS) monitoring. METHODS: A total of 34 consecutive patients who underwent DBE by the oral approach were enrolled. Patients were primarily sedated with a continuous infusion of propofol and adjusted in accordance with the BIS levels. The bolus infusion of pentazocine was performed when the propofol infusion was insufficient. The primary outcome measure of this study was to ensure the safety and efficacy of this sedation technique. The secondary purpose was to identify the characteristics of the patient who required the bolus infusion of pentazocine. RESULTS: Five patients (14.7%) required a reduction in the dose of propofol. However, no patient experienced any serious adverse events. All patients (100%) and 80.6% (25/31) of endoscopists answered that the sedation protocol was 'excellent' or 'enough' for peroral DBE. Eleven patients (32.3%) required a bolus injection of pentazocine. Age <60 years and a total procedure time of >70 min were significant risk-factors for pentazocine use. CONCLUSIONS: A combination of propofol via TCI pump, bolus injection of pentazocine as needed, and BIS monitoring was a safe and effective procedure for peroral DBE. Reasonable satisfaction indices were obtained from both patients and endoscopists. Pentazocine was required for young patients and in cases with longer procedure times.

DOI： 10.1159/000369614

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)

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

Ectopic pancreas in the stomach successfully resected by endoscopic submucosal dissection. International journal

Masaya Iwamuro, Takao Tsuzuki, Shogen Ohya, Hiroyuki Okada, Takehiro Tanaka, Keisuke Hori, Masahide Kita, Seiji Kawano, Yoshiro Kawahara, Kazuhide Yamamoto

Case reports in medicine 2015 147927 - 147927 2015

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

A 32-year-old Japanese man presented with a gastric submucosal tumor. Esophagogastroduodenoscopy showed a sessile submucosal tumor measuring approximately 10 mm in diameter on the greater curvature of the gastric antrum. Endoscopic ultrasonography examination revealed a solid tumor with a diameter of 11.8 mm, which was located in the deep mucosal and submucosal layers. The internal echogenicity was homogenous and hypoechoic. Biopsy examinations were performed twice but were not diagnostic since only the intact mucosal layer was obtained. The patient was subsequently diagnosed with ectopic pancreas in the stomach by endoscopic submucosal dissection (ESD). This case underscores the usefulness of the ESD technique for the pathological diagnosis of gastric submucosal tumors.

DOI： 10.1155/2015/147927

Recurrence after Radiotherapy for Gastric Mucosa-associated Lymphoid Tissue (MALT) Lymphoma with Trisomy 18 Reviewed

Hisashi Ishikawa, Masaya Iwamuro, Hiroyuki Okada, Keisuke Hori, Masahide Kita, Seiji Kawano, Yoshiro Kawahara, Takehiro Tanaka, Eisei Kondo, Tadashi Yoshino, Kazuhide Yamamoto

INTERNAL MEDICINE 54 ( 8 ) 911 - 916 2015

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

A 36-year-old Japanese woman presented with extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) in the stomach. The gastric lesions only partially improved after eradication therapy for Helicobacter pylori. A fluorescence in situ hybridization analysis revealed no fusion genes of API2-MALT1, although trisomy of chromosome 18 was identified. Radiation therapy was initiated to treat the gastric lymphoma lesions, resulting in complete remission. However, MALT lymphoma recurred in the stomach 16 months later. This case indicates that intensive follow-up is required for MALT lymphoma associated with chromosomal aberrations in order to detect early relapse.

DOI： 10.2169/internalmedicine.54.3784

Other Link： http://orcid.org/0000-0003-0995-9405

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

当院におけるパテンシーカプセルの使用経験

森藤由記, 川野誠司, 平岡佐規子, 井口俊博, 竹井大介, 半井明日香, 高橋索真, 秋田光洋, 原田馨太, 岡田裕之, 山本和秀

Gastroenterological Endoscopy 56 ( Suppl.1 ) 1167 - 1167 2014.4

当院における原発性小腸癌34例の検討

秋元悠, 那須淳一郎, 神崎洋光, 堤康一郎, 松原稔, 筑木隆雄, 喜多雅英, 川野誠司, 原田馨太, 加藤博也, 平岡佐規子, 河原祥朗, 岡田裕之, 八木孝仁, 山本和秀

日本消化器病学会雑誌 111 ( 臨増総会 ) A347 - A347 2014.3

Endoscopic submucosal dissection of esophageal cancer using the Mucosectom2 device: a feasibility study. International journal

