Faculty Profiles - NAKAMURA, Masanao

Papers - NAKAMURA, Masanao

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Difference of efficacy for small bowel lesion in Crohn

Sawada T, Nakamura M, Yamamura T, Maeda K, Ishikawa E, Fujishiro M

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY Vol. 36 page： 116 - 116 2021.8

Lewis score on capsule endoscopy can predict the prognosis in patients with small bowel lesions of Crohn's disease. International journal

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

Journal of gastroenterology and hepatology Vol. 36 ( 7 ) page： 1851 - 1858 2021.7

Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of Gastroenterology and Hepatology (Australia)

Background and Aim: Endoscopic evaluation of disease activity, including mucosal healing, is poorly established in Crohn's disease. We previously reported that patients with a Lewis score (LS) on capsule endoscopy < 270 had a lower risk of exacerbation without additional treatment. This study investigated prognostic predictors in patients undergoing capsule endoscopy and determined the optimal LS cut-off value. Methods: In a retrospective single-center study, 102 patients with Crohn's disease who underwent capsule endoscopy were reviewed. We reviewed the clinical course and the patients' characteristics, Crohn's Disease Activity Index, laboratory findings, LS, and Prognostic Nutritional Index (PNI) for factors potentially associated with Crohn's disease-related emergency hospitalization. Subsequently, we prospectively enrolled 66 patients with Crohn's disease and analyzed clinical outcomes according to these factors. Results: In the retrospective study, LS ≥ 270 and PNI < 45 were identified as independent predictors of Crohn's disease-related emergency hospitalization with hazard ratios of 9.48 and 3.01, respectively. Even in patients with LS ≥ 270, cumulative hospitalization rates decreased after intervention based on capsule endoscopy findings. The prospective study confirmed that patients with LS ≥ 270 or PNI < 45 had a significantly higher risk of Crohn's disease-related emergency hospitalization and that additional treatment reduced the risk of relapse. Conclusions: LS and PNI are the best available prognostic predictors in patients with Crohn's disease without gastrointestinal stenosis and can guide decisions on treatment escalation. Patients with LS ≥ 270 and PNI < 45 were at increased risk for exacerbation, and additional treatments should be considered for this group.

DOI： 10.1111/jgh.15366

An initial trial of quantitative evaluation of autoimmune pancreatitis using shear wave elastography and shear wave dispersion in transabdominal ultrasound

Suzuki Hirotaka, Ishikawa Takuya, Ohno Eizaburo, Iida Tadashi, Uetsuki Kota, Yashika Jun, Yamada Kenta, Yoshikawa Masakatsu, Furukawa Kazuhiro, Nakamura Masanao, Honda Takashi, Ishigami Masatoshi, Kawashima Hiroki, Fujishiro Mitsuhiro

PANCREATOLOGY Vol. 21 ( 4 ) page： 682 - 687 2021.6

Language：English Publisher：Pancreatology

Background/Objectives: We aimed to examine therapeutic efficacy and prognosis prediction of autoimmune pancreatitis (AIP) using shear wave elastography (SWE) and shear wave dispersion (SWD) in transabdominal ultrasound (US). Methods: The subjects were 23 patients with diffuse type 1 AIP who underwent SWE and SWD, and 34 controls with a normal pancreas. Elasticity and dispersion were defined as the pancreatic elastic modulus (PEM) and dispersion slope, respectively. PEM and dispersion slope were compared between AIP and control cases, and the short-term therapeutic effect and long-term prognosis were examined. Results: PEM (30.9 vs. 6.6 kPa, P < 0.001) and dispersion slope (15.3 vs. 13.0 (m/sec)/kHz, P = 0.011) were significantly higher in AIP cases than in controls. Among the 17 AIP patients followed-up in two weeks after treatment, these parameters were 12.7 kPa and 10.5 (m/sec)/kHz with median decrease rate of 37.2% and 32.8%, respectively, which were significantly higher than the change in the size of pancreatic parenchyma (14.4%, P = 0.026). Fourteen of these subjects were followed up for >12 months, during which 2 had relapse; diabetes improved in 5 and worsened in 2; in 60% of cases, the pancreatic parenchyma was atrophied. The % change in PEM after two weeks was tended to be higher in non-atrophy cases. Conclusion: SWE and SWD measurement in US may be useful for quantitative assessment of AIP and evaluation of short-term treatment efficacy.

