Faculty Profiles - NAKAMURA, Masanao

Papers - NAKAMURA, Masanao

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Effects of steroid use for stenosis prevention after endoscopic submucosal dissection for cervical esophageal cancer.

Koichi Muroi, Naomi Kakushima, Kazuhiro Furukawa, Satoshi Furune, Nobuhito Ito, Takashi Hirose, Eri Ishikawa, Yasuyuki Mizutani, Tsunaki Sawada, Keiko Maeda, Takeshi Yamamura, Takuya Ishikawa, Eizaburo Ohno, Masanao Nakamura, Hiroki Kawashima, Kohei Funasaka, Ryoji Miyahara, Mitsuhiro Fujishiro

International journal of clinical oncology Vol. 27 ( 5 ) page： 940 - 947 2022.5

Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Clinical Oncology

Background and aim: Esophageal stenosis is a serious complication after endoscopic submucosal dissection (ESD) for thoracic esophageal cancer (TEC), and steroid has been applied for stenosis prevention. However, the rate of stenosis and effect of steroid for ESD of cervical esophageal cancer (CEC) remain unknown. The aim was to clarify the rate and managements of post-ESD stenosis for CEC. Methods: A total of 325 lesions with 272 patients who underwent ESD for esophageal cancers were enrolled and were divided to the CEC group (43 lesions) or the TEC group (282 lesions). Patient characteristics, clinicopathological features, procedure-related outcomes of esophageal ESD, stenosis rate and clinical outcome of steroid use cases were evaluated. Results: More patients in the CEC group received preventive steroid treatment compared to the TEC group (37.2% vs 14.5%, P = 0.001). The rate of post-ESD stenosis tended to be higher in the CEC group (11.6%) than in the TEC group (6.7%). For cases of 3/4 ≤ of circumference, local injection with oral steroid had lower stenosis rate than local injection only in both groups (CEC 40% vs 100%, TEC 30.7% vs 56.3%). More sessions and longer duration of dilation were needed to release the stenosis in the CEC group (20 times vs. 5 times, P = 0.015; 196 days vs. 55 days, P = 0.043). Conclusion: The post-ESD stenosis rate of CEC tended to be higher than that of TEC. More intensive preventive measures for post-ESD stenosis may be needed for CEC than TEC.

DOI： 10.1007/s10147-022-02139-3

Relationship between psoas muscle index and long-term survival in older patients aged ≥ 80 years after endoscopic submucosal dissection for gastric cancer.

Nobuhito Ito, Kohei Funasaka, Ryoji Miyahara, Kazuhiro Furukawa, Takeshi Yamamura, Takuya Ishikawa, Eizaburo Ohno, Masanao Nakamura, Hiroki Kawashima, Yoshiki Hirooka, Mitsuhiro Fujishiro

International journal of clinical oncology Vol. 27 ( 4 ) page： 729 - 738 2022.4

Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Clinical Oncology

Background: In Japan, endoscopic submucosal dissection (ESD) has been widely performed for ESD-adapted gastric cancer, but little is known about the prognostic factors after ESD for gastric cancer in older patients. The psoas muscle index (PMI) is an indicator of sarcopenia calculated from computed tomography images and reportedly related to the prognosis of some diseases. This study aimed to explore factors related to long-term survival after ESD for gastric cancer in patients aged ≥ 80 years. Methods: We retrospectively reviewed 88 patients (63 men, 25 women) with early gastric cancer who underwent ESD at ≥ 80 years. Possible factors related to death after gastric ESD were analyzed by univariate and multivariate analyses using a Cox proportional hazards model. The estimated overall survival (OS) was compared between the groups stratified by significant factors. Results: The 5-year OS rate was 73.9% (median follow-up period, 5.4 years). In the multivariate analysis, a low PMI (< 6.36 in men, < 3.92 in women) (hazard ratio [HR] 2.89, 95% confidence interval [CI] 1.11–7.54) and high Charlson comorbidity index (CCI) (≥ 3) (HR 1.87, 95% CI 1.14–3.09) were independently related to death after ESD. The 5-year OS rates were significantly higher in the high PMI group (82.3% vs. 70.7%, P = 0.026) and the low CCI group (76.0% vs. 37.9%, P = 0.002). Conclusion: In addition to low CCI, high PMI is a predictor of long-term survival after ESD for gastric cancer in patients aged ≥ 80 years.