Yoshiro Kawahara, Keisuke Hori, Ryuta Takenaka, Junichiro Nasu, Seiji Kawano, Masahide Kita, Takao Tsuzuki, Minoru Matsubara, Sayo Kobayashi, Hiroyuki Okada, Kazuhide Yamamoto

Endoscopy 45 ( 11 ) 869 - 75 2013.11

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

BACKGROUND AND STUDY AIMS: Endoscopic submucosal dissection (ESD) is being increasingly used for superficial esophageal cancers. However, esophageal ESD is technically difficult, time consuming, and less safe compared with endoscopic mucosal resection (EMR). To perform ESD safely and more efficiently, various types of knives have been developed. This study compared the efficacy of our newly developed device, Mucosectom2, with that of conventional devices for esophageal ESD. PATIENTS AND METHODS: Between May 2007 and February 2011, ESD was performed for 172 esophageal lesions. Of these, 120 lesions were treated by conventional devices only, whereas 52 lesions were treated by conventional devices and the Mucosectom2. Procedure time, en bloc and R0 resection rates, and adverse events were retrospectively compared between the conventional and Mucosectom2 groups. RESULTS: The median procedure time was 48.0 minutes in the conventional group and 21.5 minutes in the Mucosectom2 group; the procedure time was significantly shorter in the Mucosectom2 group than in the conventional group (P < 0.0001). The en bloc and R0 resection rates were lower in the conventional group than those in the Mucosectom2 group, although these differences were not significant. The rate of exposure of the muscle layer in the Mucosectom2 group was significantly lower than in the conventional group (P = 0.04). The rates of perforation and postoperative bleeding were not significantly different between the two groups. CONCLUSIONS: This feasibility study suggests that, compared with conventional ESD devices, the Mucosectom2 may decrease the time required for esophageal ESD. Although our groups appeared comparable, they were studied at different times. Endoscopic expertise and endoscope quality may have differed during these periods, thereby affecting the results of our study. A prospective trial is therefore required to confirm our results.

DOI： 10.1055/s-0033-1344229

Endoscopic Features of Duodenal Involvement in Mantle Cell Lymphoma

IWAMURO Masaaya, OKAKA Hiroyuki, MORITO Toshiaki, KAWANO Seiji, NASU Junichiro, KAWAHARA Yoshiro, TAKATA Katsuyoshi, YOSHINO Tadashi, YAMAMOTO Kazuhide

Gastroenterological Endoscopy 55 ( 8 ) "2167 - 74" 2013.8

Language：Japanese Publisher：Japan Gastroenterological Endoscopy Society

The purpose of this study was to determine the endoscopic features of duodenal involvement in mantle cell lymphoma. Eleven patients with multiple protruding lesions were analyzed in this study. Macroscopically, multiple minute polyploid lesions, verrucous lesions, the mixed type of multiple minute polyploid lesions and verrucous lesions and submucosal tumor-like lesions were observed in 3, 3, 2 and 3 cases respectively. The multiple tiny polyploid lesions were not associated with erosive changes. Meanwhile, all verrucous lesions and submucosal tumor-like lesions presented with an erosive surface except for one verrucous lesion. In order to diagnose mantle cell lymphoma as early as possible, lesions in the duodenum presenting these endoscopic findings need to be biopsied.

DOI： 10.11280/gee.55.2167

Other Link： http://search.jamas.or.jp/link/ui/2013373163

大腸ESDにおける穿孔例の検討

原田馨太, 平岡佐規子, 岡田裕之, 井口俊博, 半井明日香, 平川智子, 秋田光洋, 喜多雅英, 松原稔, 川野誠司, 那須淳一郎, 河原祥朗, 山本和秀

日本消化器病学会雑誌 110 ( 臨増総会 ) A290 - A290 2013.2

Primary intestinal follicular lymphoma: How to identify follicular lymphoma by routine endoscopy. International journal

Masaya Iwamuro, Yoshinari Kawai, Katsuyoshi Takata, Seiji Kawano, Tadashi Yoshino, Hiroyuki Okada, Kazuhide Yamamoto

World journal of gastrointestinal endoscopy 5 ( 1 ) 34 - 8 2013.1

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

A 69-year-old Japanese female was diagnosed with primary intestinal follicular lymphoma. Esophagogastroduodenoscopy with high-definition imaging revealed not only the typical feature of whitish polyps of up to 2 mm in diameter in the duodenal second and third portions, but also more detailed morphology, such as enlarged whitish villi and tiny whitish depositions. These findings appeared to reflect the pathological structures; infiltration of lymphoma cells into the villi were probably seen as enlargement of the villi, and the formation of lymphoid follicles were shown as opaque white spots or tiny white depositions. Thus, the above features might contribute to the distinct diagnosis of intestinal follicular lymphoma. This case indicates that routine esophagogastroduodenoscopy can visualize microsurface structures, which can be pathognomonic and help to diagnose intestinal follicular lymphoma, even without magnifying endoscopy.

