2021/12/16 更新

写真a

カンザキ ヒロミツ
神崎 洋光
KANZAKI Hiromitsu
所属
岡山大学病院 助教
職名
助教
外部リンク

学位

  • 博士課程 ( 2014年12月   岡山大学大学院医歯薬学総合研究科 )

研究キーワード

  • 抗癌剤治療

  • 胃癌

  • 消化器内視鏡

  • 消化器

研究分野

  • ライフサイエンス / 腫瘍診断、治療学  / 化学療法、内視鏡治療

学歴

  • 岡山大学大学院医歯薬学総合研究    

    2006年4月 - 2014年12月

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  • 大阪医科大学    

    1997年4月 - 2003年3月

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経歴

  • 岡山大学病院   消化器内科   助教

    2019年4月 - 現在

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  • Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences   消化器・肝臓内科学   助教

    2014年4月 - 2019年3月

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  • 岡山大学病院   消化器内科   医員

    2012年4月 - 2014年3月

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  • 大阪府立成人病センター   消化管内科   医員

    2009年10月 - 2012年3月

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所属学協会

 

論文

  • Linked Color Imaging (LCI) Emphasizes the Color Changes in the Gastric Mucosa After Helicobacter pylori Eradication. 国際誌

    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   2021年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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

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  • Linked Color Imaging Focused on Neoplasm Detection in the Upper Gastrointestinal Tract : A Randomized Trial. 国際誌

    Shoko Ono, Kenro Kawada, Osamu Dohi, Shinji Kitamura, Tomoyuki Koike, Shinichiro Hori, Hiromitsu Kanzaki, Takahisa Murao, Nobuaki Yagi, Fumisato Sasaki, Keiichi Hashiguchi, Shiro Oka, Kazuhiro Katada, Ryo Shimoda, Kazuhiro Mizukami, Mitsuhiko Suehiro, Toshihisa Takeuchi, Shinichi Katsuki, Momoko Tsuda, Yuji Naito, Tatsuyuki Kawano, Ken Haruma, Hideki Ishikawa, Keita Mori, Mototsugu Kato

    Annals of internal medicine   174 ( 1 )   18 - 24   2021年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: Linked color imaging (LCI) is a new image-enhanced endoscopy technique that allows users to recognize slight differences in mucosal color. OBJECTIVE: To compare the performance of LCI with white light imaging (WLI) in detecting neoplastic lesions in the upper gastrointestinal tract. DESIGN: A controlled, multicenter trial with randomization using minimization. (University Hospital Medical Information Network Clinical Trials Registry: UMIN000023863). SETTING: 16 university hospitals and 3 tertiary care hospitals in Japan. PATIENTS: 1502 patients with known previous or current cancer of the gastrointestinal tract and undergoing surveillance for gastrointestinal cancer. INTERVENTION: WLI followed by LCI examination (WLI group) or LCI followed by WLI examination (LCI group). MEASUREMENTS: Diagnosis of 1 or more neoplastic lesions in the pharynx, esophagus, or stomach in the first examination (primary outcome) and 1 or more neoplastic lesions overlooked in the first examination (secondary outcome). RESULTS: 752 patients were assigned to the WLI group and 750 to the LCI group. The percentage of patients with 1 or more neoplastic lesions diagnosed in the first examination was higher with LCI than with WLI (60 of 750 patients or 8.0% [95% CI, 6.2% to 10.2%] vs. 36 of 752 patients or 4.8% [CI, 3.4% to 6.6%]; risk ratio, 1.67 [CI, 1.12 to 2.50; P = 0.011]). The proportion with overlooked neoplasms was lower in the LCI group than in the WLI group (5 of 750 patients or 0.67% [CI, 0.2% to 1.6%] vs. 26 of 752 patients or 3.5% [CI, 2.3% to 5.0%]; risk ratio, 0.19 [CI, 0.07 to 0.50]). LIMITATION: Endoscopists were not blinded. CONCLUSION: LCI is more effective than WLI for detecting neoplastic lesions in the pharynx, esophagus, and stomach. PRIMARY FUNDING SOURCE: Fujifilm Corporation.

    DOI: 10.7326/M19-2561

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  • Continued Aspirin Treatment May Be a Risk Factor of Delayed Bleeding after Gastric Endoscopic Submucosal Dissection under Heparin Replacement: A Retrospective Multicenter Study.

    Kenta Hamada, Hiromitsu Kanzaki, Masafumi Inoue, Shuhei Ishiyama, Kenji Yamauchi, Koji Miyahara, Tatsuya Toyokawa, Takao Tsuzuki, Jiro Miyaike, Minoru Matsubara, Sakuma Takahashi, Mamoru Nishimura, Ryuta Takenaka, Naoko Yunoki, Shinichiro Hori, Sayo Kobayashi, Yasushi Yamasaki, Yoshiro Kawahara, Hideki Ishikawa, Hiroyuki Okada

    Internal medicine (Tokyo, Japan)   59 ( 21 )   2643 - 2651   2020年11月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Objective Gastric endoscopic submucosal dissection (ESD) under heparin replacement (HR) of warfarin reportedly has a high risk of delayed bleeding (24-57%). It is possible that the delayed bleeding risk may have changed over the years. We evaluated the current risk of delayed bleeding after gastric ESD under HR of anticoagulant agents. Methods We retrospectively reviewed the delayed bleeding rate and analyzed the risk factors for delayed bleeding. Patients Consecutive patients who underwent gastric ESD under HR of anticoagulant agents from July 2015 to June 2017. Results A total of 32 patients with a solitary early gastric cancer and taking anticoagulant agents were analyzed, including 24 patients on warfarin (the warfarin group) and 8 patients on direct oral anticoagulants (the DOAC group). Three (9.4%) patients experienced delayed bleeding: three (12.5%) patients in the warfarin group and no patients in the DOAC group. Continued aspirin treatment was identified to be a risk factor of delayed bleeding (p=0.01). Conclusion Careful management may be required for patients undergoing gastric ESD under continued aspirin treatment in addition to HR of anticoagulant agents; although the delayed bleeding risk after gastric ESD under HR of anticoagulant agents might have decreased over the years.

    DOI: 10.2169/internalmedicine.4998-20

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  • 腹部内臓動脈瘤に対する血管内治療に際して発症した十二指腸潰瘍の2例

    河井 裕介, 岩室 雅也, 岡上 昇太郎, 里見 拓也, 濱田 健太, 安部 真, 榮 浩行, 河野 吉泰, 山崎 泰史, 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   114回   73 - 73   2020年11月

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    記述言語:日本語   出版者・発行元:日本消化器病学会-中国支部  

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  • Near-focus magnification and second-generation narrow-band imaging for early gastric cancer in a randomized trial.

    Naomi Kakushima, Naohiro Yoshida, Hisashi Doyama, Tomonori Yano, Takahiro Horimatsu, Noriya Uedo, Yoshinobu Yamamoto, Hiromitsu Kanzaki, Shinichiro Hori, Kenshi Yao, Ichiro Oda, Satoshi Tanabe, Chizu Yokoi, Ken Ohata, Kenichi Yoshimura, Hideki Ishikawa, Manabu Muto

    Journal of gastroenterology   2020年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: Magnifying endoscopy with narrow-band imaging (NBI) is effective for the diagnosis of early gastric cancer (EGC). However, magnifying endoscopy is not yet popular globally because of the required level of skill and lack of availability. To overcome these problems, dual-focus endoscopy (standard- and near-focus (NF) modes) has been developed. In this study, we evaluated the diagnostic performance of NF with second-generation (2G)-NBI (NF-NBI) for the diagnosis of EGC. METHODS: This was a secondary analysis of a multicenter randomized controlled trial of 4523 high-risk patients who underwent gastroscopies at 13 institutions in Japan. Patients were randomly assigned to white-light imaging (WLI) followed by 2G-NBI or to 2G-NBI followed by WLI. Lesions suspicious for EGC, newly detected by non-magnifying WLI or 2G-NBI, were subsequently observed with NF-NBI. All detected lesions were biopsied or resected. The diagnostic performance of NF-NBI was compared with the final histology. RESULTS: A total of 870 detected lesions (145 EGC, 725 non-EGC) were analyzed. Overall diagnostic performance for EGC using NF-NBI was accuracy 87.7%, sensitivity 60.7%, specificity 93.1%, positive predictive value 63.8%, and negative predictive value 92.2%. There were no significant differences in diagnostic performance between lesions detected by WLI or 2G-NBI. For lesions diagnosed with high (333 lesions) and low (537 lesions) confidences, accuracy was 92.2% and 84.9%, sensitivity was 64.7% and 58.5%, and specificity was 90.5% and 88.8%, respectively. CONCLUSION: The diagnostic performance of NF-NBI is good and acceptable for diagnosis of EGC in combination with either WLI or 2G-NBI.

    DOI: 10.1007/s00535-020-01734-3

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  • 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年10月

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    記述言語:日本語   出版者・発行元:(一社)日本消化器内視鏡学会  

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  • Nivolumab-induced IgA nephropathy in a patient with advanced gastric cancer: A case report. 査読 国際誌

    Katsuyuki Tanabe, Hiromitsu Kanzaki, Takahira Wada, Yuri Nakashima, Hitoshi Sugiyama, Hiroyuki Okada, Jun Wada

    Medicine   99 ( 21 )   e20464   2020年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    INTRODUCTION: Immune checkpoint inhibitors including nivolumab, an antibody against programmed death-1, have been increasingly introduced in various cancer treatment regimens, and are reported to be associated with immune-related adverse events. Nivolumab-induced renal injury is generally caused by acute interstitial nephritis and is managed by drug discontinuation and steroid therapy. Although this agent can infrequently induce glomerulonephritis, the pathogenesis and therapeutic strategy remain undetermined. PATIENT CONCERNS: A 78-year-old man was diagnosed with advanced gastric cancer with portal thrombosis. First- and second-line chemotherapies were ineffective; thus, nivolumab monotherapy was initiated. Although it effectively prevented tumor growth, proteinuria and microhematuria appeared 2 months later. Despite drug discontinuation, serum creatinine progressively increased from 0.72 to 1.45 mg/dL. Renal biopsy revealed mesangial IgA and C3 deposition in immunofluorescence analysis and mesangial proliferation with crescent formation in light microscopy. DIAGNOSIS: The patient was diagnosed with IgA nephropathy. Based on the temporal relationship between the nivolumab therapy and abnormal urinalysis, IgA nephropathy was considered to have been induced by nivolumab. INTERVENTIONS: A moderate dose (0.6 mg/kg/day) of prednisolone was orally administrated, with tapering biweekly. OUTCOMES: Steroid therapy stabilized his serum creatinine levels and markedly reduced proteinuria. However, bacterial pneumonia substantially impaired his performance status; thus, nivolumab could not be restarted despite tumor regrowth. LESSONS: IgA nephropathy should be recognized as an uncommon renal adverse event during nivolumab therapy. After drug discontinuation, nivolumab-induced IgA nephropathy is likely to respond to moderate doses of steroid therapy with early tapering. However, more evidence is needed to determine whether nivolumab can be safely restarted during or after steroid therapy.