DOI： 10.1007/s10147-021-02112-6

Patients with low muscle mass have characteristic microbiome with low potential for amino acid synthesis in chronic liver disease

Yamamoto Kenta, Ishizu Yoji, Honda Takashi, Ito Takanori, Imai Norihiro, Nakamura Masanao, Kawashima Hiroki, Kitaura Yasuyuki, Ishigami Masatoshi, Fujishiro Mitsuhiro

SCIENTIFIC REPORTS Vol. 12 ( 1 ) page： 3674 2022.3

Language：English Publisher：Scientific Reports

Sarcopenia is thought to be related to the microbiome, but not enough reports in chronic liver disease (CLD) patients. In addition to the differences in microbiome, the role of the microbiome in the gut is also important to be clarified because it has recently been shown that the microbiome may produce branched-chain amino acids (BCAAs) in the body. In this single-center study, sixty-nine CLD patients were divided by skeletal muscle mass index (SMI) into low (L-SMI: n = 25) and normal (N-SMI: n = 44). Microbiome was analyzed from stool samples based on V3-4 region of bacterial 16S rRNA). L-SMI had a lower Firmicutes/Bacteroidetes ratio than N-SMI. At the genus level, Coprobacillus, Catenibacterium and Clostridium were also lower while the Bacteroides was higher. Predictive functional profiling of the L-SMI group showed that genes related to nitrogen metabolism were enriched, but those related to amino acid metabolism, including BCAA biosynthesis, were lower. The genes related to 'LPS biosynthesis' was also higher. The microbiome of CLD patients with low muscle mass is characterized not only by high relative abundance of gram-negative bacteria with LPS, but also by the possibility of low potential for amino acid synthesis including BCAAs.

DOI： 10.1038/s41598-022-07810-3

Changes in the gut microbiome in relation to the degree of gastric mucosal atrophy before and after Helicobacter pylori eradication

Furune Satoshi, Yamamoto Kenta, Honda Takashi, Fujiyoshi Toshihisa, Kakushima Naomi, Furukawa Kazuhiro, Ohno Eizaburo, Nakamura Masanao, Miyahara Ryoji, Kawashima Hiroki, Ishigami Masatoshi, Hirooka Yoshiki, Fujishiro Mitsuhiro

SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY Vol. 57 ( 3 ) page： 266 - 273 2022.3

Language：English Publisher：Scandinavian Journal of Gastroenterology

Objectives: Helicobacter pylori infection causes atrophic gastritis, which affects the gut microbiome; the gastric acid concentration depends on the degree of atrophic gastritis. Helicobacter pylori eradication also affects gastric acidity. Here, we determined the differences in the post-eradication changes in the gut microbiome in relation to the progression of gastric atrophy. Materials and Methods: Ten patients were included in the closed group and five in the open group, consisting of patients with non-progressive and progressive atrophy, respectively, diagnosed by endoscopy. The faecal microbiome was analysed and compared among three time-points: before eradication, 8 weeks after eradication, and 6 months after eradication. The microbiome was analysed by targeting 16S rRNA using Illumina Miseq. Results: The relative abundance of 14 genera significantly differed between the closed and open groups before eradication, but only 12 and 6 genera presented a significant difference in the relative abundance at 8 weeks and 6 months after eradication, respectively. Of the 12 genera that differed between the closed and open groups before eradication, 8 genera, namely, Actinomyces, Aggregatibacter, Campylobacter, Granulicatella, Pyramidobacter, Streptococcus, Cardiobacterium, and Haemophilus, were oral-origin bacteria. Longitudinal changes showed that Haemophilus and Catenibacterium were consistently significantly more abundant in the open group than in the closed group during the follow-up period. Conclusion: The gut microbiome substantially differed depending on the progression of gastric atrophy, but this difference was decreased by eradication, especially the differences in the number of oral bacteria in the gut. Eradication therapy may improve dysbiosis that result from gastric atrophy.

DOI： 10.1080/00365521.2021.2005135

Fecal incontinence and oral regurgitation during duodenal endoscopic submucosal dissection using the water pressure method. International journal

Yoshihisa Takada, Takashi Hirose, Kazuki Nishida, Naomi Kakushima, Kazuhiro Furukawa, Satoshi Furune, Eri Ishikawa, Tsunaki Sawada, Keiko Maeda, Takeshi Yamamura, Takuya Ishikawa, Eizaburo Ohno, Masanao Nakamura, Takashi Honda, Masatoshi Ishigami, Hiroki Kawashima, Mitsuhiro Fujishiro

Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society Vol. 34 ( 3 ) page： 526 - 534 2022.3

Language：English Publishing type：Research paper (scientific journal) Publisher：Digestive Endoscopy