DOI： 10.4253/wjge.v5.i1.34

Clinicopathological characteristics of human epidermal growth factor receptor 2-positive Barrett's adenocarcinoma. International journal

Takehiro Tanaka, Atsushi Fujimura, Koichi Ichimura, Hiroyuki Yanai, Yasuharu Sato, Katsuyohi Takata, Hiroyuki Okada, Seiji Kawano, Shunsuke Tanabe, Tadashi Yoshino

World journal of gastroenterology 18 ( 43 ) 6263 - 8 2012.11

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

AIM: To compare the clinicopathological characteristics of human epidermal growth factor receptor 2 (HER2)-positive and HER2-negative Barrett's adenocarcinoma in Japan. METHODS: We performed immunohistochemical analysis of HER2 in 30 samples taken from patients with Barrett's adenocarcinoma and dual color in situ hybridization in cases showing 2+ reactions. We compared the clinicopathological characteristics of HER2-positive and HER2-negative patients. RESULTS: HER2 positivity was identified in 8 (27%) carcinoma samples. We found that HER2 expression was associated with p53 overexpression (100% vs 52.6% in pT1 tumor; 100% vs 54.5% in all stage tumor, P < 0.05) and protruding lesions at the early disease stage. There was no association between the mucin phenotype of the carcinomas and prognosis. HER2 expression and low clinical stage were unexpectedly different between Barrett's adenocarcinoma patients and gastric cancer patients, but the macroscopic features may be associated with earlier diagnosis in these patients. CONCLUSION: Our results suggest that HER2-positive Barrett's adenocarcinomas are associated with p53 overexpression and lesion protrusion at the early disease stage.

DOI： 10.3748/wjg.v18.i43.6263

Primary follicular lymphoma of the duodenum relapsing 11 years after resection.

Masaya Iwamuro, Hiroyuki Okada, Katsuyoshi Takata, Seiji Kawano, Yoshiro Kawahara, Junichiro Nasu, Katsuji Shinagawa, Tadashi Yoshino, Kazuhide Yamamoto

Internal medicine (Tokyo, Japan) 51 ( 9 ) 1031 - 5 2012

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

A 52-year-old Japanese woman was diagnosed with primary follicular lymphoma of the duodenum that was curatively resected by pancreatoduodenectomy. She remained in complete remission until 11 years after the surgery, when multiple enlarged intra-abdominal lymph nodes were demonstrated by computed tomography scans and positron emission tomography scans. Two years later, jejunal lesions were detected by endoscopy, and biopsy samples confirmed a recurrence of follicular lymphoma. This case indicates that primary gastrointestinal follicular lymphoma has a potential of relapse after an extended period of time, and thus patients must be followed up for over 10 years after complete remission.

A prospective analysis of efficacy and long-term outcome of radiation therapy for gastric mucosa-associated lymphoid tissue lymphoma. International journal

Hiroyuki Okada, Mitshuhiro Takemoto, Yoshiro Kawahara, Junichiro Nasu, Ryuta Takenaka, Seiji Kawano, Masafumi Inoue, Koichi Ichimura, Takehiro Tanaka, Katsushi Shinagawa, Tadashi Yoshino, Kazuhide Yamamoto

Digestion 86 ( 3 ) 179 - 86 2012

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

BACKGROUND/AIMS: Few studies exist on the efficacy and long-term outcome of radiation therapy (RT) for gastric mucosa-associated lymphoid tissue (MALT) lymphoma. METHODS: Twenty-two patients with stage I or stage II(1) disease were prospectively evaluated, including 14 patients without Helicobacter pylori(H. pylori) infection and 8 patients with persistent lymphoma after H. pylori eradication. RT dose was 30 Gy in daily fractions of 1.5 Gy. All patients underwent endoscopic and histological follow-up regularly. RESULTS: The study included 22 patients with a mean age of 63 years. The t(11;18)(q21;q21) translocation occurred in 8 of the 22 cases. All patients showed complete remission without any serious toxicity. At a median follow-up evaluation 74 months (range 27-159) after completion of RT, the overall and relapse-free survival rates after 5 years were 91 and 84%, respectively. Although no patient showed local recurrence of lymphoma, distant recurrence was detected in 3 patients, all of whom were H. pylori negative; MALT lymphoma relapsed in two patients with the t(11;18)(q21;q21) translocation, and diffuse large-cell lymphoma developed in one patient without the translocation. CONCLUSION: RT provides excellent local control of the gastric MALT lymphoma. However, continuous follow-up is mandatory as relapse may occur in other sites.