DOI： 10.1016/j.pan.2021.02.014

An evaluation of resectability among endoscopic treatment methods for rectal neuroendocrine tumors <10 mm. International journal

Kazuhiro Toriyama, Takeshi Yamamura, Masanao Nakamura, Keiko Maeda, Tsunaki Sawada, Yasuyuki Mizutani, Eri Ishikawa, Kazuhiro Furukawa, Takuya Ishikawa, Eizaburo Ohno, Hiroki Kawashima, Mitsuhiro Fujishiro

Arab journal of gastroenterology : the official publication of the Pan-Arab Association of Gastroenterology Vol. 22 ( 2 ) page： 104 - 110 2021.6

Language：English Publishing type：Research paper (scientific journal) Publisher：Arab Journal of Gastroenterology

Background and Study Aims: With respect to rectal neuroendocrine tumor (NET) resection, it remains unclear which of the following methods is the most effective: conventional endoscopic mucosal resection (cEMR), EMR using a fitted cap (EMR-C), EMR with a ligation band device (EMR-L), or endoscopic submucosal dissection (ESD). Thus, in this study, we aim to retrospectively evaluate the most effective endoscopic resection for rectal NETs < 10 mm. Patients and methods: In total, 61 consecutive patients with primary rectal NETs < 10 mm in diameter were included in this study; they were then divided into three groups: those with cEMR; those with modified EMR (mEMR) involving EMR-C and EMR-L; and those with ESD. The primary endpoint was to evaluate the difference in the complete en bloc resection rate. The secondary endpoint was to investigate differences in procedure time and complications. Results: Among the three groups, a significant difference was found in procedure time (cEMR vs ESD, P < .01; mEMR vs ESD, P < .01), en bloc resection rate (cEMR vs mEMR, P = .015), tumor size (mEMR vs ESD, P < .01), percentage of tumor diameter ≥ 5 mm (mEMR vs ESD, P < .01), and complete en bloc resection rate (cEMR vs mEMR, P = .014). Meanwhile, no significant difference was noted in terms of complication rate among the three groups. Conclusion: The mEMR was the most suitable resection method for rectal NETs < 10 mm with respect to the risks and benefits from procedure-related factors, such as complete en bloc resection rate, procedure time, and complication rate.

DOI： 10.1016/j.ajg.2021.05.007

Endoscopic removal of a fish bone piercing the bile duct after pancreaticoduodenectomy

Ishikawa Takuya, Kawashima Hiroki, Ohno Eizaburo, Nakamura Masanao, Yamada Suguru, Hayashi Masamichi, Fujishiro Mitsuhiro

ENDOSCOPY Vol. 53 ( 05 ) page： E164 - E165 2021.5

Effects of endoscopy-related procedure time on musculoskeletal disorders in Japanese endoscopists: a cross-sectional study

Matsuzaki Ippei, Ebara Takeshi, Tsunemi Mafu, Hatta Yoshifumi, Yamamoto Kojiro, Baba Akemi, Hattori Masashi, Nakamura Masanao, Fujishiro Mitsuhiro

ENDOSCOPY INTERNATIONAL OPEN Vol. 09 ( 05 ) page： E674 - E683 2021.5

Clinical Features of Ischemic Enteritis Diagnosed by Double-Balloon Endoscopy. International journal

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

Canadian journal of gastroenterology & hepatology Vol. 2021 page： 8875564 - 8875564 2021.4

Language：English Publishing type：Research paper (scientific journal) Publisher：Canadian Journal of Gastroenterology and Hepatology