Objectives: Endoscopic submucosal dissection (ESD) in the duodenum is challenging. The water pressure method (WP-ESD) has been developed with a decreased rate of perforation. However, details of perioperative adverse events of WP-ESD are unknown. The purpose of this study was to clarify the frequency and related factors of fecal incontinence and oral regurgitation during WP-ESD. Methods: A chart-based retrospective analysis was performed on 43 patients who underwent duodenal WP-ESD. The saline volume given into the body was calculated in all cases. All adverse events during WP-ESD until 6 weeks were extracted, and factors related to intraoperative fecal incontinence or oral regurgitation were analyzed. The frequency of fecal incontinence and oral regurgitation was also compared to those of 83 conventional ESD cases. Results: In WP-ESD, intraoperative fecal incontinence occurred in 12 (28%), oral regurgitation in six (14%), and aspiration pneumonia in one patient. For fecal incontinence, the infusion speed (saline volume divided by resection time) around 17 mL/min was a significant factor in multivariable analysis. For oral regurgitation, only tumor size was a significant factor in univariate analysis (P = 0.027). Significant difference was observed in the frequency of fecal incontinence between WP-ESD and conventional ESD (28% vs. 0%, P < 0.001), but no difference was observed in oral regurgitation or aspiration pneumonia. Conclusions: Intraoperative fecal incontinence is a unique adverse event of WP-ESD related to the infusion speed. WP-ESD did not pose a risk for oral regurgitation, but we should be aware of the risk in large tumor cases.

DOI： 10.1111/den.14070

Safety and efficacy of the endoscopic delivery of capsule endoscopes in adult and pediatric patients: Multicenter Japanese study (AdvanCE‐J study)

Naoki Ohmiya, Shiro Oka, Yoshiko Nakayama, Itaru Iwama, Masanao Nakamura, Hirotaka Shimizu, Akihiko Sumioka, Naoki Abe, Takahiro Kudo, Satoshi Osawa, Hitoshi Honma, Takeru Okuhira, Shoji Mtsufuji, Hiroyuki Imaeda, Kazuhiro Ota, Ryo Matsuoka, Naoki Hotta, Mikihiro Inoue, Konosuke Nakaji, Hiroyuki Takamaru, Keiji Ozeki, Taku Kobayashi, Naoki Hosoe, Hisao Tajiri, Shinji Tanaka

Digestive Endoscopy Vol. 34 ( 3 ) page： 543 - 552 2022.3

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

Background and Aim: We retrospectively determined the safety and efficacy of the endoscopic delivery (ED) of capsule endoscopes. Methods: We enrolled 10,156 patients who underwent small bowel capsule endoscopy (SBCE), 3182 who underwent patency capsule (PC), and 1367 who underwent colon capsule endoscopy (CCE), at 11 gastroenterological and nine pediatric centers. Results: Small bowel capsule endoscopies, PCs, and CCEs were endoscopically delivered to 546 (5.4%), 214 (6.7%), and 14 (1.0%) patients, respectively. Only mild complications occurred for 21.6% (167/774), including uneventful mucosal damage, bleeding, and abdominal pain. Successful ED of SBCE to the duodenum or jejunum occurred in 91.8% and 90.7% of patients aged <16 years and ≥16 years, respectively (P = 0.6661), but the total enteroscopy rate was higher in the first group (91.7%) than in the second (76.2%, P < 0.0001), for whom impossible ingestion (87.3%) was significantly more common than prolonged lodging in the stomach (64.2%, P = 0.0010). Successful PC and CCE delivery to the duodenum occurred in 84.1% and 28.6%, thereafter the patency confirmation rate and total colonoscopy rate was 100% and 61.5%, respectively. The height, weight, and age cutoff points in predicting spontaneous ingestion were 132 cm, 24.8 kg, and 9 years 2 months, respectively, in patients aged <16 years. Patients aged ≥16 years could not swallow the SBCEs mainly due to dysphagia (75.0%); those who retained it in the esophagus due to cardiac disease (28.6%), etc. and in the stomach due to diabetes mellitus (15.7%), etc. Conclusions: This large-scale study supports the safety and efficacy of ED in adult and pediatric patients. UMIN000042020.