DOI： 10.1159/000339497

Usefulness and Problems of Endoscopic Ultrasonography in Prediction of the Depth of Tumor Invasion in Early Gastric Cancer

Tsuzuki Takao, Okada Hiroyuki, Nasu Junichiro, Takenaka Ryuta, Inoue Masafumi, Kawano Seiji, Kita Masahide, Hori Keisuke, Yamamoto Kazuhide

Acta Medica Okayama 65 ( 2 ) 105 - 112 2011.4

Proton pump inhibitor dose-related healing rate of artificial ulcers after endoscopic submucosal dissection: a prospective randomized controlled trial. International journal

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

Digestion 84 ( 1 ) 46 - 53 2011

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

BACKGROUND/AIMS: Two studies have reported on the superiority of a proton pump inhibitor (PPI) compared with a histamine-2-receptor antagonist for the treatment of artificial ulcers after endoscopic submucosal dissection (ESD), but the optimal dose of PPI remains to be defined. The aim of this study was to evaluate the possibility of reducing the dose of PPI. The authors thus compared 30 mg (standard-dose) and 15 mg (half-dose) lansoprazole in terms of ulcer healing, prevention of bleeding and quality of life. METHODS: 91 patients with gastric mucosal neoplasm were enrolled. All patients who underwent ESD were administered lansoprazole 30 mg daily during the first week, after which they were randomly assigned to either the standard-dose or half-dose group. RESULTS: One patient in each group developed hematemesis. The stage of ulcers, ulcer reduction ratios and scores on the Gastrointestinal Symptom Rating Scale did not differ at 28 and 56 days. The costs of PPI for the half-dose group and standard-dose group were 7,326.5 and 11,698.4 JPY, respectively, i.e. a difference of 471.9 JPY. CONCLUSIONS: A reduced dose of PPI after 1 week of ESD was equivalent in treatment performance to the standard dose and cheaper.

DOI： 10.1159/000321660

Does pretreatment with lansoprazole influence Helicobacter pylori eradication rate and quality of life? International journal

Masafumi Inoue, Hiroyuki Okada, Shinichiro Hori, Yoshiro Kawahara, Seiji Kawano, Ryuta Takenaka, Tatsuya Toyokawa, Yasuhiro Onishi, Yasushi Shiratori, Kazuhide Yamamoto

Digestion 81 ( 4 ) 218 - 22 2010

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

BACKGROUND/AIMS: It is controversial whether pretreatment with a proton pump inhibitor (PPI) before Helicobacter pylori eradication treatment decreases the eradication rate. To determine the effects of pretreatment with lansoprazole alone, followed by an H. pylori eradication regimen (lansoprazole 30 mg, amoxicillin 750 mg and clarithromycin 200 mg twice daily for 1 week), on the eradication rate and quality of life (QoL) of the patient. METHODS: Patients with H. pylori-positive peptic ulcer were randomly assigned to two groups. The patients received either lansoprazole (30 mg) once daily for 6-8 weeks before H. pylori eradication (group A), or eradication treatment and then lansoprazole (30 mg) for 6-8 weeks (group B). To assess the QoL of the patients, the Gastrointestinal Symptom Rating Scale (GSRS) questionnaire was evaluated. RESULTS: A total of 116 patients were enrolled. The cure rates were 78.9% in group A and 78.0% in group B. In both groups, GSRS analysis showed a significant improvement of the overall GSRS score at the assessment of eradication efficacy, compared to baseline; there was no difference between the groups. CONCLUSION: With this H. pylori eradication regimen, there was no difference in the cure rates and QoL associated with PPI pretreatment.

DOI： 10.1159/000260416

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

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 2009.12

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

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

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

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 2009.1

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

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

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

Language：Japanese Publisher：(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。

Other Link： 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. International journal

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 2008.11

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

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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