研究者詳細 - 山崎　泰史

論文 - 山崎　泰史

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免疫抑制剤とステロイド内服に着目した大腸ESD後の発熱とPECSのリスク因子に関する検討

山本峻平, 衣笠秀明, 山崎泰史, 青山祐樹, 竹井健介, 大森正泰, 原田馨太, 平岡佐規子, 能祖一裕, 岡田裕之

日本消化管学会雑誌 6 ( Suppl. ) 209 - 209 2022年1月

Clinicopathological Characteristics of Superficial Barrett's Adenocarcinoma in a Japanese Population: A Retrospective, Multicenter Study.

Kenta Hamada, Hiromitsu Kanzaki, Koji Miyahara, Masahiro Nakagawa, Hirokazu Mouri, Motowo Mizuno, Sakuma Takahashi, Shinichiro Hori, Junichiro Nasu, Takao Tsuzuki, Jiro Miyaike, Ryuta Takenaka, Kenji Yamauchi, Sayo Kobayashi, Tatsuya Toyokawa, Masafumi Inoue, Mamoru Nishimura, Minoru Matsubara, Jun Tomoda, Yasushi Yamasaki, Takehiro Tanaka, Yasuhiro Shirakawa, Yoshiro Kawahara, Toshiyoshi Fujiwara, Hiroyuki Okada

Internal medicine (Tokyo, Japan) 61 ( 8 ) 1115 - 1123 2022年

記述言語：英語掲載種別：研究論文（学術雑誌）

Objective Although Barrett's adenocarcinoma (BA) remains a minor disease in Japan, its incidence has been gradually increasing. We analyzed the characteristics of BA in Japanese populations. Methods We retrospectively reviewed medical records and analyzed the clinicopathological differences between short-segment Barrett's esophagus (SSBE) and long-segment Barrett's esophagus (LSBE), as well as metastasis. Local recurrence and metachronous lesions were analyzed only in patients who underwent endoscopic resection (ER). Patients Consecutive patients who had pathological T1 BAs resected by ER or surgery from January 2003 to December 2017. Results A total of 168 patients were analyzed, including 139 with SSBE and 29 with LSBE. In total, 67% of the SSBE lesions and 32% of the LSBE lesions were located between 0 and 3 o'clock (p=0.0014). No patients who achieved pathological margin-free resection (pR0) and 17% of patients who did not achieve pR0 experienced local recurrence (p=0.0131). None of the patients without lymphovascular involvement, a poorly differentiated component, lesion size of >30 mm, and submucosal invasion of >500 μm experienced metastasis. The 5-year cumulative incidence rate of metachronous BA after ER was 0% in patients with SSBE and 40% in patients with LSBE (p=0.0005). Conclusion Superficial BA was likely to be detected at the right anterior wall of SSBE in the Japanese population. The risk for metachronous BA after ER was high in Japanese patients with LSBE, as in Western patients.

DOI： 10.2169/internalmedicine.6942-20

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The Impact of KRAS Mutation in Patients With Sporadic Nonampullary Duodenal Epithelial Tumors. 国際誌

Hideaki Kinugasa, Hiromitsu Kanzaki, Takehiro Tanaka, Shumpei Yamamoto, Yasushi Yamasaki, Kazuhiro Nouso, Kouichi Ichimura, Masahiro Nakagawa, Toshiharu Mitsuhashi, Hiroyuki Okada

Clinical and translational gastroenterology 12 ( 11 ) e00424 2021年11月

記述言語：英語掲載種別：研究論文（学術雑誌）

INTRODUCTION: The genomic characterization of primary nonampullary duodenal adenocarcinoma indicates a genetic resemblance to gastric and colorectal cancers. However, a correlation between the clinical and molecular characteristics of these cancers has not been established. This study aimed to elucidate the clinicopathological features of sporadic nonampullary duodenal epithelial tumors, including their molecular characteristics and prognostic factors. METHODS: One hundred forty-eight patients with sporadic nonampullary duodenal epithelial tumors were examined in this study. Patient sex, age, TNM stage, tumor location, treatment methods, histology, KRAS mutation, BRAF mutation, Fusobacterium nucleatum, mucin phenotype, and programmed death-ligand 1 (PD-L1) status were evaluated. KRAS and BRAF mutations, Fusobacterium nucleatum, mucin phenotype, and PD-L1 status were analyzed by direct sequencing, quantitative polymerase chain reaction, and immunochemical staining. RESULTS: The median follow-up duration was 119.4 months. There were no deaths from duodenal adenoma (the primary disease). Kaplan-Meier analysis for duodenal adenocarcinoma showed a significant effect of TNM stage (P < 0.01). In univariate analysis of primary deaths from duodenal adenocarcinoma, TNM stage II or higher, undifferentiated, KRAS mutations, gastric phenotype, intestinal phenotype, and PD-L1 status were significant factors. In multivariate analysis, TNM stage II or higher (hazard ratio: 1.63 × 1010, 95% confidence interval: 18.66-6.69 × 1036) and KRAS mutation (hazard ratio: 3.49, confidence interval: 1.52-7.91) were significant factors. DISCUSSION: Only KRAS mutation was a significant prognostic factor in primary sporadic nonampullary duodenal adenocarcinoma in cases in which TNM stage was considered.