DOI： 10.1111/den.14104

The impact of the age-adjusted Charlson comorbidity index as a prognostic factor for endoscopic papillectomy in ampullary tumors

Takada Yoshihisa, Kawashima Hiroki, Ohno Eizaburo, Ishikawa Takuya, Mizutani Yasuyuki, Iida Tadashi, Yamamura Takeshi, Kakushima Naomi, Furukawa Kazuhiro, Nakamura Masanao, Honda Takashi, Ishigami Masatoshi, Ito Akihiro, Hirooka Yoshiki

JOURNAL OF GASTROENTEROLOGY Vol. 57 ( 3 ) page： 199 - 207 2022.3

Language：English Publisher：Journal of Gastroenterology

Background: The prognostic nutritional index (PNI) and Charlson comorbidity index (CCI) have been useful for predicting the prognosis based on nutritional condition and comorbidities in surgery and endoscopic mucosal dissection. The age-adjusted CCI (ACCI) has also been reported to be useful in surgery, but it has not been applied to endoscopic treatment. We therefore clarified the prognostic factors associated with ampullary tumors treated with endoscopic papillectomy (EP). Methods: From January 2003 to December 2020, 236 patients who underwent EP for sporadic ampullary tumors at Nagoya University Hospital were included in this study. The 5-year survival and ability to predict the prognosis were evaluated in terms of the sex, PNI, ACCI, final pathological diagnosis, and intraductal extension. Results: During a median follow-up period of 1558 days, 17 patients died. No patient died of the primary disease. The 5-year survival rate was 91.1%. In a univariate analysis, only a high ACCI (≥ 5) was extracted as a significant prognostic factor (Odds ratio, 12.2; 95% confidence interval, 3.81–39.3; p < 0.001). The 5-year survival rates for a low ACCI (≤ 4) and high ACCI were 96.6% and 73.5%, respectively (p < 0.001). Conclusions: A high ACCI is an important prognostic factor associated with the 5-year survival and a risk of death from other illness. Ampullary tumors suitable for EP are less likely to be a prognostic factor, and treatment-free follow-up may be acceptable in patients with a high ACCI.

DOI： 10.1007/s00535-022-01853-z

Artificial intelligence-based diagnosis of upper gastrointestinal subepithelial lesions on endoscopic ultrasonography images.

Keiko Hirai, Takamichi Kuwahara, Kazuhiro Furukawa, Naomi Kakushima, Satoshi Furune, Hideko Yamamoto, Takahiro Marukawa, Hiromitsu Asai, Kenichi Matsui, Yoji Sasaki, Daisuke Sakai, Koji Yamada, Takahiro Nishikawa, Daijuro Hayashi, Tomohiko Obayashi, Takuma Komiyama, Eri Ishikawa, Tsunaki Sawada, Keiko Maeda, Takeshi Yamamura, Takuya Ishikawa, Eizaburo Ohno, Masanao Nakamura, Hiroki Kawashima, Masatoshi Ishigami, Mitsuhiro Fujishiro

Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association Vol. 25 ( 2 ) page： 382 - 391 2022.3

Language：English Publishing type：Research paper (scientific journal) Publisher：Gastric Cancer

Background: Endoscopic ultrasonography (EUS) is useful for the differential diagnosis of subepithelial lesions (SELs); however, not all of them are easy to distinguish. Gastrointestinal stromal tumors (GISTs) are the commonest SELs, are considered potentially malignant, and differentiating them from benign SELs is important. Artificial intelligence (AI) using deep learning has developed remarkably in the medical field. This study aimed to investigate the efficacy of an AI system for classifying SELs on EUS images. Methods: EUS images of pathologically confirmed upper gastrointestinal SELs (GIST, leiomyoma, schwannoma, neuroendocrine tumor [NET], and ectopic pancreas) were collected from 12 hospitals. These images were divided into development and test datasets in the ratio of 4:1 using random sampling; the development dataset was divided into training and validation datasets. The same test dataset was diagnosed by two experts and two non-experts. Results: A total of 16,110 images were collected from 631 cases for the development and test datasets. The accuracy of the AI system for the five-category classification (GIST, leiomyoma, schwannoma, NET, and ectopic pancreas) was 86.1%, which was significantly higher than that of all endoscopists. The sensitivity, specificity, and accuracy of the AI system for differentiating GISTs from non-GISTs were 98.8%, 67.6%, and 89.3%, respectively. Its sensitivity and accuracy were significantly higher than those of all the endoscopists. Conclusion: The AI system, classifying SELs, showed higher diagnostic performance than that of the experts and may assist in improving the diagnosis of SELs in clinical practice.