    DOI: 10.1097/MD.0000000000020464

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  • Early gastric cancer detection in high-risk patients: a multicentre randomised controlled trial on the effect of second-generation narrow band imaging. 国際誌

    Naohiro Yoshida, Hisashi Doyama, Tomonori Yano, Takahiro Horimatsu, Noriya Uedo, Yoshinobu Yamamoto, Naomi Kakushima, Hiromitsu Kanzaki, Shinichiro Hori, Kenshi Yao, Ichiro Oda, Chikatoshi Katada, Chizu Yokoi, Ken Ohata, Kenichi Yoshimura, Hideki Ishikawa, Manabu Muto

    Gut   2020年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    OBJECTIVE: Early detection of gastric cancer has been the topic of major efforts in high prevalence areas. Whether advanced imaging methods, such as second-generation narrow band imaging (2G-NBI) can improve early detection, is unknown. DESIGN: This open-label, randomised, controlled tandem trial was conducted in 13 hospitals. Patients at increased risk for gastric cancer were randomly assigned to primary white light imaging (WLI) followed by secondary 2G-NBI (WLI group: n=2258) and primary 2G-NBI followed by secondary WLI (2G-NBI group: n=2265) performed by the same examiner. Suspected early gastric cancer (EGC) lesions in both groups were biopsied. Primary endpoint was the rate of EGC patients in the primary examination. The main secondary endpoint was the positive predictive value (PPV) for EGC in suspicious lesions detected (primary examination). RESULTS: EGCs were found in 44 (1.9%) and 53 (2.3%; p=0.412) patients in the WLI and 2G-NBI groups, respectively, during primary EGD. In a post hoc analysis, the overall rate of lesions detected at the second examination was 25% (n=36/145), with no significant differences between groups. PPV for EGC in suspicious lesions was 13.5% and 20.9% in the WLI (50/371 target lesions) and 2G-NBI groups (59/282 target lesions), respectively (p=0.015). CONCLUSION: The overall sensitivity of primary endoscopy for the detection of EGC in high-risk patients was only 75% and should be improved. 2G-NBI did not increase EGC detection rate over conventional WLI. The impact of a slightly better PPV of 2G-NBI has to be evaluated further. TRIAL REGISTRATION NUMBER: UMIN000014503.

    DOI: 10.1136/gutjnl-2019-319631

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  • The Color Difference between Differentiated Early Gastric Cancer and Suspicious Mucosal Areas on Linked Color Imaging. 査読

    Kanzaki H, Kawahara Y, Okada H

    Digestion   1 - 6   2019年11月

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

    Gotoda T, Kanzaki H, Okamoto Y, Obayashi Y, Baba Y, Hamada K, Sakae H, Abe M, Iwamuro M, Kawano S, Kawahara Y, Okada H

    Gastrointestinal endoscopy   2019年10月

  • The relationship between peripheral neuropathy and efficacy in second-line chemotherapy for unresectable advanced gastric cancer: a prospective observational multicenter study protocol (IVY). 査読

    Tanioka H, Nagasaka T, Uno F, Inoue M, Okita H, Katata Y, Kanzaki H, Kuramochi H, Satake H, Shindo Y, Doi A, Nasu J, Yamashita H, Yamaguchi Y

    BMC cancer   19 ( 1 )   941   2019年10月

  • The clinicopathological differences of sporadic non-ampullary duodenal epithelial neoplasm depending on tumor location. 査読

    Matsueda K, Kanzaki H, Matsueda K, Nasu J, Yoshioka M, Nakagawa M, Inoue M, Inaba T, Imagawa A, Takatani M, Takenaka R, Suzuki S, Tomoda J, Yagi T, Fujiwara T, Tanaka T, Okada H

    Journal of gastroenterology and hepatology   34 ( 9 )   1540 - 1544   2019年9月

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

    Sakae H, Iwamuro M, Okamoto Y, Obayashi Y, Baba Y, Hamada K, Gotoda T, Abe M, Kono Y, Kanzaki H, Kawano S, Kawahara Y, Tanaka T, Yanai H, Okada H

    Digestion   1 - 8   2019年9月

  • Differentiation between duodenal neoplasms and non-neoplasms using magnifying narrow-band imaging - Do we still need biopsies for duodenal lesions? 査読

    Yamasaki Y, Takeuchi Y, Kanesaka T, Kanzaki H, Kato M, Ohmori M, Tonai Y, Hamada K, Matsuura N, Iwatsubo T, Akasaka T, Hanaoka N, Higashino K, Uedo N, Ishihara R, Okada H, Iishi H

    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society   2019年7月

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

    Kono Y, Kanzaki H, Tsuzuki T, Takatani M, Nasu J, Kawai D, Takenaka R, Tanaka T, Iwamuro M, Kawano S, Kawahara Y, Fujiwara T, Okada H

    Journal of gastroenterology   54 ( 5 )   419 - 426   2019年5月

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

    Abe M, Iwamuro M, Kawahara Y, Kanzaki H, Kawano S, Tanaka T, Tsumura M, Makino T, Noda Y, Marunaka H, Nishizaki K, Okada H

    Acta medica Okayama   73 ( 2 )   109 - 115   2019年4月

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

    Iwamuro M, Tanaka T, Nishida K, Kanzaki H, Kawano S, Kawahara Y, Yoshino T, Okada H

    Ecancermedicalscience   13   933   2019年

  • Diffuse redness in linked color imaging is useful for diagnosing current Helicobacter pylori infection in the stomach. 査読

    Iwamuro M, Sakae H, Kanzaki H, Okada H

    Journal of general and family medicine   19 ( 5 )   176 - 177   2018年9月

  • Conventional versus traction-assisted endoscopic submucosal dissection for gastric neoplasms: a multicenter, randomized controlled trial (with video). 査読 国際誌

    Masao Yoshida, Kohei Takizawa, Sho Suzuki, Yoshiki Koike, Satoru Nonaka, Yasushi Yamasaki, Takeyoshi Minagawa, Chiko Sato, Chihiro Takeuchi, Ko Watanabe, Hiromitsu Kanzaki, Hiroyuki Morimoto, Takafumi Yano, Kosuke Sudo, Keita Mori, Takuji Gotoda, Hiroyuki Ono

    Gastrointestinal endoscopy   87 ( 5 )   1231 - 1240   2018年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND AND AIMS: The aim of this study was to clarify whether dental floss clip (DFC) traction improves the technical outcomes of endoscopic submucosal dissection (ESD). METHODS: A superiority, randomized control trial was conducted at 14 institutions across Japan. Patients with single gastric neoplasm meeting the indications of the Japanese guidelines for gastric treatment were enrolled and assigned to receive conventional ESD or DFC traction-assisted ESD (DFC-ESD). Randomization was performed according to a computer-generated random sequence with stratification by institution, tumor location, tumor size, and operator experience. The primary endpoint was ESD procedure time, defined as the time from the start of the submucosal injection to the end of the tumor removal procedure. RESULTS: Between July 2015 and September 2016, 640 patients underwent randomization. Of these, 316 patients who underwent conventional ESD and 319 patients who underwent DFC-ESD were included in our analysis. The mean ESD procedure time was 60.7 and 58.1 minutes for conventional ESD and DFC-ESD, respectively (P = .45). Perforation was less frequent in the DFC-ESD group (2.2% vs .3%, P = .04). For lesions located in the greater curvature of the upper or middle stomach, the mean procedure time was significantly shorter in the DFC-ESD group (104.1 vs 57.2 minutes, P = .01). CONCLUSIONS: Our findings suggest that DFC-ESD does not result in shorter procedure time in the overall patient population, but it can reduce the risk of perforation. When selectively applied to lesions located in the greater curvature of the upper or middle stomach, DFC-ESD provides a remarkable reduction in procedure time.

    DOI: 10.1016/j.gie.2017.11.031

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  • Current status and feasibility of endoscopic full-thickness resection in Japan: Results of a questionnaire survey 査読

    Yorimasa Yamamoto, Noriya Uedo, Nobutsugu Abe, Hirohito Mori, Haruo Ikeda, Hiromitsu Kanzaki, Kingo Hirasawa, Naohiro Yoshida, Osamu Goto, Shuko Morita, Pinghong Zhou

    Digestive Endoscopy   30   2 - 6   2018年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Blackwell Publishing  

    DOI: 10.1111/den.13045

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  • Postoperative bleeding risk after gastric endoscopic submucosal dissection during antithrombotic drug therapy 査読

    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 (Australia)   33 ( 2 )   453 - 460   2018年2月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Blackwell Publishing  

    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

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  • Clinical outcome of patients with obscure gastrointestinal bleeding during antithrombotic drug therapy 査読

    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年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:SAGE Publications Ltd  

    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

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  • Esophageal granular cell tumors can be differentiated from leiomyomas using endoscopic ultrasonography 査読

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

    Internal Medicine   57 ( 11 )   1509 - 1515   2018年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Japanese Society of Internal Medicine  

    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.

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  • Underwater endoclip closure after endoscopic resection for duodenal adenomas 査読

    Yasushi Yamasaki, Hiromitsu Kanzaki, Yoshiro Kawahara, Hiroyuki Okada

    Annals of Gastroenterology   31 ( 1 )   121   2018年

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    記述言語:英語   出版者・発行元:Hellenic Society of Gastroenterology  

    DOI: 10.20524/aog.2017.0202

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  • Two cases of white globe appearance in non-cancerous stomach. 査読

    Iwamuro M, Tanaka T, Sakae H, Yamasaki Y, Kanzaki H, Kawano S, Kawahara Y, Okada H

    Ecancermedicalscience   12   856   2018年

  • Two Cases of White Globe Appearance in Autoimmune Atrophic Gastritis. 査読

    Iwamuro M, Tanaka T, Kanzaki H, Kawano S, Kawahara Y, Okada H

    Case reports in gastrointestinal medicine   2018   7091520   2018年

  • The characteristics and outcomes of small bowel adenocarcinoma: a multicentre retrospective observational study 査読

    Hiroyuki Sakae, Hiromitsu Kanzaki, Junichiro Nasu, Yutaka Akimoto, Kazuhiro Matsueda, Masao Yoshioka, Masahiro Nakagawa, Shinichiro Hori, Masafumi Inoue, Tomoki Inaba, Atsushi Imagawa, Masahiro Takatani, Ryuta Takenaka, Seiyu Suzuki, Toshiyoshi Fujiwara, Hiroyuki Okada

    BRITISH JOURNAL OF CANCER   117 ( 11 )   1607 - 1613   2017年11月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:NATURE PUBLISHING GROUP  

    Background: Small bowel adenocarcinoma (SBA) is a rare malignancy that accounts for 1-2% of gastrointestinal tumours. We investigated the clinical characteristics, outcomes, and prognostic factors of primary SBA.
    Methods: We retrospectively analysed the characteristics and clinical courses of 205 SBA patients from 11 institutions in Japan between June 2002 and August 2013.
    Results: The primary tumour was in the duodenum and jejunum/ileum in 149 (72.7%) and 56 (27.3%) patients, respectively. Sixty-four patients (43.0%) with duodenal adenocarcinoma were asymptomatic and most cases were detected by oesophagogastroduodenoscopy (EGD), which was not specifically performed for the detection or surveillance of duodenal tumours. In contrast, 47 patients (83.9%) with jejunoileal carcinoma were symptomatic. The 3-year survival rate for stage 0/I, II, III, and IV cancers was 93.4%, 73.1%, 50.9%, and 15.1%, respectively. Multivariate analysis revealed performance status 3-4, high carcinoembryonic antigen, high lactate dehydrogenase (LDH), low albumin, symptomatic at diagnosis, and stage III/IV disease were independent factors for overall survival (OS). Ten patients (18.5%) with stage IV disease were treated with a combination of resection of primary tumour, local treatment of metastasis, and chemotherapy; this group had a median OS of 36.9 months.
    Conclusions: Although most SBA patients were diagnosed with symptomatic, advanced stage disease, some patients with duodenal carcinoma were detected in early stage by EGD. High LDH and symptomatic at diagnosis were identified as novel independent prognostic factors for OS. The prognosis of advanced SBA was poor, but combined modality therapy with local treatment of metastasis might prolong patient survival.