DOI： 10.14309/ctg.0000000000000424

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非典型的な発症を呈した潰瘍性大腸炎合併壊疽性膿皮症の1例

嶋崎岳, 青山祐樹, 井口俊博, 平岡佐規子, 竹井健介, 井川翔子, 山本峻平, 安富絵里子, 大森正泰, 竹内桂子, 山崎泰史, 衣笠秀明, 原田馨太, 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 116回・127回 78 - 78 2021年11月

腎移植後に発症した巨大な大腸潰瘍の一例

山下航矢, 山崎泰史, 西村慎吾, 荒木元朗, 青山祐樹, 竹井健介, 井川翔子, 安富絵里子, 大森正泰, 井口俊博, 衣笠秀明, 原田馨太, 平岡佐規子, 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 116回・127回 69 - 69 2021年11月

A preclinical feasibility study of endoscopic barostat: A possible diagnostic tool for visceral hypersensitivity in functional dyspepsia

Yuki Ushimaru, Tatsuhiro Masaoka, Noriko Matsuura, Yasushi Yamasaki, Yoji Takeuchi, Kotaro Yamashita, Takuro Saito, Koji Tanaka, Kazuyoshi Yamamoto, Tomoki Makino, Tsuyoshi Takahashi, Yukinori Kurokawa, Hidetoshi Eguchi, Yuichiro Doki, Kiyokazu Nakajima

Digestive Diseases 2021年10月

掲載種別：研究論文（学術雑誌）出版者・発行元：S. Karger AG

Introduction:
Diagnosing functional dyspepsia requires excluding organic disease and gastrointestinal function evaluation; however, there are no modalities to evaluate these simultaneously. This preclinical study examined the possibility of an endoscopic barostat.
Methods:
Ultrathin endoscopy and our newly developed pressure-regulated endoscopic insufflator, which insufflates the gastrointestinal tract until the preset pressure is achieved, were used. The actual intragastric pressure was measured using an optical fiber manometer placed in the stomach. Experiment-1: in an ex vivo experiment, we insufflated the isolated stomach and verified whether the intragastric pressure reached the preset pressure. Experiment-2: we inserted the endoscope orally in a porcine stomach, insufflated the stomach, and verified whether the intragastric pressure reached the preset pressure. Finally, we insufflated the stomach at a random pressure to verify the functional tests for proof-of-concept.
Results:
Experiment-1: the intragastric pressure reached the preset pressure. After reaching the plateau, the pressure remained stable at the preset pressure (Huber M-value: 1.015, Regression line: 0.988, 95% confidence interval [CI]: 0.994–0.994). Experiment-2: the intragastric pressure reached the preset pressure. After reaching the plateau, the pressure remained stable at the preset pressure (Huber M-value: 1.018, Regression line: 0.971, 95% CI: 0.985–0.986). At randomly preset pressures, the transendoscopic theoretical intragastric pressure detected by the insufflator was correlated with the actual pressure measured by the pressure manometer.
Conclusions:
This proof-of-concept study shows that a pressure-regulated endoscopic insufflator provides stable intragastric pressure at the preset level, with the potential of an endoscopic barostat to assess visceral the hypersensitivity related to functional dyspepsia.