DOI： 10.1007/s10120-021-01261-x

今月の主題炎症性腸疾患の粘膜治癒を再考する主題 Crohn病における小腸粘膜治癒評価の意義-小腸カプセル内視鏡の立場から

中村正直, 山村健史, 前田啓子, 澤田つな騎, 石川恵里, 角嶋直美, 古川和宏, 飯田忠, 水谷泰之, 石川卓哉, 大野栄三郎, 川嶋啓揮, 藤城光弘

胃と腸 Vol. 57 ( 2 ) page： 183 - 189 2022.2

Gastrointestinal: Idiopathic omental hemorrhage

Furukawa K., Yamamura T., Nakamura M., Kawashima H., Fujishiro M.

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY Vol. 37 ( 2 ) page： 282 - 282 2022.2

Initial experience of tofacitinib for treating refractory moderate-to-severe ulcerative colitis.

Masanao Nakamura, Takeshi Yamamura, Keiko Maeda, Tsunaki Sawada, Yasuyuki Mizutani, Eri Ishikawa, Takuya Ishikawa, Naomi Kakushima, Kazuhiro Furukawa, Eizaburo Ohno, Hiroki Kawashima, Takashi Honda, Masatoshi Ishigami, Mitsuhiro Fujishiro

Nagoya journal of medical science Vol. 84 ( 1 ) page： 169 - 179 2022.2

Language：English Publisher：Nagoya Journal of Medical Science

Ulcerative colitis (UC) is an incurable, chronic inflammatory disease of the large bowel whose etiology and pathogenesis have not yet been comprehensively explained. Tofacitinib is a small molecule Janus kinase inhibitor that was introduced for treating refractory UC. We aimed to examine the efficacy and safety of tofacitinib for the treatment of 18 patients with UC. Continuous treatment rates were 50, 38, and 33% at 8, 24, and 52 weeks, respectively. Overall, 83.3% of these patients showed tumor necrosis factor (TNF) antibody failure status. When the effective status was defined as a Lichtiger index (LI) that decreased by 3 points or more or was less than 4 points and remission status was defined as an LI less than 4 points, the effective and remission rates (%) at 2, 8, and 16 weeks were 55.5 (10/18) and 22.2 (4/18), 38.8 (7/18) and 33.3 (6/18), and 38.8 (7/18) and 38.8 (7/18), respectively. Background characteristics of 2-week responders and non-responders were compared. C-reactive protein level in responders was significantly lower than that in non-responders, and the hemoglobin level in responders was significantly higher than that in non-responders. This study provides preliminary results of the effectiveness of tofacitinib even for TNF antibody and tacrolimus failure patients.

DOI： 10.18999/nagjms.84.1.169

Usefulness of Macroscopic On-Site Evaluation Using a Stereomicroscope during EUS-FNB for Diagnosing Solid Pancreatic Lesions

Ishikawa Takuya, Ohno Eizaburo, Mizutani Yasuyuki, Iida Tadashi, Uetsuki Kota, Yashika Jun, Yamada Kenta, Gibo Noriaki, Aoki Toshinori, Kataoka Kunio, Mori Hiroshi, Takada Yoshihisa, Takahashi Hidekazu, Aoi Hironori, Kato Katsuyuki, Yamamura Takeshi, Kakushima Naomi, Furukawa Kazuhiro, Nakamura Masanao, Hirooka Yoshiki, Kawashima Hiroki

CANADIAN JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY Vol. 2022 page： 2737578 2022.1

Language：English Publisher：Canadian Journal of Gastroenterology and Hepatology

Background/Aims. The usefulness of macroscopic on-site evaluation (MOSE) during endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) has been reported, but a specific method for MOSE has not been established. We aimed to investigate the usefulness of MOSE using a stereomicroscope (S-MOSE) for the diagnosis of solid pancreatic lesions (SPLs). Methods. We reviewed a total of 60 consecutive patients who underwent both S-MOSE and rapid on-site cytopathological evaluation (ROSE) during EUS-FNB between July 2019 and October 2020, and the usefulness of S-MOSE in comparison with histology was evaluated. A 22-gauge Franseen needle was used to perform EUS-FNB in all patients, and only the specimens obtained by the first pass were evaluated. The final diagnosis was based on the surgical specimen or the clinical course consistent with the EUS-FNB results. Results. The final diagnoses of the 60 patients included 45 patients with pancreatic ductal adenocarcinoma, 6 with autoimmune pancreatitis, 4 with mass-forming pancreatitis, 1 with pancreatic metastasis, 2 with pancreatic neuroendocrine tumor, and 2 with intraductal papillary mucinous carcinoma. The histological diagnostic accuracy of the first pass of EUS-FNB was 83.3% (50/60). The agreement between the S-MOSE and the histological diagnosis was 90% (54/60). The positive predictive value of S-MOSE for histological diagnosis was 90.7%, which can be an indicator of when to stop the EUS-FNB procedure. There were no immediate or delayed adverse events reported after the FNB based on the chart and medical visit history review. Conclusion. In the EUS-FNB of SPLs, S-MOSE can be an alternative to ROSE for specimen evaluation and has the potential to shorten the procedure time.