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  • Linked color imaging (LCI), a novel image-enhanced endoscopy technology, emphasizes the color of early gastric cancer. 査読

    Kanzaki H, Takenaka R, Kawahara Y, Kawai D, Obayashi Y, Baba Y, Sakae H, Gotoda T, Kono Y, Miura K, Iwamuro M, Kawano S, Tanaka T, Okada H

    Endoscopy international open   5 ( 10 )   E1005 - E1013   2017年10月

  • Deterioration of duodenal lymphangiectasia after radiotherapy for gastric malt lymphoma 査読

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

    ecancermedicalscience   11   752   2017年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Cancer Intelligence  

    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

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  • Evaluation of the bleeding risk with various antithrombotic therapies after gastric endoscopic submucosal dissection. 査読

    Gotoda T, Hori K, Iwamuro M, Kono Y, Miura K, Kanzaki H, Kawano S, Kawahara Y, Okada H

    Endoscopy international open   5 ( 7 )   E653 - E662   2017年7月

  • Management of early gastric cancer that meet the indication for radical lymph node dissection following endoscopic resection: a retrospective cohort analysis 査読

    Satoru Kikuchi, Shinji Kuroda, Masahiko Nishizaki, Tetsuya Kagawa, Hiromitsu Kanzaki, Yoshiro Kawahara, Shunsuke Kagawa, Takehiro Tanaka, Hiroyuki Okada, Toshiyoshi Fujiwara

    BMC SURGERY   17 ( 1 )   72   2017年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:BIOMED CENTRAL LTD  

    Background: Endoscopic resection (ER) has been widely accepted as the standard treatment for early gastric cancer (EGC). However, in patients considered to have undergone non-curative ER due to their potential risk of lymph node metastasis (LNM), additional gastrectomy is recommended. The aim of the present study was to identify EGC patients after non-curative ER at high risk of LNM.
    Methods: A total of 150 patients who had undergone ER for EGC were diagnosed as non-curative ER due to their potential risk of LNM. Clinicopathological data and clinical outcomes were examined retrospectively.
    Results: Additional gastrectomy with lymph node dissection was performed in 73 patients, and the remaining 77 patients were followed-up without additional gastrectomy. In patients who underwent additional gastrectomy, 8 patients had local residual tumor, and 8 patients had LNM, which were limited in the peritumoral nodes. Only lymphatic invasion (p = 0.012) was a statistically significant factor for LNM. The 5-year overall survival and recurrence-free survival were not significantly different between patients with and without additional gastrectomy.
    Conclusion: Additional gastrectomy with lymph node dissection is recommended for patients who were diagnosed as non-curative ER with lymphatic invasion, and minimizing the extent of lymph node dissection may be allowed for these patients.

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  • Multicenter Prospective Study on the Safety of Upper Gastrointestinal Endoscopic Procedures in Antithrombotic Drug Users 査読

    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年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:SPRINGER  

    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.
    To evaluate the safety of upper gastrointestinal endoscopic procedures in antithrombotic drug users.
    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.
    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.
    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.

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  • Pseudomelanosis duodeni: A case report 査読

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

    Journal of Japanese Society of Gastroenterology   114 ( 7 )   1264 - 1268   2017年

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Japanese Society of Gastroenterology  

    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

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  • Investigation of mucosal pattern of gastric antrum using magnifying narrow-band imaging in patients with chronic atrophic fundic gastritis 査読

    Yasushi Yamasaki, Noriya Uedo, Hiromitsu Kanzaki, Minoru Kato, Kenta Hamada, Kenji Aoi, Yusuke Tonai, Noriko Matsuura, Takashi Kanesaka, Takeshi Yamashina, Tomofumi Akasaka, Noboru Hanaoka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara, Yasuhiko Tomita, Hiroyasu Iishi

    Annals of Gastroenterology   30 ( 3 )   302 - 308   2017年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Hellenic Society of Gastroenterology  

    Background Magnifying narrow-band imaging (M-NBI) can reportedly help predict the presence and distribution of atrophy and intestinal metaplasia in the gastric corpus. However, the micro-mucosal pattern of the antrum shown by M-NBI differs from that of the corpus. We studied the distribution and histology of the micro-mucosal pattern in the antrum based on magnifying endoscopy. Methods Endoscopic images of the greater curvature of the antrum were evaluated in 50 patients with chronic atrophic fundic gastritis (CAFG). The extent of CAFG was evaluated by autofluorescence imaging. The micro-mucosal pattern was evaluated by M-NBI and classified into groove and white villiform types. The localization of white villiform type mucosa was classified into three types in relation to the areae gastricae: null, central, and segmental types. Biopsies were taken from regions showing different micro-mucosal patterns. Associations among the extent of CAFG, micro-mucosal pattern, and histology were examined. Results As the extent of CAFG increased, the proportion of white villiform type mucosa increased, whereas that of groove type mucosa decreased (P=0.022). In patients with extensive CAFG, most of the areae gastricae was composed of the segmental or central type of white villiform type mucosa (P=0.044). The white villiform type mucosa had significantly higher grades of atrophy (P=0.002) and intestinal metaplasia (P&lt
    0.001) than did the groove type mucosa. Conclusion White villiform type mucosa is indicative of atrophy and intestinal metaplasia in the gastric antrum. It extends to the whole or central part of the areae gastricae as CAFG becomes more extensive.

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  • Impact of early tumor reduction on outcome differs by histological subtype in stage III non-small-cell lung cancer treated with definitive radiotherapy 査読

    Hiromitsu Kanzaki, Masaaki Kataoka, Atsushi Nishikawa, Kotaro Uwatsu, Kei Nagasaki, Noriko Nishijima, Takashi Ochi, Teruhito Mochizuki

    International Journal of Clinical Oncology   21 ( 5 )   853 - 861   2016年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Springer Tokyo  

    Background: We retrospectively investigated the impact on survival of early tumor reduction during definitive radiotherapy for inoperable stage III non-small cell lung cancer (NSCLC) patients, according to their histological subtypes. Methods: Between November 2006 and December 2012, 152 consecutive patients with inoperable stage III NSCLC who underwent definitive radiotherapy were reviewed retrospectively. Forty-one patients were excluded for not satisfying the inclusion criteria. Forty-five (40.5 %) and 48 (43.2 %) patients were diagnosed with squamous cell carcinoma (SQC) and adenocarcinoma (ADC), respectively. The tumor reduction rate (TRR) was defined as follows: TRR = 1−[gross tumor volume (GTV) on computed tomography at shrinking irradiation field planning]/(GTV on computed tomography at the initial treatment planning). The Cox proportional hazard model was used to identify significant prognostic factors for overall survival (OS) and progression-free survival (PFS). Results: We evaluated 111 patients, with a median follow-up time of 52.2 months in surviving patients. The median TRR was 45.9 %. In all patients, there were significant associations between TRR and PFS (P = 0.036) on multivariate analysis, although TRR had no correlation with OS (P = 0.141). With respect to histological subtype, multivariate analyses revealed that a higher TRR showed significant associations with better OS and PFS in the SQC group (P = 0.013 and 0.040, respectively). In contrast, a higher TRR was associated with poorer OS in the ADC group (P = 0.030)
    there was no association between TRR and PFS. Conclusion: We found that a higher TRR is a promising prognostic factor for better survival and disease control in SQC patients.

    DOI: 10.1007/s10147-016-0982-0

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  • Propofol sedation with a target-controlled infusion pump and bispectral index monitoring system in elderly patients during a complex upper endoscopy procedure 査読

    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 - 764   2016年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:MOSBY-ELSEVIER  

    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 mu g/mL [interquartile range (IQR), 1.9-2.3]; group B: median 1.6 mu g/mL [IQR, 1.3-1.8]; and group C: median 1.4 mu g/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.

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  • A White Lesion in the Stomach Localized Gastric Crystal-Storing Histiocytosis 査読

    Masaya Iwamuro, Hiromitsu Kanzaki, Hiroyuki Okada

    GASTROENTEROLOGY   150 ( 1 )   44 - 45   2016年1月

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    記述言語:英語   出版者・発行元:W B SAUNDERS CO-ELSEVIER INC  

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  • Does Helicobacter pylori Exacerbate Gastric Mucosal Injury in Users of Nonsteroidal Anti-Inflammatory Drugs? A Multicenter, Retrospective, Case-Control Study 査読

    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年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:EDITORIAL OFFICE GUT & LIVER  

    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 esophago-gastroduodenoscopy 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 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% Cl, 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. pyloripositivity (OR, 1.8; 95% Cl, 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. (Gut Liver 2016;10:69-75)

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  • 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 査読

    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年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:KARGER  

    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. (C) 2016 S. Karger AG, Basel

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  • Endoscopic Resection of a Pedunculated Brunner's Gland Hamartoma of the Duodenum. 査読

    Iwamuro M, Tanaka T, Ando S, Gotoda T, Kanzaki H, Kawano S, Kawahara Y, Okada H

    Case reports in gastrointestinal medicine   2016   6707235   2016年

  • An alternative option for "resect and discard" strategy, using magnifying narrow-band imaging: a prospective "proof-of-principle" study 査読

    Yoji Takeuchi, Masao Hanafusa, Hiromitsu Kanzaki, Takashi Ohta, Noboru Hanaoka, Sachiko Yamamoto, Koji Higashino, Yasuhiko Tomita, Noriya Uedo, Ryu Ishihara, Hiroyasu Iishi

    JOURNAL OF GASTROENTEROLOGY   50 ( 10 )   1017 - 1026   2015年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:SPRINGER JAPAN KK  

    The "resect and discard" strategy is beneficial for cost savings on screening and surveillance colonoscopy, but it has the risk to discard lesions with advanced histology or small invasive cancer (small advanced lesion; SALs). The aim of this study was to prove the principle of new "resect and discard" strategy with consideration for SALs using magnifying narrow-band imaging (M-NBI).
    Patients undergoing colonoscopy at a tertiary center were involved in this prospective trial. For each detected polyp < 10 mm, optical diagnosis (OD) and virtual management ("leave in situ", "discard" or "send for pathology") were independently made using non-magnifying NBI (N-NBI) and M-NBI, and next surveillance interval were predicted. Histological and optical diagnosis results of all polyps were compared.
    While the management could be decided in 82 % of polyps smaller than 10 mm, 24/31 (77 %) SALs including two small invasive cancers were not discarded based on OD using M-NBI. The sensitivity [90 % confidence interval (CI)] of M-NBI for SALs was 0.77 (0.61-0.89). The risk for discarding SALs using N-NBI was significantly higher than that using M-NBI (53 vs. 23 %, p = 0.02). The diagnostic accuracy (95 % CI) of M-NBI in distinguishing neoplastic from non-neoplastic lesions [0.88 (0.86-0.90)] was significantly better than that of N-NBI [0.84 (0.82-0.87)] (p = 0.005).
    The results of our study indicated that our "resect and discard" strategy using M-NBI could work to reduce the risk for discarding SALs including small invasive cancer (UMIN-CTR, UMIN000003740).

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  • A target-controlled infusion system with bispectral index monitoring of propofol sedation during endoscopic submucosal dissection. 査読

    Imagawa A, Hata H, Nakatsu M, Matsumi A, Ueta E, Suto K, Terasawa H, Sakae H, Takeuchi K, Fujihara M, Endo H, Yasuhara H, Ishihara S, Kanzaki H, Jinno H, Kamada H, Kaji E, Moriya A, Ando M

    Endoscopy international open   3 ( 1 )   E2 - 6   2015年2月

  • An Effective and Safe Sedation Technique Combining Target-Controlled Infusion Pump with Propofol, Intravenous Pentazocine, and Bispectral Index Monitoring for Peroral Double-Balloon Endoscopy 査読

    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 - 116   2015年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:KARGER  

    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. (c) 2015 S. Karger AG, Basel

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  • Intramucosal Gastric Mixed Adenoneuroendocrine Carcinoma Completely Resected with Endoscopic Submucosal Dissection 査読

    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   54 ( 8 )   917 - 920   2015年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPAN SOC INTERNAL MEDICINE  

    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.