DOI： 10.1159/000520375

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Application of convolutional neural networks for evaluating the depth of invasion of early gastric cancer based on endoscopic images. 国際誌

Kenta Hamada, Yoshiro Kawahara, Takayoshi Tanimoto, Akimitsu Ohto, Akira Toda, Toshiaki Aida, Yasushi Yamasaki, Tatsuhiro Gotoda, Taiji Ogawa, Makoto Abe, Shotaro Okanoue, Kensuke Takei, Satoru Kikuchi, Shinji Kuroda, Toshiyoshi Fujiwara, Hiroyuki Okada

Journal of gastroenterology and hepatology 2021年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND AND AIM: Recently, artificial intelligence (AI) has been used in endoscopic examination and is expected to help in endoscopic diagnosis. We evaluated the feasibility of AI using convolutional neural network (CNN) systems for evaluating the depth of invasion of early gastric cancer (EGC), based on endoscopic images. METHODS: This study used a deep CNN model, ResNet152. From patients who underwent treatment for EGC at our hospital between January 2012 and December 2016, we selected 100 consecutive patients with mucosal (M) cancers and 100 consecutive patients with cancers invading the submucosa (SM cancers). A total of 3508 non-magnifying endoscopic images of EGCs, including white-light imaging, linked color imaging, blue laser imaging-bright, and indigo-carmine dye contrast imaging, were included in this study. A total of 2288 images from 132 patients served as the development dataset, and 1220 images from 68 patients served as the testing dataset. Invasion depth was evaluated for each image and lesion. The majority vote was applied to lesion-based evaluation. RESULTS: The sensitivity, specificity, and accuracy for diagnosing M cancer were 84.9% (95% confidence interval [CI] 82.3%-87.5%), 70.7% (95% CI 66.8%-74.6%), and 78.9% (95% CI 76.6%-81.2%), respectively, for image-based evaluation, and 85.3% (95% CI 73.4%-97.2%), 82.4% (95% CI 69.5%-95.2%), and 83.8% (95% CI 75.1%-92.6%), respectively, for lesion-based evaluation. CONCLUSIONS: The application of AI using CNN to evaluate the depth of invasion of EGCs based on endoscopic images is feasible, and it is worth investing more effort to put this new technology into practical use.

DOI： 10.1111/jgh.15725

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A novel clip closure method using precutting and a reopenable clip after colorectal endoscopic submucosal dissection. 国際誌

Masayasu Ohmori, Yasushi Yamasaki, Shumpei Yamamoto, Hideaki Kinugasa, Keita Harada, Sakiko Hiraoka, Hiroyuki Okada

Endoscopy 54 ( 8 ) E401-E402 2021年8月

Nonrecurrence Rate of Underwater EMR for ≤20-mm Nonampullary Duodenal Adenomas: A Multicenter Prospective Study (D-UEMR Study). 国際誌

Yasushi Yamasaki, Noriya Uedo, Takuji Akamatsu, Tomo Kagawa, Reiji Higashi, Osamu Dohi, Masanori Furukawa, Yu Takahashi, Takuya Inoue, Shouichi Tanaka, Ryuta Takenaka, Mikitaka Iguchi, Takuji Kawamura, Takao Tsuzuki, Tomoaki Yamasaki, Takeshi Yamashina, Junichiro Nasu, Tomohiko Mannami, Atsushi Yamauchi, Kazuhiro Matsueda, Shigeyuki Aizawa, Toshiharu Mitsuhashi, Hiroyuki Okada

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association 2021年7月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND AND AIMS: Endoscopic resection of nonampullary duodenal adenoma is often challenging, and its technique has not yet been standardized. To overcome the practical difficulty of conventional endoscopic mucosal resection, underwater endoscopic mucosal resection (UEMR) was recently developed; therefore, we investigated the effectiveness and safety of UEMR for nonampullary duodenal adenoma. METHODS: A multicenter, prospective cohort study was conducted at 21 institutions in Japan. We enrolled patients with no more than 2 nonampullary duodenal adenomas ≤20 mm in size, who were scheduled to undergo UEMR. After UEMR, follow-up endoscopies were scheduled at 2 and 12 months after the procedure, and biopsy specimens were taken from the post-UEMR scars. The primary endpoint was the proportion of patients with histologically proven nonrecurrence at follow-up endoscopy and biopsy. RESULTS: A total of 155 patients with 166 lesions underwent UEMR. One patient with a non-neoplastic lesion in the resected specimen and 10 patients with 10 lesions who were lost to follow-up were excluded. Finally, 144 patients with 155 lesions who received all follow-up endoscopies were analyzed for the primary endpoint. The proportion of patients with proven nonrecurrence was 97.2% (n = 140 of 144; 95% confidence interval, 92.8%-99.1%) which exceeded the predefined threshold value (92%). Two cases of delayed bleeding (1.2%) occurred and they were successfully managed by clips. All recurrences were successfully treated by additional endoscopic treatment. CONCLUSIONS: This multicenter, prospective cohort study demonstrated effectiveness and safety of UEMR for nonampullary duodenal adenomas ≤20 mm in size. (University Hospital Medical Network Clinical Trials Registry, Number: UMIN000030414).