DOI： 10.1155/2022/2737578

Evaluation of ulcerative colitis activity using transabdominal ultrasound shear wave elastography. International journal

Kenta Yamada, Takuya Ishikawa, Hiroki Kawashima, Eizaburo Ohno, Tadashi Iida, Eri Ishikawa, Yasuyuki Mizutani, Tsunaki Sawada, Keiko Maeda, Takeshi Yamamura, Naomi Kakushima, Kazuhiro Furukawa, Masanao Nakamura, Masatoshi Ishigami, Mitsuhiro Fujishiro

Quantitative imaging in medicine and surgery Vol. 12 ( 1 ) page： 618 - 626 2022.1

Language：English Publishing type：Research paper (scientific journal) Publisher：Quantitative Imaging in Medicine and Surgery

Background: Transabdominal ultrasound (US) has been reported to be effective in the evaluation of ulcerative colitis (UC). US can measure shear wave elastography (SWE) and shear wave dispersion (SWD), which may be correlated with inflammation and necrosis. We aimed to investigate the relationship between UC activity and SWE and SWD. Methods: Patients with UC who underwent US within 2 days before or after a colonoscopy between April 2019 and March 2020 were included. SWE and SWD were measured in the sigmoid colon; the correlations of SWE and SWD with the Lichtiger index and the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) were investigated. We also compared SWE and SWD between patients with mucosal healing and those in the active phase according to the UCEIS. Results: Twenty-six UC patients were enrolled. The median Lichtiger index, UCEIS, SWE values, and SWD values were 8 [interquartile range (IQR), 5.3–10.8], 4 (IQR, 3.3–5), 1.69 (IQR, 1.49–2.16) m/s, and 11.9 (IQR, 10.9–13.3) (m/s)/kHz, respectively. The Lichtiger index and UCEIS were negatively correlated with the SWE values (rs=−0.404 and rs=−0.506) but not with the SWD values (rs=0.004 and rs=0.002). The SWE values differed significantly between the mucosal healing and active phase groups [2.40 (IQR, 2.18–3.38) vs. 1.62 (IQR, 1.44–1.95) m/s, P=0.007], whereas the SWD values did not [13.1 (IQR, 7.05–21.6) vs. 11.9 (IQR, 11.1–13.2) (m/s)/kHz, P=0.918]. Conclusions: SWE may be useful for the evaluation of UC activity and could be a noninvasive method of assessing disease severity.

DOI： 10.21037/qims-21-403

Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma in the Gastrointestinal Tract in the Modern Era

Ishikawa Eri, Nakamura Masanao, Satou Akira, Shimada Kazuyuki, Nakamura Shotaro

CANCERS Vol. 14 ( 2 ) 2022.1

Language：English Publisher：Cancers

Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) typically arises from sites such as the stomach, where there is no organized lymphoid tissue. Close associations between Helicobacter pylori and gastric MALT lymphoma or Campylobacter jejuni and immunoproliferative small intestinal disease (IPSID) have been established. A subset of tumors is associated with chromosomal rearrangement and/or genetic alterations. This disease often presents as localized disease, requiring diverse treatment approaches, from antibiotic therapy to radiotherapy and immunochemotherapy. Eradication therapy for H. pylori effectively cures gastric MALT lymphoma in most patients. However, treatment strategies for H. pylori-negative gastric MALT lymphoma are still challenging. In addition, the effectiveness of antibiotic therapy has been controversial in intestinal MALT lymphoma, except for IPSID. Endoscopic treatment has been noted to usually achieve complete remission in endoscopically resectable colorectal MALT lymphoma with localized disease. MALT lymphoma has been excluded from post-transplant lymphoproliferative disorders with the exception of Epstein–Barr virus (EBV)-positive marginal zone lymphoma (MZL). We also describe the expanding spectrum of EBV-negative MZL and a close association of the disease with the gastrointestinal tract.

DOI： 10.3390/cancers14020446

Feasibility of endoscopic ultrasonography using a 60-MHz ultrasound miniature probe in the upper gastrointestinal tract.