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  • Prompt Resolution of Hypoglycemia by Hepatic Transarterial Embolization for Malignant Insulinoma with Multiple Liver Metastases 査読

    Shinichiro Muro, Junichiro Nasu, Ryo Harada, Minoru Matsubara, Asuka Nakarai, Hiromitsu Kanzaki, Kouichiro Tsutsumi, Hironari Kato, Takehiro Tanaka, Hiroyasu Fujiwara, Masatoshi Uno, Hiroyuki Okada, Kazuhide Yamamoto

    ACTA MEDICA OKAYAMA   68 ( 5 )   307 - 311   2014年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:OKAYAMA UNIV MED SCHOOL  

    A 45-year-old female who presented with loss of consciousness and a cold sweat was found to have a pancreatic tumor and multiple liver metastases. Laboratory studies showed marked hypoglycemia and inappropriately elevated serum insulin, C-peptide, and serum tumor markers. Fine needle aspiration revealed Grade 3 small-cell type primary pancreatic neuroendocrine carcinoma. Consequently, the diagnosis of malignant insulinoma was made. Transarterial embolization (TAE) for hepatic metastases resulted in the reduction of tumor volume and prompt resolution of hypoglycemic attacks, whereas diazoxide and systemic chemotherapy had been ineffective for controlling blood glucose levels, and octreotide was unavailable due to the allergic effect. This case report highlights the potential usefulness of TAE for malignant insulinomas in the management of hypoglycemia.

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  • Endoscopic optical diagnosis provides high diagnostic accuracy of esophageal squamous cell carcinoma 査読

    Kengo Nagai, Ryu Ishihara, Shingo Ishiguro, Takashi Ohta, Hiromitsu Kanzaki, Takeshi Yamashina, Kenji Aoi, Noriko Matsuura, Takashi Ito, Mototsugu Fujii, Sachiko Yamamoto, Noboru Hanaoka, Yoji Takeuchi, Koji Higashino, Noriya Uedo, Hiroyasu Iishi, Masaharu Tatsuta, Yasuhiko Tomita, Takashi Matsunaga

    BMC GASTROENTEROLOGY   14   141   2014年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:BIOMED CENTRAL LTD  

    Background: Recent technological advances have stimulated the development of endoscopic optical biopsy technologies. This study compared the accuracy of endoscopic diagnosis using magnifying narrow-band imaging (NBI) and histologic diagnosis of esophageal squamous lesions.
    Methods: Patients at high risk for esophageal squamous cell carcinoma were examined with endoscopy and subsequent biopsy. The lesions diagnosed as cancer on NBI and the lesions diagnosed as cancer on biopsy were resected endoscopically or surgically. Histological diagnoses of resected specimens, the reference standards in this study, were made by a pathologist who was blind to both the endoscopic and biopsy diagnoses. The primary outcome was the accuracy of endoscopic and biopsy diagnosis. A noninferiority trial design with a noninferiority margin of -10% was chosen to investigate the accuracy of endoscopic diagnosis using magnifying NBI.
    Results: Between November 2010 and October 2012, a total of 111 lesions in 85 patients were included in the analysis. The accuracy of endoscopic diagnosis and biopsy diagnosis for all lesions was 91.0% (101/111) and 85.6% (95/111), respectively. The difference in diagnostic accuracy was 5.4% (95% confidence interval: -2.9%-13.7%). The accuracy of endoscopic diagnosis and biopsy diagnosis of invasive cancers was 94.9% (74/78) and 84.6% (66/78), respectively. The difference was 10.3% (95% confidence interval: 1.6%-19.0%) for invasive cancers. The lower bound of the 95% confidence interval was above the prestated -10% in both cases.
    Conclusion: Noninferiority of endoscopic diagnosis by magnifying NBI to histologic diagnosis by biopsy was established in this study (p = 0.0001).

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  • Proposal of a new 'resect and discard' strategy using magnifying narrow band imaging: Pilot study of diagnostic accuracy 査読

    Yoji Takeuchi, Masao Hanafusa, Hiromitsu Kanzaki, Takashi Ohta, Noboru Hanaoka

    DIGESTIVE ENDOSCOPY   26   90 - 97   2014年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:WILEY-BLACKWELL  

    Background and Aim
    A 'resect and discard' strategy using non-magnifying narrow band imaging (N-NBI) has been proposed for reducing screening colonoscopy costs, but it does not take into consideration advanced histology and magnifying NBI (M-NBI) that can potentially further improve the 'resect and discard' strategy. We conducted a pilot study to investigate the feasibility of M-NBI for the new 'resect and discard' strategy with consideration for advanced histology.
    Methods
    The present study involved 63 patients. For each polyp, optical diagnosis was independently made using N-NBI and M-NBI, a decision (discard or send for pathology) was made based on the M-NBI findings, and histological and optical diagnosis results were compared.
    Results
    Sensitivity, specificity and accuracy (95% confidence interval) of M-NBI for lesions with advanced histology were 1.00 (0.36-1.00), 0.92 (0.91-0.92) and 0.92 (0.90-0.92), respectively. Whereas the management of 86% of small polyps could be decided without formal histopathology, lesions with advanced histology were not discarded using M-NBI. The diagnostic accuracy of M-NBI in distinguishing neoplastic from non-neoplastic lesions was higher than that of N-NBI.
    Conclusions
    We propose a new resect and discard strategy with advanced histology using M-NBI that is a promising strategy to reduce the costs of histopathology and to minimize the risk of discarding important lesions.

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  • A case of fulminant liver failure associated with hepatitis C virus 査読

    Hiromitsu Kanzaki, Akinobu Takaki, Takahito Yagi, Fusao Ikeda, Tetsuya Yasunaka, Kazuko Koike, Yasuhiro Miyake, Yoshiaki Iwasaki, Kazuhiro Nouso, Hiroshi Sadamori, Susumu Shinoura, Yuzo Umeda, Ryuichi Yoshida, Masashi Utusmi, Toshiyoshi Fujiwara, Kazuhide Yamamoto

    Clinical Journal of Gastroenterology   7 ( 2 )   170 - 174   2014年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Springer-Verlag Tokyo  

    Fulminant hepatitis due to acute hepatitis C virus (HCV) infection is rarely observed. We present a case study of a 21-year-old male patient who developed HCV-associated fulminant hepatitis after receiving steroid pulse therapy for optic neuritis. Despite daily plasmapheresis, the disease progressed to irreversible liver failure with grade 3 hepatic encephalopathy by the 6th day after symptom onset. The patient received a liver transplant on the 8th day. Serum anti-HCV antibody was negative at that time, but became positive on the 12th day. Positive HCV RNA in the serum at admission was reported after transplantation. Positive changes in anti-HCV antibodies and acute hepatitis with massive necrosis in the histology of the explanted liver indicated fulminant hepatitis due to acute HCV infection. Because of severe hepatitis recurrence, he started 12 months of interferon therapy on the 48th day, and obtained sustained virological response. His anti-HCV antibodies became negative again by 1.5 years after cessation of therapy. HCV genomes recovered from the patient's serum on the 7th and 48th days revealed 2 different clones out of 20 clones with 30 % amino acid difference in hypervariable region 1 of HCV second envelope glycoprotein. One of the 2 clones expanded further after liver transplantation. We conclude that early diagnosis of HCV-associated fulminant hepatitis requires the detection of HCV RNA in the serum. Severe hepatitis recurrence after liver transplantation might occur in patients with fulminant hepatitis due to HCV because of its monoclonal expansion. © 2014 Springer.

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  • Clinical outcomes of endoscopic mucosal resection and endoscopic submucosal dissection as a transoral treatment for superficial pharyngeal cancer 査読

    Noboru Hanaoka, Ryu Ishihara, Yoji Takeuchi, Motoyuki Suzuki, Hirokazu Uemura, Takashi Fujii, Kunitoshi Yoshino, Noriya Uedo, Koji Higashino, Takashi Ohta, Hiromitsu Kanzaki, Masao Hanafusa, Kengo Nagai, Fumi Matsui, Hiroyasu Iishi, Masaharu Tatsuta, Yasuhiko Tomita

    HEAD AND NECK-JOURNAL FOR THE SCIENCES AND SPECIALTIES OF THE HEAD AND NECK   35 ( 9 )   1248 - 1254   2013年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:WILEY-BLACKWELL  

    Background. Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have been introduced for the treatment of superficial pharyngeal cancer.
    Methods. Sixty superficial pharyngeal cancers in 45 patients were treated by EMR or ESD. Resectability and curability, complications, and survival were analyzed retrospectively.
    Results. The en bloc resection and curative resection rate were higher with ESD (100; 81.6%) than with EMR (59; 50%). In subgroup analysis with regard to tumor size <= 10 mm, both resection rates were comparative. All the patients had preserved larynx and swallowing, speech, and airway function. Two of the 45 patients died of other diseases, local recurrence was observed in 4 of 18 patients with noncurative resection with a median observation period of 38 months. No recurrence was observed in patients with curative resection.
    Conclusions. ESD or EMR for superficial pharyngeal cancer is minimally invasive treatment and lesions larger than 10 mm should be referred for ESD. (C) 2012 Wiley Periodicals, Inc. Head Neck 35: 1248-1254, 2013

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  • Randomized Study of Two Endo-knives for Endoscopic Submucosal Dissection of Esophageal Cancer 査読

    Hiromitsu Kanzaki, Ryu Ishihara, Takashi Ohta, Kengo Nagai, Fumi Matsui, Takeshi Yamashina, Masao Hanafusa, Sachiko Yamamoto, Noboru Hanaoka, Yoji Takeuchi, Koji Higashino, Noriya Uedo, Hiroyasu Iishi, Masaharu Tatsuta

    AMERICAN JOURNAL OF GASTROENTEROLOGY   108 ( 8 )   1293 - 1298   2013年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:NATURE PUBLISHING GROUP  

    OBJECTIVES: Settings for endoscopic submucosal dissection (ESD) of esophageal cancer have not been standardized, and no studies have directly compared ESD devices in humans.
    METHODS: We conducted a randomized study to compare the performances of two different endo-knives, the Flush knife and Mucosectom, for esophageal ESD in 48 lesions. All procedures were initiated by two endoscopists, who were assisted by senior endoscopists with verbal advice. In the Flush-knife group, mucosal incision with a 2-mm Flush knife was followed by submucosal dissection using a 1-mm Flush knife. In the Mucosectom group, mucosal incision with a 2-mm Flush knife was followed by submucosal dissection with a Mucosectom. The primary outcome variable was the procedure time required for submucosal dissection. The secondary outcome variables were total procedure time, self-completion rates, and adverse events.
    RESULTS: Total procedure time in the Mucosectom group was significantly shorter than in the Flush-knife group (57 +/- 21 vs. 83 +/- 27 min, respectively; P < 0.001). The submucosal-dissection time in the Mucosectom group was significantly shorter than in the Flush-knife group (40 +/- 18 vs. 61 +/- 23 min, respectively; P < 0.001). The self-completion rate in the Mucosectom group was slightly higher than in the Flush-knife group, but the difference was not signifi cant (91.7 % vs. 75 %, respectively; P = 0.25). One perforation and one postoperative bleeding occurred in the Flush-knife group, both of which were treated successfully by endoscopic treatment.
    CONCLUSIONS: The Mucosectom reduced the procedure and submucosal-dissection times of esophageal ESD, without increasing adverse events.