DOI： 10.1016/j.cgh.2021.06.043

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Heterogeneous distribution of Fusobacterium nucleatum in the progression of colorectal cancer. 国際誌

Shumpei Yamamoto, Hideaki Kinugasa, Mami Hirai, Hiroyuki Terasawa, Eriko Yasutomi, Shohei Oka, Masayasu Ohmori, Yasushi Yamasaki, Toshihiro Inokuchi, Keita Harada, Sakiko Hiraoka, Kazuhiro Nouso, Takehiro Tanaka, Fuminori Teraishi, Toshiyoshi Fujiwara, Hiroyuki Okada

Journal of gastroenterology and hepatology 36 ( 7 ) 1869 - 1876 2021年7月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND AND AIM: Fusobacterium nucleatum (Fn) is involved in colorectal cancer (CRC) growth and is a biomarker for patient prognosis and management. However, the ecology of Fn in CRC and the distribution of intratumoral Fn are unknown. METHODS: We evaluated Fn and the status of KRAS and BRAF in 200 colorectal neoplasms (118 adenomas and 82 cancers) and 149 matched adjacent normal mucosas. The differentiation status between "surface" and "deep" areas of cancer tissue and matched normal mucosa were analyzed in 46 surgical samples; the Ki-67 index was also evaluated in these samples. RESULTS: Fusobacterium nucleatum presence in the tumor increased according to pathological stage (5.9% [adenoma] to 81.8% [stage III/IV]), while Fn presence in normal mucosa also increased (7.6% [adenoma] to 40.9% [stage III/IV]). The detection rates of Fn on the tumor surface and in deep areas were 45.7% and 32.6%, while that of normal mucosa were 26.1% and 23.9%, respectively. Stage III/IV tumors showed high Fn surface area expression (66.7%). Fn intratumoral heterogeneity (34.8%) was higher than that of KRAS (4.3%; P < 0.001) and BRAF (2.2%; P < 0.001). The Ki-67 index in Fn-positive cases was higher than that in negative cases (93.9% vs 89.0%; P = 0.01). CONCLUSIONS: Fusobacterium nucleatum was strongly present in CRC superficial areas at stage III/IV. The presence of Fn in the deep areas of adjacent normal mucosa also increased. The intratumoral heterogeneity of Fn is important in the use of Fn as a biomarker, as Fn is associated with CRC proliferative capacity.

DOI： 10.1111/jgh.15361

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炎症性腸疾患患者における月経に関連する症状の変化および挙児希望に関わる検討

安富絵里子, 平岡佐規子, 青山祐樹, 井川翔子, 山本峻平, 大森正泰, 山崎泰史, 井口俊博, 衣笠秀明, 川野誠司, 原田馨太, 岡田裕之

日本高齢消化器病学会誌 24 ( 1 ) 195 - 195 2021年7月

多発深掘れ潰瘍を呈したメサラジン不耐潰瘍性大腸炎の一例

竹井健介, 井口俊博, 青山祐樹, 井川翔子, 安富絵里子, 山本峻平, 大森正康, 岡昌平, 山崎泰史, 衣笠秀明, 原田馨太, 平岡佐規子, 岡田裕之

日本消化器内視鏡学会中国支部例会 126回 61 - 61 2021年6月

Leucine-rich alpha-2 glycoprotein as a marker of mucosal healing in inflammatory bowel disease. 国際誌

Eriko Yasutomi, Toshihiro Inokuchi, Sakiko Hiraoka, Kensuke Takei, Shoko Igawa, Shumpei Yamamoto, Masayasu Ohmori, Shohei Oka, Yasushi Yamasaki, Hideaki Kinugasa, Masahiro Takahara, Keita Harada, Masaki Furukawa, Kouichi Itoshima, Ken Okada, Fumio Otsuka, Takehiro Tanaka, Toshiharu Mitsuhashi, Jun Kato, Hiroyuki Okada