Hiromitsu Asai, Kazuhiro Furukawa, Ryoji Miyahara, Kohei Funasaka, Satoshi Furune, Masanao Nakamura, Hiroki Kawashima, Masatoshi Ishigami, Yoshiki Hirooka, Mitsuhiro Fujishiro

Journal of medical ultrasonics (2001) Vol. 49 ( 1 ) page： 61 - 69 2022.1

Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of Medical Ultrasonics

Purpose: The use of higher frequencies in ultrasound allows for a more detailed image. This study aimed to investigate the feasibility of delineating the gastrointestinal wall using a 60-MHz miniature ultrasound probe. Methods: A phantom study was performed using a multipurpose ultrasonic phantom model, and the depth of imaging was evaluated using 60-MHz and 20-MHz miniature probes and 7.5-MHz conventional convex-type endoscopic ultrasonography. A total of 25 visualized areas from a total of 16 specimens from 16 patients were enrolled. The structures of the layers of the esophagus, stomach, and duodenum were evaluated using a 60-MHz probe and a pathological specimen created from endoscopically or surgically resected specimens. Results: The 60-MHz probe was able to render to a depth of 2 mm and visualize the esophagus, stomach, and duodenum in five layers, respectively, within the depiction range. The depiction ranges of the 20-MHz probe and 7.5-MHz conventional endoscopic ultrasonography were 5 mm and 60 mm, respectively. The 60-MHz probe visualized the muscularis mucosae as the fourth layer in the esophagus, the fourth layer in the stomach, and the second layer in the duodenum. Muscularis mucosae were delineated in almost all cases, except in two cases where the layered structure disappeared. Conclusion: The 60-MHz probe provided good visualization of the muscularis mucosae and structure of the layers down to the submucosa, which improves the ability to diagnose the depth of early cancer invasion of the upper gastrointestinal tract, leading to more appropriate treatments.

DOI： 10.1007/s10396-021-01172-5

Differentiation Between Solid Pseudopapillary Neoplasm of the Pancreas and Nonfunctional Pancreatic Neuroendocrine Neoplasm Using Endoscopic Ultrasound

Kataoka Kunio, Ishikawa Takuya, Ohno Eizaburo, Mizutani Yasuyuki, Iida Tadashi, Furukawa Kazuhiro, Nakamura Masanao, Honda Takashi, Ishigami Masatoshi, Kawashima Hiroki, Hirooka Yoshiki, Fujishiro Mitsuhiro

PANCREAS Vol. 51 ( 1 ) page： 106 - 111 2022.1

Language：English Publisher：Pancreas

Objectives We investigated the utility of endoscopic ultrasound (EUS) for differentiating between solid pseudopapillary neoplasm of the pancreas (SPN) and pancreatic neuroendocrine neoplasm (PanNEN). Methods A retrospective analysis was performed on 29 and 77 consecutive patients with pathologically proven SPN and nonfunctional PanNEN. In patients who underwent contrast-enhanced harmonic EUS (CH-EUS), lesions were classified into 3 vascular patterns (hypoechoic/isoechoic/hyperechoic), and the presence of "the alveolus nest sign,"which we previously reported as a characteristic feature of SPN on CH-EUS, was also assessed. Results Conventional EUS findings showed that calcification echoes were significantly more frequent in SPN lesions than in PanNEN lesions (19/29 [66%] vs 21/77 [27%], P = 0.001) as was internal isoechogenicity or hyperechogenicity (10/29 [34%] vs 11/77 [14%], P = 0.029). Contrast-enhanced harmonic EUS findings showed that SPN lesions more frequently had the isoechoic or hypoechoic vascular pattern, and significantly more frequently had the alveolus nest sign (18/25 [72%] vs 4/60 [7%], P < 0.001). In a multivariate analysis, the presence of the alveolus nest sign contributed the most to the SPN diagnosis (odds ratio, 70; 95% confidence interval, 6.2-786). Conclusions Endoscopic ultrasound, particularly the presence of the alveolus nest sign on CH-EUS, is useful for differentiating SPN from PanNEN.

DOI： 10.1097/MPA.0000000000001966

Endoscopic resection of a duodenal neuroendocrine tumor

Furukawa Kazuhiro, Nakamura Masanao, Kawashima Hiroki, Fujishiro Mitsuhiro

REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS Vol. 114 ( 5 ) page： 291 - 292 2022

Language：English Publisher：Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva

A 50-year-old female with a histologically-proven duodenal neuroendocrine tumor (d-NET) was referred to our hospital for further examination. Esophagogastroduodenoscopy revealed a reddened, hemispheric lesion in the anterior wall of the duodenal bulb. Magnifying endoscopy with narrow-band imaging showed dilatated vessels without variable calibers on the surface. Endoscopic ultrasonography confirmed a 6-mm hypoechoic lesion extending into the submucosa.