Introduction. Ischemic enteritis (IE) is a relatively rare small bowel disease that is diagnosed via double-balloon endoscopy (DBE), although the lack of established diagnostic criteria can make it difficult to confirm the diagnosis. This study aimed to describe the clinical characteristics, endoscopic imaging features, and treatments for IE at our center. Patients and Methods. We retrospectively searched the DBE database (1,521 patients) at Nagoya University Hospital for patients with IE and collected data regarding endoscopic findings, clinical background, and histological findings. The cases were categorized according to whether they involved transient or stenotic IE. Results. The DBE database included 24 patients (14 men) with IE. Transient IE was identified in 9 patients, and stenotic IE was identified in 15. Half of the patients had a history of cerebrovascular and cardiovascular disease. A granular structure at the ulcer base was the most frequently observed DBE finding at the stenotic site. Enterography using the contrast medium revealed that transient IE had a similar stenotic lesion length, relative to stenotic IE, although stenotic IE had a significantly higher stenosis ratio (81% vs. 63%, P=0.033). Small bowel enteroclysis revealed the "lead pipe"sign (11 patients), thumbprinting (3 patients), and the serrated lumen sign (1 patient). Only 1 patient with stenotic IE experienced recurrence after conservative treatment. Conclusion. During DBE, IE was characterized by cannular stenosis with extended and variable ulceration types, which spread over the edge of the stenosis, and a granular appearance at the ulcer base. These findings may help guide the diagnosis of IE.

DOI： 10.1155/2021/8875564

Variability measurements provide additional value to shear wave elastography in the diagnosis of pancreatic cancer

Yoshikawa Masakatsu, Ishikawa Takuya, Ohno Eizaburo, Iida Tadashi, Furukawa Kazuhiro, Nakamura Masanao, Honda Takashi, Ishigami Masatoshi, Kinoshita Fumie, Kawashima Hiroki, Fujishiro Mitsuhiro

SCIENTIFIC REPORTS Vol. 11 ( 1 ) page： 7409 2021.4

Language：English Publisher：Scientific Reports

Shear wave elastography (SWE) is a technique to non-invasively and quantitatively evaluate tissue stiffness. We aimed to investigate whether we can differentiate pancreatic cancer (PC) from normal pancreatic parenchyma (NPP) by SWE using transabdominal ultrasound. We investigated a total of 106 patients (84 with NPP and 22 with PC) whose pancreatic elastic modulus was measured by two-dimensional SWE (2D-SWE). Intra-rater reliability in this study was examined, and three measurements were sufficiently reliable. There were no differences between the two groups in factors that could affect SWE measurements. The median value of the elastic modulus was 5.70 kPa in the PC patients and 5.66 kPa in the NPP group, which was not significantly different (P = 0.785). On the contrary, the range was 8.64 kPa and 4.72 kPa, with a significantly greater range in the PC patients (P = 0.001). In conclusion, the median elastic modulus measured by 2D-SWE was not significantly different between PC and NPP, and evaluating the obtained elastic modulus itself is not useful in differentiation. However, the variability was significantly greater in PC than in NPP. Evaluating the range of elasticities will provide additional information in SWE, which may be useful in the diagnosis of PC.

DOI： 10.1038/s41598-021-86979-5

The relationship between oral-origin bacteria in the fecal microbiome and albumin-bilirubin grade in patients with hepatitis C

Kenta Yamamoto, Takashi Honda, Takanori Ito, Yoji Ishizu, Teiji Kuzuya, Masanao Nakamura, Ryoji Miyahara, Hiroki Kawashima, Masatoshi Ishigami, Mitsuhiro Fujishiro

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY Vol. 36 ( 3 ) page： 790 - 799 2021.3