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  • Pink-color sign in esophageal squamous neoplasia, and speculation regarding the underlying mechanism 査読

    Ryu Ishihara, Hiromitsu Kanzaki, Hiroyasu Iishi, Kengo Nagai, Fumi Matsui, Takeshi Yamashina, Noriko Matsuura, Takashi Ito, Mototsugu Fujii, Sachiko Yamamoto, Noboru Hanaoka, Yoji Takeuchi, Koji Higashino, Noriya Uedo, Masaharu Tatsuta, Yasuhiko Tomita, Shingo Ishiguro

    WORLD JOURNAL OF GASTROENTEROLOGY   19 ( 27 )   4300 - 4308   2013年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:BAISHIDENG PUBL GRP CO LTD  

    AIM: To investigate the reasons for the occurrence of the pink-color sign of iodine-unstained lesions.
    METHODS: In chromoendoscopy, the pink-color sign of iodine-unstained lesions is recognized as useful for the diagnosis of esophageal squamous cell carcinoma. Patients with superficial esophageal neoplasms treated by endoscopic resection were included in the study. Areas of mucosa with and without the pink-color sign were evaluated histologically. The following histologic features that were possibly associated with the pink-color sign were evaluated. The keratinous layer and basal cell layer were classified as present or absent. Cellular atypia was classified as high grade, moderate grade or low grade, based on nuclear irregularity, mitotic figures, loss of polarity, chromatin pattern and nuclear/cytoplasmic ratio. Vascular change was assessed based on dilatation, tortuosity, caliber change and variability in shape. Vessels with these four findings were classified as positive for vascular change. Endoscopic images of the lesions were captured immediately after iodine staining, 2-3 min after iodine staining and after complete fading of iodine staining. Quantitative analysis of color changes after iodine staining was also performed.
    RESULTS: A total of 61 superficial esophageal neoplasms in 54 patients were included in the study. The lesions were located in the cervical esophagus in one case, the upper thoracic esophagus in 10 cases, the mid-thoracic esophagus in 33 cases, and the lower thoracic esophagus in 17 cases. The median diameter of the lesions was 20 mm (range: 2-74 mm). Of the 61 lesions, 28 were classified as pink-color sign positive and 33 as pink-color sign negative. The histologic diagnosis was high-grade intraepithelial neoplasia (HGIN) or cancer invading into the lamina propria in 26 of the 28 pink-color sign positive lesions. There was a significant association between pink-color sign positive epithelium and HGIN or invasive cancer (P = 0.0001). Univariate analyses found that absence of the keratinous layer and cellular atypia were significantly associated with the pink-color sign. After Bonferroni correction, there were no significant associations between the pink-color sign and presence of the basal membrane or vascular change. Multivariate analyses found that only absence of the keratinous layer was independently associated with the pink-color sign (OR = 58.8, 95%CI: 5.5-632). Quantitative analysis was performed on 10 superficial esophageal neoplasms with both pink-color sign positive and negative areas in 10 patients. Pink-color sign positive mucosa had a lower mean color value in the late phase (pinkish color) than in the early phase (yellowish color), and had similar mean color values in the late and final phases. These findings suggest that pink-color positive mucosa underwent color fading from the color of the iodine (yellow) to the color of the mucosa (pink) within 2-3 min after iodine staining. Pink-color sign negative mucosa had similar mean color values in the late and early phases (yellowish color), and had a lower mean color value in the final phase (pinkish color) than in the late phase. These findings suggest that pink-color sign negative mucosa did not undergo color fading during the 2-3 min after iodine staining, and underwent color fading only after spraying of sodium thiosulfate.
    CONCLUSION: The pink-color sign was associated with absence of the keratinous layer. This sign may be caused by early fading of iodine staining. (c) 2013 Baishideng. All rights reserved.

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  • Histological features responsible for brownish epithelium in squamous neoplasia of the esophagus by narrow band imaging 査読

    Hiromitsu Kanzaki, Ryu Ishihara, Shingo Ishiguro, Kengo Nagai, Fumi Matsui, Takeshi Yamashina, Takashi Ohta, Sachiko Yamamoto, Noboru Hanaoka, Masao Hanafusa, Yoji Takeuchi, Koji Higashino, Noriya Uedo, Hiroyasu Iishi, Yasuhiko Tomita

    Journal of Gastroenterology and Hepatology (Australia)   28 ( 2 )   274 - 278   2013年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Blackwell Publishing  

    Background and Aim: Esophageal squamous neoplasias usually appear brown under narrow band imaging as a result of microvascular proliferation, and brownish color changes in the areas between vessels, referred to as brownish epithelium. However, the reasons for the development of this brownish epithelium and its clinical implications have not been fully investigated. Methods: Patients with superficial esophageal neoplasias treated by endoscopic resection were included in the study. Areas of mucosa with brownish and non-brownish epithelia were evaluated histologically. Results: A total of 68 superficial esophageal neoplasias in 58 patients were included in the analysis. Of the 68 lesions, 32 were classified in the brownish epithelium group, and 36 in the non-brownish epithelium group. Brownish epithelium was significantly associated with a diagnosis of high-grade intraepithelial neoplasia or invasive cancer (P&lt
    0.0001). Thinning of the keratinous layer, thinning of the epithelium, and cellular atypia were significantly associated with brownish epithelium by univariate analysis, and thinning of the keratinous layer and thinning of the epithelium were confirmed to be independent factors by multivariate analysis. The odds ratios were 9.6 (95% confidence interval: 2.0-46.3) for thinning of the keratinous layer, and 4.6 (95% confidence interval: 1.1-19.4) for thinning of the epithelium. Conclusions: Brownish epithelium is an important finding in the diagnosis of esophageal squamous neoplasia, and may be related to thinning of the keratinous layer, caused by neoplastic cell proliferation, and thinning of the epithelium. © 2012 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.

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  • Safety and curative ability of endoscopic submucosal dissection for superficial esophageal cancers at least 50 mm in diameter 査読

    Takeshi Yamashina, Ryu Ishihara, Noriya Uedo, Kengo Nagai, Fumi Matsui, Natsuko Kawada, Takashi Oota, Hiromitsu Kanzaki, Masao Hanafusa, Sachiko Yamamoto, Noboru Hanaoka, Yoji Takeuchi, Koji Higashino, Hiroyasu Iishi

    DIGESTIVE ENDOSCOPY   24 ( 4 )   220 - 225   2012年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:WILEY-BLACKWELL  

    Background and Aim: Limited data are available regarding the use of endoscopic submucosal dissection (ESD) for superficial esophageal cancers =50 mm in diameter. The aim of the present study was to investigate the safety and success of ESD for superficial esophageal cancers =50 mm. Methods: A total of 39 patients with superficial esophageal squamous cell carcinoma =50 mm were treated with ESD at Osaka Medical Center for Cancer and Cardiovascular Diseases between January 2004 and April 2011, and were analyzed in a retrospective study. Results: En bloc resection was achieved in all patients. One mediastinal emphysema without perforation occurred during the procedure. Stricture developed in 11 of 39 patients, requiring a median of five endoscopic balloon dilatation procedures. Thirty-three clinical epithelial or lamina propria mucosal cancers were treated by ESD with curative intent, of which invasion into the muscularis mucosa or deeper was detected in seven and lymphovascular involvement in three. The en bloc resection rate was 100% with a tumor-free margin achieved in 92% of lesions. The curative resection and complication rates during ESD were 70% and 2.5%, respectively. Conclusion: ESD achieved a high en bloc resection rate of 92% with a tumor-free margin. Curative resection rate of ESD in patients with clinical epithelial or lamina propria mucosal cancers was not low at 70%. However, the risk of stricture must be taken into account when considering the use of ESD in lesions =50 mm.

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  • Risk Factors of Chest Pain after Endoscopic Resection of Early Esophageal Cancer 査読

    Takuya Inoue, Ryu Ishihara, Noriya Uedo, Natsuko Kawada, Yoshiki Tsujii, Hiromitsu Kanzaki, Masao Hanahusa, Noboru Hanaoka, Sachiko Yamamoto, Yoji Takeuchi, Koji Higashino, Hiroyasu Iishi, Masaharu Tatsuta

    HEPATO-GASTROENTEROLOGY   59 ( 117 )   1446 - 1449   2012年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:H G E UPDATE MEDICAL PUBLISHING S A  

    Background/Aims: Although endoscopic resection is sometimes associated with chest pain, the risk factors for this complication have not been investigated. Methodology: From January 2003 to December 2007, 241 patients were treated by endoscopic resection and 139 patients who met our criteria were analyzed. The case group was 40 patients who took an analgesic after endoscopic resection because of chest pain. The controls were 79 patients who did not experience chest pain after endoscopic resection. Twenty patients experienced chest pain, but did not take any analgesics. Results: Although, 60 patients (43%) experienced chest pain, this was treatable by a common analgesic. Univariate analysis revealed that female gender had significant association and resection of posterior wall mucosa had marginal association with chest pain and analgesic use. No significant association with chest pain and analgesic use was found for age, resection method, use of acid suppressing drugs, lesion size and site. Logistic-regression analysis showed that significant risk factors for chest pain and analgesic use were female gender (odds ratio 3.45) and resection of posterior wall mucosa (odds ratio 3.13). Conclusions: Female gender and resection of posterior wall mucosa were associated with chest pain and analgesic use after endoscopic resection.

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  • Predicting the effects of chemoradiotherapy for squamous cell carcinoma of the esophagus by induction chemotherapy response assessed by positron emission tomography: toward PET-response-guided selection of chemoradiotherapy or esophagectomy 査読

    Ryu Ishihara, Sachiko Yamamoto, Hiroyasu Iishi, Kengo Nagai, Fumi Matui, Natsuko Kawada, Takashi Ohta, Hiromitsu Kanzaki, Masao Hanafusa, Noboru Hanaoka, Yoji Takeuchi, Koji Higashino, Noriya Uedo, Naotoshi Sugimoto, Yoshifumi Kawaguchi, Kinji Nishiyama, Masaaki Motoori, Masahiko Yano, Takuya Hosoki

    INTERNATIONAL JOURNAL OF CLINICAL ONCOLOGY   17 ( 3 )   225 - 232   2012年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:SPRINGER TOKYO  

    We have developed a treatment protocol for esophageal cancer involving a single course of induction chemotherapy followed by chemoradiotherapy. This study aimed to determine if it was possible to predict the effects of chemoradiotherapy on the basis of the response to induction chemotherapy, assessed by positron emission tomography (PET).
    Sixteen patients with Stage II-IVA esophageal cancer were treated using this protocol from April 2007 to July 2010. Chemotherapy involved a fluorouracil and platinum-based combination regimen. All patients received PET scans before and 12-24 days after the beginning of induction chemotherapy. Associations between the response to induction chemotherapy assessed by PET and the effects of chemoradiotherapy were evaluated.
    Induction chemotherapy followed by chemoradiotherapy resulted in complete response (CR) in 10 of the 16 patients. The reduction in maximum standardized uptake value (SUVmax) was 58 +/- A 12% in patients with CR (n = 10), compared with 14 +/- A 16% in patients without CR (n = 6) (P < 0.0001). Using a cut-off value of 55% for SUVmax reduction rate, eight of 10 cancers with CR and six of six cancers without CR were correctly identified, providing a sensitivity and specificity of 80 and 100%, respectively. The overall 1-year survival rates for patients with an SUVmax reduction rate > 55% (responders) were 100%, compared with 60% for patients with an SUVmax reduction rate a parts per thousand currency sign55% (non-responders), respectively.
    The response to a single course of induction therapy assessed by PET was significantly associated with the effects of chemoradiotherapy.