Scientific reports 11 ( 1 ) 11086 - 11086 2021年5月

記述言語：英語掲載種別：研究論文（学術雑誌）

Leucine-rich alpha-2 glycoprotein (LRG) may be a novel serum biomarker for patients with inflammatory bowel disease. The association of LRG with the endoscopic activity and predictability of mucosal healing (MH) was determined and compared with those of C-reactive protein (CRP) and fecal markers (fecal immunochemical test [FIT] and fecal calprotectin [Fcal]) in 166 ulcerative colitis (UC) and 56 Crohn's disease (CD) patients. In UC, LRG was correlated with the endoscopic activity and could predict MH, but the performance was not superior to that of fecal markers (areas under the curve [AUCs] for predicting MH: LRG: 0.61, CRP: 0.59, FIT: 0.75, and Fcal: 0.72). In CD, the performance of LRG was equivalent to that of CRP and Fcal (AUCs for predicting MH: LRG: 0.82, CRP: 0.82, FIT: 0.70, and Fcal: 0.88). LRG was able to discriminate patients with MH from those with endoscopic activity among UC and CD patients with normal CRP levels. LRG was associated with endoscopic activity and could predict MH in both UC and CD patients. It may be particularly useful in CD.

DOI： 10.1038/s41598-021-90441-x

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周期的発熱、及び腹痛精査中に診断された正中弓状靱帯圧迫症候群の1例

乃美優孝, 井口俊博, 青山祐樹, 竹井健介, 安富絵里子, 井川翔子, 大森正泰, 岡昌平, 竹内桂子, 山崎泰史, 衣笠秀明, 原田馨太, 平岡佐規子, 岡田裕之, 徳増一樹, 大塚文男, 矢野修也, 菊地覚次, 坂本真樹

日本消化器病学会中国支部例会プログラム・抄録集 115回 83 - 83 2021年5月

Propensity score-matched analysis of endoscopic resection for recurrent colorectal neoplasms: A pilot study. 国際誌

Masayasu Ohmori, Yasushi Yamasaki, Hiroyoshi Iwagami, Hiroko Nakahira, Noriko Matsuura, Satoki Shichijo, Akira Maekawa, Takashi Kanesaka, Sachiko Yamamoto, Koji Higashino, Noriya Uedo, Ryu Ishihara, Hiroyuki Okada, Yoji Takeuchi

Journal of gastroenterology and hepatology 36 ( 9 ) 2568 - 2574 2021年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND AND AIM: Local residual/recurrent colorectal lesions after endoscopic resection (ER) are difficult to treat with conventional ER. Underwater endoscopic mucosal resection (UEMR) and endoscopic submucosal dissection (ESD) are reportedly effective. We investigated the appropriate indications of ESD and UEMR for recurrent colorectal lesions. METHODS: This single-center, retrospective, observational study was conducted at a tertiary cancer institute. Patients who underwent UEMR or ESD for residual/recurrent colorectal lesions after ER from October 2013 to February 2019 were enrolled. Propensity score matching was performed between the UEMR and ESD groups to compare the clinical characteristics, treatment, and outcomes. RESULTS: In total, 30 UEMRs and 21 ESDs were performed. Median (range) diameter of the lesions was 8 mm (2-22 mm) in UEMR and 15 mm (2-58 mm) in ESD. Median procedure time in UEMR was significantly shorter than that of ESD (4 min [2-15 min] vs 70 min [17-193 min], P < 0.001). En bloc and complete resection rates of ESD were significantly higher than that of UEMR (73% vs 100%, 41% vs 81%, respectively). No adverse events occurred with UEMR, but there were two cases (10%) of delayed perforation with ESD. Neither group reported recurrence after treatment. Propensity score-matched cases showed significantly shorter procedure time and hospitalization period in UEMR than in ESD. CONCLUSIONS: The outcomes of UEMR and ESD were comparable. UEMR could be a useful salvage therapy for small local residual/recurrent colorectal lesions after ER with shorter procedure time and hospitalization period.

DOI： 10.1111/jgh.15519

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Underwater endoscopic mucosal resection versus endoscopic submucosal dissection for 20-30 mm colorectal polyps. 国際誌

Takahiro Inoue, Kentaro Nakagawa, Yasushi Yamasaki, Satoki Shichijo, Takashi Kanesaka, Akira Maekawa, Koji Higashino, Noriya Uedo, Ryu Ishihara, Yoji Takeuchi