DOI： 10.17235/reed.2021.8232/2021

Indications and Limitations Associated with the Patency Capsule Prior to Capsule Endoscopy

Nakamura Masanao, Kawashima Hiroki, Ishigami Masatoshi, Fujishiro Mitsuhiro

Internal Medicine Vol. 61 ( 1 ) page： 5 - 13 2022

Language：English Publisher：The Japanese Society of Internal Medicine

<p>The retention of the capsule used during small bowel capsule endoscopy (SBCE) is a serious complication that can occur in patients with known or suspected small bowel stenosis, and a prior evaluation of the patency of the gastrointestinal (GI) tract is therefore essential. Patency capsule (PC) is a non-diagnostic capsule the same size as the diagnostic SBCE. To date, there are no clear guidelines regarding the contraindications for undergoing a PC evaluation prior to SBCE. Each small bowel disorder has specific occasions to inhibit the progress of PC and SBCE, even though they do not have any stenotic symptoms or abnormalities on imaging. In this review, we summarize the indications and limitations of PC prior to SBCE, especially the contraindications, and discuss clinical scenarios in which even PC should be avoided, and therefore such areas of stenosis should be evaluated by alternative modalities. We thus propose this new algorithm to evaluate the patency of the GI tract for patients with suspected and known small bowel stenosis in order that they may undergo SBCE safely. </p>

DOI： 10.2169/internalmedicine.6823-20

Immunoproliferative Small Intestinal Disease Diagnosed by Double-balloon Endoscopy with Biopsy Sampling

Meza Miguel Ricardo Rodríguez, Nakamura Masanao, Yamamura Takeshi, Maeda Keiko, Sawada Tsunaki, Ishikawa Eri, Kakushima Naomi, Furukawa Kazuhiro, Ohno Eizaburo, Honda Takashi, Kawashima Hiroki, Ishigami Masatoshi

Internal Medicine Vol. 61 ( 17 ) page： 2593 - 2599 2022

Language：English Publishing type：Research paper (scientific journal) Publisher：The Japanese Society of Internal Medicine

<p>We herein report an 80-year-old man diagnosed with immunoproliferative small intestine disease (IPSID) via small bowel endoscopy with a biopsy. He developed persistent diarrhea and subsequently presented with hypoproteinemia and moderate anemia. Transanal double-balloon endoscopy showed prominent villous edema in the middle and lower ileum, while a histological examination showed high lymphocyte/plasma cell infiltration in the mucosal layer. Furthermore, an immunostaining analysis showed that Cluster of differentiation (CD) 3 and CD20 were partially positive, while CD138 was diffusely positive. Immunoglobulin A positivity was also observed. He was diagnosed with IPSID and received a nutritional agent and minocycline. After three months, the patients' symptoms improved. </p>

DOI： 10.2169/internalmedicine.8847-21

THE ROLE OF CAPSULE ENDOSCOPY IN THE MANAGEMENT OF CROHN’S DISEASE

NAKAMURA Masanao, YAMAMURA Takeshi

GASTROENTEROLOGICAL ENDOSCOPY Vol. 64 ( 2 ) page： 131 - 142 2022

Language：Japanese Publisher：Japan Gastroenterological Endoscopy Society

<p>The entire small bowel can be visualized non-invasively by capsule endoscopy (CE). Therefore, CE is considered a good tool to evaluate Crohnʼs disease (CD) lesions in the entire small intestine. In contrast, the investigation is associated with a potential risk of capsule retention due to small bowel stenosis; therefore, the appropriate modality should be selected based on the clinical background and patency of the gastrointestinal tract.</p><p>The applications of CE in clinical practice include (1) initial diagnosis of CD and differentiation from other inflammatory diseases, (2) identifying the small intestinal lesions of CD and their distribution, and (3) evaluation of the therapeutic effect and endoscopic monitoring of patients in clinical remission. CD is characterized by conspicuous erosions and small ulcers from the jejunum to the ileum. CE has the highest detection sensitivity of CD in the small intestine compared to other modalities. CE should be performed 6 months after the start of treatment to determine the therapeutic effect. In the event of low endoscopic activity or in cases of remission, laboratory data should be assessed regularly and CE should be performed within 2 years. Diagnosis and monitoring with the appropriate modality, including CE, can ensure long-term maintenance of clinical remission and avoidance of surgery in patients with CD.</p>

DOI： 10.11280/gee.64.131

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