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  • Factors predicting perforation during endoscopic submucosal dissection for gastric cancer 査読

    Takashi Ohta, Ryu Ishihara, Noriya Uedo, Yoji Takeuchi, Kengo Nagai, Fumi Matsui, Natsuko Kawada, Takeshi Yamashina, Hiromitsu Kanzaki, Masao Hanafusa, Sachiko Yamamoto, Noboru Hanaoka, Koji Higashino, Hiroyasu Iishi

    GASTROINTESTINAL ENDOSCOPY   75 ( 6 )   1159 - 1165   2012年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:MOSBY-ELSEVIER  

    Background: Perforation is a common complication of endoscopic submucosal dissection (ESD), but little is known about the relevant risk factors.
    Objective: To investigate the risk factors for perforation.
    Design: Retrospective study.
    Setting: A cancer referral center.
    Patients: A total of 1795 early gastric tumors in 1500 patients treated by ESD from July 2002 to December 2010 were included in the analysis.
    Main Outcome Measurements: The associations between the incidence of perforation and patient and lesion characteristics were investigated.
    Results: Perforation during ESD occurred in 50 lesions (2.8%). Univariate analysis identified tumor location (upper, middle, or lower stomach), tumor diameter (<= 20 or >20 mm), and treatment period (lesions treated in the first or second period) as predictors of perforation. Multivariate analysis identified tumor location (upper stomach), tumor diameter (>20 mm), and treatment period (first half) as independent risk factors for perforation. The odds ratios were 2.4 (95% CI, 1.3-4.7; P = .006) for lesions in the upper stomach and 1.9 (95% CI, 1.0-3.5; P = .04) for lesions larger than 20 mm. Perforation risks were 5.4% for lesions in the upper stomach and 4.4% for lesions larger than 20 mm. Three patients required emergency surgery, but the rest of the patients were successfully treated with endoscopic clipping. There was no perforation-related mortality.
    Limitations: Single-center, retrospective study design.
    Conclusions: Lesions in the upper stomach and lesions larger than 20 mm were independent risk factors for perforation during ESD. Patients should be made aware of the estimated high risks of these lesions before undergoing ESD. (Gastrointest Endosc 2012;75:1159-65.)

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  • Comprehensive investigation of areae gastricae pattern in gastric corpus using magnifying narrow band imaging endoscopy in patients with chronic atrophic fundic gastritis. 査読

    Kanzaki H, Uedo N, Ishihara R, Nagai K, Matsui F, Ohta T, Hanafusa M, Hanaoka N, Takeuchi Y, Higashino K, Iishi H, Tomita Y, Tatsuta M, Yamamoto K

    Helicobacter   17 ( 3 )   224 - 231   2012年6月

  • Autofluorescence imaging endoscopy for screening of esophageal squamous mucosal high-grade neoplasia: A phase II study 査読

    Ryu Ishihara, Takuya Inoue, Noboru Hanaoka, Yoji Takeuchi, Yoshiki Tsujii, Hiromitsu Kanzaki, Takashi Oota, Masao Hanafusa, Sachiko Yamamoto, Kengo Nagai, Fumi Matsui, Natsuko Kawada, Koji Higashino, Noriya Uedo, Hiroyasu Iishi

    JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   27 ( 1 )   86 - 90   2012年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:WILEY-BLACKWELL  

    Background and Aim: Few prospective studies examining the efficacy of autofluorescence imaging (AFI) screening for esophageal cancer have been reported. This study aimed to investigate the diagnostic value of AFI endoscopy for the screening of squamous mucosal high-grade neoplasia of the esophagus, performed by experienced and less-experienced endoscopists.
    Methods: Patients with a history of esophageal neoplasia or head and neck cancer underwent AEI endoscopic screening, followed by chromoendoscopy using iodine staining as the reference standard. The primary outcome was the sensitivity of API for detecting new squamous mucosa] high-grade neoplasias. The secondary outcome was the positive predictive value (PPV) of AFI.
    Results: Of a total 364 patients who underwent endoscopic examination, 43 new mucosa] high-grade neoplasias were detected. The sensitivities of API in the experienced and less-experienced endoscopist groups were 71% (95% confidence interval [CI]: 55-87%) and 50% (95% CI: 32-68%), respectively. The PPV of API in the experienced and the less-experienced endoscopist groups were 25% (95% CI: 16-34%) and 26% (95% Cl: 15-37%), respectively. The sensitivity of API in lesions 10 mm (31%, 5/16 lesions) was significantly lower than that in lesions > 10 mm (78%. 21/27 lesions) (P= 0.003).
    Conclusions: The sensitivity of AEI for the detection of new squamous mucosal high-grade neoplasias, and its PPV, were both low. Based on these results, a randomized study to compare API with standard techniques is not justified.

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  • Intralesional steroid injection to prevent stricture after endoscopic submucosal dissection for esophageal cancer: A controlled prospective study 査読

    Hanaoka N, Ishihara R, Takeuchi Y, Uedo N, Higashino K, Ohta T, Kanzaki H, Hanafusa M, Nagai K, Matsui F, Iishi H, Tatsuta M, Ito Y

    Endoscopy   44 ( 11 )   1007 - 1011   2012年

  • Conflicting clinical environment about the management of antithrombotic agents during the periendoscopic period in Japan 査読

    Satoshi Ono, Mitsuhiro Fujishiro, Hiromitsu Kanzaki, Noriya Uedo, Chizu Yokoi, Junichi Akiyama, Masaki Sugawara, Ichiro Oda, Shoko Suzuki, Yoshiyuki Fujita, Shunsuke Tsubata, Masaaki Hirano, Masakatsu Fukuzawa, Mikinori Kataoka, Toshiro Kamoshida, Shinji Hirai, Tetsuya Sumiyoshi, Hitoshi Kondo, Yorimasa Yamamoto, Kazuhisa Okada, Yoshinori Morita, Shoko Fujiwara, Shinji Morishita, Masao Matsumoto, Kazuhiko Koike

    JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   26 ( 9 )   1434 - 1440   2011年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:WILEY-BLACKWELL  

    Background and Aims: Although there are guidelines for the management of antithrombotic agents during the periendoscopic period, gaps between various guidelines create a confusing situation in daily clinical practice. The purpose of this study was to examine the current management of antithrombotic agents during the periendoscopic period in Japan.
    Methods: This is a prospective cohort study in 12 high-volume endoscopy centers in Japan. A total of 970 outpatients receiving antithrombotic agents underwent endoscopies (705 esophagogastroduodenoscopies and 265 colonoscopies) with or without invasive procedures. Main outcome measures are adverse events in these patients.
    Results: Need for cessation of antithrombotics before endoscopy was mostly determined by non-gastroenterologists (51%) who are unfamiliar with the Japan Gastroenterological Endoscopy Society (JGES) guideline, although cessation periods after endoscopy for most patients were determined by endoscopists (78%). Consequently, most patients underwent endoscopy without cessation (25%) or after a cessation period of 6-7 days (33%), indicating low permeation of the JGES guideline in Japan. Among 970 patients, two patients experienced major complications that may be related to thromboembolic events or gastrointestinal bleeding (95% confidence interval [CI]: 0-0.7%). One of these patients died due to sudden onset ventricular tachycardia. Invasive procedures, including 40 biopsies and two mucosal resections, were performed in 42 patients without cessation of antithrombotics, and no patients experienced major complications (95% CI: 0-8.4%).
    Conclusions: This study revealed a conflicting clinical environment due to absence of a unified guideline in Japan. Further accumulation of data is mandatory to establish a unified guideline based upon solid evidence.

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  • Significance of each narrow-band imaging finding in diagnosing squamous mucosal high-grade neoplasia of the esophagus. 査読

    Ishihara R, Inoue T, Uedo N, Yamamoto S, Kawada N, Tsujii Y, Kanzaki H, Hanafusa M, Hanaoka N, Takeuchi Y, Higashino K, Iishi H, Tatsuta M, Tomita Y, Ishiguro S

    Journal of gastroenterology and hepatology   25 ( 8 )   1410 - 1415   2010年8月

  • Inflammatory Myoglandular Polyps: A Case Series of Four Patients and Review of the Literature 査読

    Shoji Hirasaki, Hiromitsu Kanzaki, Minoru Matsubara, Seiyuu Suzuki

    GASTROENTEROLOGY RESEARCH AND PRACTICE   2010   984092   2010年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:HINDAWI PUBLISHING CORPORATION  

    Background. Inflammatory myoglandular polyp (IMGP) is a nonneoplastic colorectal polyp. Only a small number of cases have been reported, and the pathogenesis remains unclear. Methods. We analyzed colonoscopy and histologic findings in 4 patients with IMGP. Histologic confirmation of the inflammatory granulation tissue in the lamina propria, proliferation of smooth muscle, and hyperplastic glands with variable cystic changes formed the criteria for the selection of patients. Results. We treated four cases of IMGP and reviewed the literature on this disease. Three cases were located in the sigmoid colon or descending colon. All 4 polyps were identified as red, pedunculated lesions. All 4 cases had no symptoms. In two cases, endoscopic findings of polyps were necessary to be differentiated from juvenile polyps. Conclusions. Pedunculated lesions are the main pattern of IMGP. An analysis of endoscopic and histologic features in IMGP of the colorectum revealed that colonic IMGPs resembled juvenile polyps. On colonoscopy, IMGP should generally be taken into consideration as a differential diagnosis of peduncular polyp.

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  • Clinical features and outcomes of delayed perforation after endoscopic submucosal dissection for early gastric cancer 査読

    Hanaoka N, Uedo N, Ishihara R, Higashino K, Takeuchi Y, Inoue T, Chatani R, Hanafusa M, Tsujii Y, Kanzaki H, Kawada N, Iishi H, Tatsuta M, Tomita Y, Miyashiro I, Yano M

    Endoscopy   42 ( 12 )   1112 - 1115   2010年

  • Composite paraganglioma-ganglioneuroma in the retroperitoneum 査読

    Shoji Hirasaki, Hiromitsu Kanzaki, Masato Okuda, Seiyuu Suzuki, Tetsuji Fukuhara, Toshihito Hanaoka

    WORLD JOURNAL OF SURGICAL ONCOLOGY   7   81   2009年11月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:BIOMED CENTRAL LTD  

    Background: Paragangliomas occur most commonly in head and neck region and much less frequently, they are found in the retroperitoneum. Composite paraganglioma-ganglioneuroma of the retroperitoneum is very rare.
    Case presentation: We present an unusual case of retroperitoneal composite paraganglioma-ganglioneuroma discovered on computed tomography in a 63-year-old female patient. Routine hematological examination and biochemical tests were within normal limits. Plasma adrenaline was 0.042 ng/ml, plasma noradrenaline 0.341 ng/ml, and plasma dopamine <0.01 ng/ml. An abdominal contrast-enhanced CT scan and magnetic resonance imaging revealed a 6.5 cm heterogeneous retroperitoneal mass with a cystic component. The retroperitoneal tumor accumulated (131)I-Metaiodobenzylguanidine ((131)I-MIBG) 48 hours after radioisotope injection. Under the diagnosis of paraganglioma in the retroperitoneum, the patient underwent surgery. The resected tumor (6.5 x 5 x 3 cm) was solid and easily removed en bloc. The cut surface of the tumor and histology revealed two different components in the tumor: paraganglioma centrally and ganglioneuroma on the periphery. She remains disease-free 18 months after surgery.
    Conclusion: This case reminds us that neuroendocrine tumor should be included in the differential diagnosis of a retroperitoneal mass although composite paraganglioma-ganglioneuroma in the retroperitoneum is very rare.