Journal of gastroenterology and hepatology 36 ( 9 ) 2549 - 2557 2021年3月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND AND AIM: Endoscopic submucosal dissection (ESD) for large polyps provides a high en bloc resection rate, accurate pathological diagnosis, and low recurrence rate. However, ESD requires advanced techniques, and underwater endoscopic mucosal resection (UEMR) is an alternative. We investigated the efficacy and safety of UEMR for 20-30 mm colorectal lesions compared with ESD. METHODS: We retrospectively evaluated systematically collected data of patients who underwent UEMR or ESD for 20-30 mm sessile colorectal lesions. Outcome measures were the incidence of local recurrence, procedure time, en bloc resection rate, and incidence of adverse events. We performed propensity score matching and inverse probability weighting adjustment to control for possible confounders. RESULTS: We evaluated 125 patients undergoing UEMR and 306 patients undergoing ESD. Using propensity score matching, we analyzed 74 lesions in each group. UEMR had a shorter procedure time than ESD [6.7 min (95% confidence interval (CI), 5.3-8.1 min) vs 64.8 min (95% CI, 57.4-72.2 min), respectively]. Although the en bloc resection rate with UEMR was inferior to ESD [61% (95% CI, 49-72%) vs 99% (95% CI, 93-100%), respectively], there was no significant difference in the local recurrence rate between the procedures [0% (95% CI, 0-4.0%) in each group]. Inverse probability weighting adjustment revealed that neither ESD nor UEMR had a significant association with local recurrence. CONCLUSIONS: Underwater endoscopic mucosal resection for 20-30 mm colorectal lesions was comparable with ESD regarding long-term outcomes, with a shorter procedure time, despite the lower en bloc resection rate.

DOI： 10.1111/jgh.15494

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Stop taking routine biopsy specimens for the diagnose of a duodenal adenoma! 国際誌

Yasushi Yamasaki, Noriya Uedo

Endoscopy international open 9 ( 3 ) E470-E471 2021年3月

潰瘍性大腸炎診療におけるバイオマーカーの位置づけを考える新規LRGも含め

安富絵里子, 平岡佐規子, 竹井健介, 井川翔子, 山本峻平, 大森正泰, 岡昌平, 山崎泰史, 井口俊博, 衣笠秀明, 原田馨太, 岡田裕之

日本消化器病学会雑誌 118 ( 臨増総会 ) A360 - A360 2021年3月

Optimization of insufflation and pressure control in third-space endoscopy. 国際誌

Yuki Ushimaru, Noriko Matsuura, Yasushi Yamasaki, Yoji Takeuchi, Kotaro Yamashita, Takuro Saito, Koji Tanaka, Tomoki Makino, Tsuyoshi Takahashi, Yukinori Kurokawa, Makoto Yamasaki, Hidetoshi Eguchi, Yuichiro Doki, Kiyokazu Nakajima

Surgical endoscopy 36 ( 1 ) 817 - 825 2021年2月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Third-space endoscopy requires a delicate and accurate insufflation technique to secure the endoscopic visualization and maintain the working space. However, optimal third-space insufflation parameters have yet to be determined. The aim of this study was to assess: (1) the diversity of endoluminal third-space pressure by manual insufflation, and (2) the performance of the insufflation settings for third-space endoscopy. METHODS: A submucosal tunnel was created in the upper posterior wall of the porcine stomach. Using two-channel esophagogastroduodenoscopy, one channel was used for insufflation and the other was used for pressure measurement. Experiment 1 Endoluminal submucosal tunnel pressure was measured in a 10-cm submucosal tunnel of a single porcine. Six board-certified endoscopists in turn maintained what they considered sufficient exposure under manual insufflation. Experiment 2 Endoluminal submucosal tunnel pressure and number of insufflations were measured using the pressure-regulated insufflation device; the differences in the submucosal tunnel length (long: 10-cm, short: 4-cm) and the insufflation route diameter (large: 3.8-mm, small: 2.2-mm) were compared. RESULTS: Experiment 1 The endoluminal submucosal tunnel pressure profiles during third-space endoscopy varied between endoscopists. Experiment 2 Longer submucosal tunnels and larger insufflation route diameters lead to stable endoluminal submucosal tunnel pressure. The gap with the preset pressure of the insufflator and endoluminal pressure narrowed, and the required number of insufflations decreased with longer tunnel length and larger route diameter. CONCLUSIONS: The pressure dynamics in third-space endoscopy differed among endoscopists. Longer submucosal tunnels and larger insufflation route diameters lead to stable endoluminal submucosal tunnel pressure.

DOI： 10.1007/s00464-021-08319-y

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SAPHO症候群に対しイキセキズマブ投与後に腸炎を発症した1例

森悠記, 倉岡紗樹子, 竹井健介, 井川翔子, 安富絵里子, 山本峻平, 大森正泰, 岡昌平, 山崎泰史, 井口俊博, 衣笠秀明, 原田馨太, 平岡佐規子, 岡田裕之

日本消化管学会雑誌 5 ( Suppl. ) 319 - 319 2021年1月

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