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  • PEDUNCULATED INVERTED HYPERPLASTIC POLYP OF THE SIGMOID COLON TREATED WITH ENDOSCOPIC POLYPECTOMY 査読

    Shoji Hirasaki, Hiromitsu Kanzaki, Seiyuu Suzuki, Atsuko Shirakawa

    DIGESTIVE ENDOSCOPY   21 ( 4 )   275 - 276   2009年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:WILEY-BLACKWELL PUBLISHING, INC  

    A case of inverted hyperplastic polyp of the sigmoid colon is reported. The patient was a 67-year-old woman who visited our hospital for further evaluation of constipation. Colonoscopy revealed a pedunculated polyp with linear central depression, about 12 mm in diameter, in the sigmoid colon. Excluding the polyp, there was no lesion in the colorectum. Endoscopic polypectomy was performed. Histological examination of the specimen revealed a stalked polyp that had scattered goblet cells and elongated tubules with serrated profiles in the superficial portion. The nodules of deep tubules impinged on the muscularis mucosae. Proliferation of fibromuscular tissue was not seen in the polyp. There was no evidence of malignancy. This polyp was diagnosed as an inverted hyperplastic polyp. Pedunculated-type inverted hyperplastic polyp of the colon is rare.

    DOI: 10.1111/j.1443-1661.2009.00906.x

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  • A case of liposarcoma of the ascending colon mesenterium 査読

    Seiyuu Suzuki, Shoji Hirasaki, Eiichiro Yumoto, Hiromichi Yamane, Eiji Matsumoto, Shuji Matsumura, Hiromitsu Kanzaki, Masato Okuda, Atsuko Shirakawa

    Journal of Japanese Society of Gastroenterology   106 ( 9 )   1343 - 1350   2009年9月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)  

    We encountered a rare case of liposarcoma of the ascending colon mesenterium. A 53-year-old man visited our hospital because of a mass, 12 x 8cm in diameter, in the right upper abdomen. On computed tomography (CT), the tumor showed irregular density with a smooth surface and was enhanced irregularly. A part of the tumor protruded into the colon in the upper portion of the ascending colon. The tumor was surgically resected by right hemicolectomy. Histological diagnosis of the tumor was well-differentiated liposarcoma, sclerosing variant. Radiological findings seemed to reflect the pathological findings well.

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  • A case of hepatocellular carcinoma with skin injury of the upper abdominal wall after transcatheter arterial chemoembolization: A case report 査読

    Hiromitsu Kanzaki, Kazuhiro Nouso, Koji Miyahara, Naoko Kajikawa, Sayo Kobayashi, Ichiro Sakakihara, Shota Iwadow, Shuji Uematsu, Ryoichi Okamoto, Kunihiro Shiraga, Motowo Mizuno, Yasuyuki Araki

    Cases Journal   2 ( 9 )   7197   2009年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Introduction: Transcatheter arterial chemoembolization has been widely used to treat advanced hepatocellular carcinoma that cannot be treated by local ablation therapies or surgical resection. The effectiveness of transcatheter arterial chemoembolization in prolonging survival has been well established, and approximately one third of newly discovered hepatocellular carcinoma patients were repeatedly treated by transcatheter arterial chemoembolization in Japan. Various kinds of complications have been reported, and many of which are general complications such as hepatic coma, jaundice, fever-up, ascites, and bile duct injury. The hepatic falciform artery is found frequently during postmortem anatomic dissection and the incidence of hepatic falciform artery is reported to be over 60%. Hepatic falciform artery is known to be the responsible artery for supraumbilical skin rash development after arterial chemo infusion therapy
    however, skin complications after transcatheter arterial chemoembolization are rare. Case presentation: A 70-year-old female with chronic hepatitis C infection was diagnosed as having hepatocellular carcinoma (S4, 20 mm in diameter). Transcatheter arterial chemoembolization was performed via the left hepatic artery, which was a feeding artery of the hepatocellular carcinoma. Two days after that, supraumbilical skin rash with local tenderness and redness appeared. Retrospective analysis revealed that occlusion of the hepatic falciform artery branching from the left hepatic artery with micromaterials caused the skin lesion. Conclusion: We should keep in mind that anticancer drugs or embolic materials can flow into the HFA and may cause abdominal wall injury after transcatheter arterial chemoembolization. © 2009 Kanzaki et al.
    licensee Cases Network Ltd.

    DOI: 10.4076/1757-1626-2-7197

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  • Lobulated inflammatory myoglandular polyp in the ascending colon observed by magnifying endoscopy and treated with endoscopic polypectomy 査読

    Hiromitsu Kanzaki, Shoji Hirasaki, Masato Okuda, Kenichiro Kudo, Seiyuu Suzuki

    WORLD JOURNAL OF GASTROENTEROLOGY   14 ( 30 )   4838 - 4840   2008年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:W J G PRESS  

    The patient was a 33-year-old man with hematochezia. Colonoscopy revealed a lobulated peduncular polyp with bleeding, about 40 mm in diameter, in the ascending colon. The polyp had both red and white components and a mosaic pattern. Magnifying observation revealed a red rugged surface component, and smooth white nodules with enlarged round or oval crypt openings. Endoscopic polypectomy was performed. Histological examination of the specimen revealed inflammatory granulation tissue in the lamina propria, proliferation of smooth muscle, and hyperplastic glands with cystic change. This polyp was diagnosed as inflammatory myoglandular polyp (IMGP). Lobulated-type IMGP in the ascending colon is rare. (C) 2008 The WJG Press. All rights reserved.

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  • A ruptured large extraluminal ileal gastrointestinal stromal tumor causing hemoperitoneum 査読

    Shoji Hirasaki, Kohei Fujita, Minoru Matsubara, Hiromitsu Kanzaki, Hiromichi Yamane, Masato Okuda, Seiyuu Suzuki, Atsuko Shirakawa, Hideyuki Saeki

    WORLD JOURNAL OF GASTROENTEROLOGY   14 ( 18 )   2928 - 2931   2008年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:W J G PRESS  

    We describe an 87-year-old woman with a large ileal gastrointestinal stromal tumor (GIST) causing hemoperitoneum. A CT scan demonstrated a large heterogeneous mass measuring about 13 cm x 11 cm in the pelvis and hemoperitoneum, with a non-uniform enhancement pattern. The mass was diagnosed as a GIST originating from the gastrointestinal tract. She underwent an urgent laparotomy and an ileal GIST with a rupture was found 130 cm from the anal to the Treitzs ligament. Hemoperitoneum caused by ileal GIST rupture is a rare condition. Bleeding in the large tumor leading to rupture of the capsule might cause hemoperitoneum in the present case. (c) 2008 WJG. All rights reserved.

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  • Treatment of gastric remnant cancer post distal gastrectomy by endoscopic submucosal dissection using an insulation-tipped diathermic knife 査読

    Shoji Hirasaki, Hiromitsu Kanzaki, Minoru Matsubara, Kohei Fujita, Shuji Matsumura, Seiyuu Suzuki

    WORLD JOURNAL OF GASTROENTEROLOGY   14 ( 16 )   2550 - 2555   2008年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:W J G PRESS  

    AIM: To evaluate the effectiveness of endoscopic submucosal dissection using an insulation-tipped diathermic knife (IT-ESD) for the treatment of patients with gastric remnant cancer.
    METHODS: Thirty-two patients with early gastric cancer in the remnant stomach, who underwent distal gastrectomy due to gastric carcinoma, were treated with endoscopic mucosal resection (EMR) or ESD at Sumitomo Besshi Hospital and Shikoku Cancer Center in the 10-year period from January 1998 to December 2007, including 17 patients treated with IT-ESD. Retrospectively, patient backgrounds, the one-piece resection rate, complete resection (CR) rate, operation time, bleeding rate, and perforation rate were compared between patients treated with conventional EMR and those treated with IT-ESD.
    RESULTS: The CR rate (40% in the EMR group vs 82% in the IT-ESD group) was significantly higher in the IT-ESD group than in the EMR group; however, the operation time was significantly longer for the IT-ESD group (57.6 +/- 31.9 min vs 21.1 +/- 12.2 min). No significant differences were found in the rate of underlying cardiopulmonary disease (IT-ESD group, 12% vs EMR group, 13%), one-piece resection rate (100% vs 73%), bleeding rate (18% vs 6.7%), and perforation rate (0% vs 0%) between the two groups.
    CONCLUSION: IT-ESD appears to be an effective treatment for gastric remnant cancer post distal gastrectomy because of its high CR rate. It is useful for histological confirmation of successful treatment. The long-term outcome needs to be evaluated in the future. (C) 2008 WJG. All rights reserved.

    DOI: 10.3748/wjg.14.2550

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  • Ileal schwannoma developing into ileocolic intussusception 査読

    Shoji Hirasaki, Hiromitsu Kanzaki, Kohei Fujita, Seiyuu Suzuki, Kazuyasu Kobayashi, Hiromitsu Suzuki, Hideyuki Saeki

    WORLD JOURNAL OF GASTROENTEROLOGY   14 ( 4 )   638 - 640   2008年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:W J G PRESS  

    Intussusception is rare in adults. We describe a 47-year-old man with ileal schwannoma that led to ileocolic intussusception. Abdominal ultrasonography, abdominal CT scan and barium enema confirmed an ileal tumor. Colonoscopy revealed a peduncular submucosal tumor (SMT) 75 mm long with an ulcerated apex at the ascending colon. The provisional diagnosis was a gastrointestinal stromal tumor of the terminal ileum. Ileocecal resection was carried out and the tumor was histologically diagnosed as schwannoma. Abdominal pain resolved postoperatively. This case reminds us that ileal schwannoma should be included in the differential diagnosis of intussusception caused by an SMT in the intestine. (c) 2008 WJG. All rights reserved.

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  • Papillary adenocarcinoma occurring in a gastric hyperplastic polyp observed by magnifying endoscopy and treated with endoscopic mucosal resection 査読

    Shoji Hirasaki, Hiromitsu Kanzaki, Kohei Fujita, Shuji Matsumura, Eiji Matsumoto, Eiichiro Yumoto, Seiyuu Suzuki

    INTERNAL MEDICINE   47 ( 10 )   949 - 952   2008年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPAN SOC INTERNAL MEDICINE  

    The patient was a 75-year-old man. He had been diagnosed with gastric hyperplastic polyp 4 years previously. The color of the apex of this polyp was whitish. Magnifying endoscopy findings revealed disappearance of the mucosal microstructure with irregular branched capillaries at the top of the polyp. Endoscopic mucosal resection (EMR) was performed. Histological examination revealed that a part of the polyp surface was replaced with papillary adenocarcinoma. Diagnosis of papillary adenocarcinoma in a hyperplastic polyp with mucosal invasion was made. Magnifying endoscopy was useful for the detection of gastric cancer occurring in the hyperplastic polyp in the present case.

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  • Minute signet ring cell carcinoma occurring in gastric hyperplastic polyp 査読

    Shoji Hirasaki, Seiyuu Suzuki, Hiromitsu Kanzaki, Kohei Fujita, Shuji Matsumura, Eiji Matsumoto

    WORLD JOURNAL OF GASTROENTEROLOGY   13 ( 43 )   5779 - 5780   2007年11月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:W J G PRESS  

    We describe a 45-year-old woman with minute signet ring cell carcinoma occurring in a gastric hyperplastic polyp. A biopsy specimen obtained from the gastric hyperplastic polyp revealed signet ring cell carcinoma. Endoscopic mucosal resection (EMR) was performed to confirm the diagnosis. Histological examination of the EMR specimen revealed focal signet ring cell carcinoma in the hyperplastic polyp. There are few cases of gastric hyperplastic polyp associated with signet ring cell carcinoma. (C) 2007 WJG. All rights reserved.

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  • Treatment of over 20 mm gastric cancer by endoscopic submucosal dissection using an insulation-tipped diathermic knife 査読

    Shoji Hirasaki, Hiromitsu Kanzaki, Minoru Matsubara, Kohei Fujita, Fusao Ikeda, Hideaki Taniguchi, Eiichiro Yumoto, Seiyuu Suzuki

    WORLD JOURNAL OF GASTROENTEROLOGY   13 ( 29 )   3981 - 3984   2007年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:W J G PRESS  

    AIM: To evaluate the effectiveness of endoscopic submucosal dissection using an insulation-tipped diathermic knife (IT-ESD) for the treatment of patients with over 20 mm early gastric cancer (EGC).
    METHODS: A total of 112 patients with over 10 mm EGC were treated with IT-ESD at Sumitomo Besshi Hospital and Shikoku Cancer Center in the 5 year period from January 2002 to December 2006, including 40 patients with over 20 mm EGC. We compared patient backgrounds, the one-piece resection rate, complete resection (CR) rate, operation time, bleeding rate, perforation rate between patients with over 20 mm EGC [over 20 mm group (21-40 mm)] and the remaining patients (under 20 mm group).
    RESULTS: We found no significant difference in the rate of underlying cardiopulmonary disease (over 20 mm group vs under 20 mm group, 5.0% vs 5.6%), one-piece resection rate (95% vs 96%), CR rate (85% vs 89%), operation time (72.3 min vs 66.5 min), bleeding rate (5% vs 4.2%), and perforation rate (0% vs 1.4%) between the 2 groups. Three patients in each group had submucosal invasion and two in each groups underwent additional surgery.
    CONCLUSION: There was no significant difference in the outcome resulting from IT-ESD between the 2 groups. Our study proves that IT-ESD is a feasible treatment for patients with over 20 mm mucosal gastric cancer although the long-term outcome should be evaluated in the future. (c) 2007 WJG. All rights reserved.

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  • Early stage of colonic adenocarcinoma associated with traditional serrated adenoma 査読

    Hiromitsu Kanzaki, Shoji Hirasaki, Seiyuu Suzuki, Minoru Matsubara, Kohei Fujita, Norio Koide

    INTERNAL MEDICINE   46 ( 23 )   1911 - 1914   2007年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPAN SOC INTERNAL MEDICINE  

    We describe a 68-year-old woman diagnosed as having a colonic adenocarcinoma associated with traditional serrated adenoma (SA) with submucosal invasion of the sigmoid colon. Colonoscopy revealed a 0-IIa+ IIc colon cancer with a SA component, about 12 mm in diameter, in the sigmoid colon. She underwent laparoscopy-assisted resection of the sigmoid colon. In the resected specimen, colon cancer with mucin pools was adjacent to the SA. Cases of colonic adenocarcinoma associated with traditional SA with submucosal invasion are relatively rare. This case suggests that SA may play a role in the development of colorectal cancer.

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▼全件表示

書籍等出版物

  • 非乳頭部十二指腸腺腫の自然経過

    神崎 洋光( 範囲: 主著)

    消化器内視鏡  2019年7月 

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  • 次世代抗体医薬品の現状と未来 -臨床の現場-

    神崎 洋光( 範囲: 主著)

    臨床化学  2019年 

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MISC

  • Clinicopathological features of gastric cancer in young patients; Multicenter retrospective study

    Yoshiyasu Kono, Hiromitsu Kanzaki, Masahiro Takatani, Junichirou Nasu, Ryuta Takenaka, Hiroyuki Sakae, Ko Miura, Takehiro Tanaka, Shunsuke Kagawa, Hiroyuki Okada

    ANNALS OF ONCOLOGY   28   2017年10月

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    記述言語:英語   掲載種別:研究発表ペーパー・要旨(国際会議)   出版者・発行元:OXFORD UNIV PRESS  

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  • Multicenter Prospective Study on the Safety of Upper Gastrointestinal Endoscopic Procedures in Antithrombotic Drug Users (vol 62, pg 730, 2017)

    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年4月

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    記述言語:英語   出版者・発行元:SPRINGER  

    DOI: 10.1007/s10620-017-4486-1

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  • Current Status of Treatment Strategy for Sporadic Non-Ampullary Duodenal Adenoma: Japanese Multicenter Retrospective Observation Trial

    Hiromitsu Kanzaki, Hiroyuki Sakae, Tatsuhiro Gotoda, Yoshiyasu Kono, Kou Miura, Masaya Iwamuro, Masahide Kita, Seiji Kawano, Yoshiro Kawahara, Hiroyuki Okada

    GASTROINTESTINAL ENDOSCOPY   83 ( 5 )   AB324 - AB324   2016年5月

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    記述言語:英語   掲載種別:研究発表ペーパー・要旨(国際会議)   出版者・発行元:MOSBY-ELSEVIER  

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  • Efficacy for the Recognition of Early Gastric Cancer Using Linked Color Imaging (LCI), the Novel Image Enhanced Endoscopy in Terms of the Value of Color Difference

    Hiromitsu Kanzaki, Yoshiro Kawahara, Hiroyuki Sakae, Tatsuhiro Gotoda, Yoshiyasu Kono, Kou Miura, Masaya Iwamuro, Masahide Kita, Seiji Kawano, Hiroyuki Okada

    GASTROENTEROLOGY   150 ( 4 )   S889 - S890   2016年4月

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    記述言語:英語   掲載種別:研究発表ペーパー・要旨(国際会議)   出版者・発行元:W B SAUNDERS CO-ELSEVIER INC  

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  • 原発性小腸癌34例の治療成績

    秋元 悠, 那須 淳一郎, 岩室 雅也, 神崎 洋光, 堤 康一郎, 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, 八木 孝仁, 大塚 文男, 岡田 裕之

    日本病院総合診療医学会雑誌   9 ( 1 )   23 - 29   2015年10月

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    記述言語:日本語   出版者・発行元:(一社)日本病院総合診療医学会  

    当院の原発性小腸癌患者34例の治療成績を解析した。原発部位は十二指腸29例、空腸3例、回腸1例、空腸または回腸1例、臨床病期はStage I 11例、Stage II 5例、Stage III 6例、Stage IV 12例。治療内容は、Stage Iでは内視鏡的切除5例と手術6例、Stage II/Stage IIIでは全例手術、Stage IVでは化学療法のみが3例、化学療法+原発巣切除が3例、原発巣切除+転移巣切除が4例、緩和治療が2例で、5年生存率はStage I/IIが80%、Stage IIIが33%、Stage IVが39%であった。(著者抄録)

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  • Clinical Features of Delayed Bleeding After Endoscopic Submucosal Dissection for Large Superficial Colorectal Tumor

    Masao Hanafusa, Yoji Takeuchi, Takashi Ohta, Hiromitsu Kanzaki, Noboru Hanaoka, Koji Higashino, Noriya Uedo, Ryu Ishihara, Hiroyasu Iishi

    GASTROINTESTINAL ENDOSCOPY   75 ( 4 )   418 - 418   2012年4月

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    記述言語:英語   掲載種別:研究発表ペーパー・要旨(国際会議)   出版者・発行元:MOSBY-ELSEVIER  

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  • A Single Session of Intralesional Steroid Injection to Prevent Esophageal Stricture After Endoscopic Submucosal Dissection for Esophageal Squamous Cell Carcinoma

    Noboru Hanaoka, Ryu Ishihara, Yoji Takeuchi, Noriya Uedo, Koji Higashino, Takashi Ohta, Hiromitsu Kanzaki, Masao Hanafusa, Hiroyasu Iishi

    GASTROINTESTINAL ENDOSCOPY   75 ( 4 )   175 - 175   2012年4月

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    記述言語:英語   掲載種別:研究発表ペーパー・要旨(国際会議)   出版者・発行元:MOSBY-ELSEVIER  

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  • Eradication of hepatitis C virus subgenomic replicon by interferon results in aberrant retinol-related protein expression

    Koike K, Takaki A, Kato N, Ouchida M, Kanzaki H, Yasunaka T, Shiraha H, Miyake Y, Yamamoto K

    Acta Med Okayama   66 ( 6 )   461 - 468   2012年

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  • Helicobacterと内視鏡技術(第22回) autofluorescence imaging(AFI)によるHelicobacter pylori感染粘膜の診断

    鼻岡 昇, 上堂 文也, 井上 拓也, 竹内 洋司, 石原 立, 東野 晃治, 辻井 芳樹, 長井 健悟, 松井 芙美, 太田 高志, 神崎 洋光, 花房 正雄, 河田 奈都子, 飯石 浩康, 竜田 正晴

    Helicobacter Research   15 ( 2 )   86 - 92   2011年4月

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    記述言語:日本語   出版者・発行元:(株)先端医学社  

    自家蛍光電子内視鏡(AFI)は青色の励起光を照射した際に、粘膜および粘膜下層に存在する内因性蛍光物質から生じる微弱な自家蛍光を内視鏡下にとらえ、リアルタイムでモニター上に疑似カラー表示する装置である。AFIで胃体部を観察すると萎縮性胃炎のない正常胃底腺粘膜は紫色に描出されるのに対し、萎縮や腸上皮化生のある体部胃炎粘膜は緑色に描出される。つまり、AFIによる胃体部粘膜の観察によって萎縮性胃炎の広がりを領域として評価することができる。AFIは萎縮性胃炎の広がり診断に対して白色光観察よりも精度が高く、色素噴霧や薬剤投与の必要がなく、複数個の生検も要しないため低侵襲かつ簡便な方法である。(著者抄録)

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  • 粘膜下層深部浸潤下部直腸癌に対する内視鏡治療+化学放射線療法の実施可能性

    長井 健悟, 竹内 洋司, 大植 雅之, 松井 芙美, 河田 奈都子, 辻井 芳樹, 太田 高志, 神崎 洋光, 花房 正雄, 鼻岡 昇, 山本 幸子, 東野 晃治, 上堂 文也, 石原 立, 飯石 浩康, 竜田 正晴, 真貝 竜史, 能浦 真吾

    日本消化器病学会雑誌   108 ( 臨増総会 )   A263 - A263   2011年3月

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    記述言語:日本語   出版者・発行元:(一財)日本消化器病学会  

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  • Intermittent hemorrhage from biliary varices caused by portal biliopathy after pancreatoduodenectomy successfully treated with trans-ileocolic vein obliteration

    Hiromitsu Kanzaki, Hirofumi Kawamoto, Etsuji Ishida, Hidefumi Mimura, Yutaka Sadamori, Yoshiro Kawahara, Hiroki Takayama, Seiyu Suzuki, Kazuhide Yamamoto

    GASTROINTESTINAL ENDOSCOPY   71 ( 3 )   620 - 621   2010年3月

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    記述言語:英語   出版者・発行元:MOSBY-ELSEVIER  

    DOI: 10.1016/j.gie.2009.10.009

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  • Application of radiollrequency ablation therapy for the treatment of metastatic liver cancers

    Kazuhiro Nouso, Shuji Uematsu, Kunihiro Shiraga, Ryoichi Okamoto, Shota Iwado, Hiromitsu Kanzaki, Koji Miyahara, Sayo Kobayashi, Ichiro Sakakihara, Naoko Kajikawa, Hironori Tanaka, Shin-ichiro Nakamura, Yoshiyuki Kobayashi, Kohsaku Sakaguchi, Yasuyuki Araki

    GASTROENTEROLOGY   132 ( 4 )   A203 - A203   2007年4月

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    記述言語:英語   掲載種別:研究発表ペーパー・要旨(国際会議)   出版者・発行元:W B SAUNDERS CO-ELSEVIER INC  

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