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

Background: Bacteria of oral origin (BO) in the gut are associated with prognosis in patients with cirrhosis. The Greengenes database (gg_13_8) is widely used in microbiome analysis, but the expanded Human Oral Microbiome Database (eHOMD), a specialized database for BO, can add more detailed information. We used each database to evaluate the relationship between the albumin–bilirubin grade (ALBI) and the microbiome in patients with hepatitis C. Methods: Eighty patients were classified into the low ALBI group (LA; n = 34) or high ALBI group (HA; n = 46). Isolated DNA from stool was amplified to target the V3–4 regions of 16S rRNA. The microbiomes of the two groups were compared using gg_13_8 or eHOMD. We evaluated the associations between microbiomes and prognoses using Cox proportional hazards models. Results: At the genus level, the two groups differed significantly regarding 6 (gg_13_8) and 7 (eHOMD) types of bacteria. All types except Akkermansia are classified as BO. Both databases showed an increase in Streptococcus and Veillonella. eHOMD showed a decrease in Fusobacterium and an increase in Fretibacterium; both produce various types of short-chain fatty acids. At the species level, the two groups demonstrated significant differences in 2 (gg_13_8) and 6 (eHOMD) bacterial types. Selenomonas noxia and Streptococcus salivarius were related to poor prognosis in univariate analysis. Conclusion: The HA group demonstrated increased BO, most of which produce lactic acid or acetic acid. The correlation between the microbiome and metabolism might be related to prognosis. eHOMD was a useful database for analyzing BO.

DOI： 10.1111/jgh.15206

Diagnostic yield of colon capsule endoscopy for Crohn's disease lesions in the whole gastrointestinal tract. International journal

Keisaku Yamada, 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

BMC gastroenterology Vol. 21 ( 1 ) page： 75 - 75 2021.2

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

Background: Crohn’s disease (CD) can involve the upper gastrointestinal (GI) tract as well as the small and large bowel. PillCam colon capsule endoscopy (PCCE-2) enables observation of the whole GI tract, but its diagnostic yield for CD lesions in the whole GI tract remains unknown. Aim: To elucidate the diagnostic yield of PCCE-2 in patients with CD. Methods: Patients with CD who underwent PCCE-2 and double-balloon endoscopy (DBE) using oral and anal approaches were evaluated for CD lesions in the whole GI tract. We divided the small bowel into three segments (jejunum, ileum, and terminal ileum), and the large bowel into four segments (right colon, transverse colon, left colon, rectum). Detection of ulcer scars, erosion, ulcers, bamboo joint-like appearance, and notch-like appearance was assessed in each segment. The diagnostic yield of PCCE-2 was analyzed based on the DBE results as the gold standard. Results: Of the total 124 segments, the sensitivities of PCCE-2 for ulcer scars, erosion, and ulcers were 83.3%, 93.8%, and 88.5%, respectively, and the specificities were 76.0%, 78.3%, and 81.6%, respectively. For the 60 small bowel segments, the sensitivities were 84.2%, 95.5%, and 90.0%, respectively, and the specificities were 63.4%, 86.8%, and 87.5%, respectively. For the 64 large bowel segments, the sensitivities were 80.0%, 90.0%, and 83.3%, respectively, and the specificities were 84.7%, 72.2%, and 77.6%, respectively. Conclusion: PCCE-2 provides a high diagnostic yield for lesions in the whole GI tract of patients with CD. Thus, we recommend its use as a pan-enteric tool in clinical settings.

DOI： 10.1186/s12876-021-01657-0

Ustekinumab is effective against small bowel lesions in Crohn's disease: two case reports.

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

Clinical journal of gastroenterology Vol. 14 ( 1 ) page： 129 - 135 2021.2

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

We encountered two patients with Crohn’s disease (CD) for whom induction of ustekinumab was effective for the management of small intestinal lesions with stenosis. The first symptomatic CD case was a 40-year-old female with longitudinal ulcers in the small bowel found at double-balloon endoscopy. She was in a biologic-naïve condition. Her symptoms improved immediately after ustekinumab induction. We confirmed the condition of intestinal mucosa by double-balloon endoscopy. Deep ulcers remained open at 24 weeks and were scarred at 72 weeks. The second case was a 50-year-old male who failed to respond to treatment with anti-TNFα agents. The lumen was narrow caused by circumferential ulcer, and an endoscope could not pass the site before induction. The circumferential ulcer had been healed by ustekinumab induction, and an endoscope passed through at 72 weeks. These two cases support the therapeutic efficacy of ustekinumab in alleviating small bowel lesions in CD patients.

DOI： 10.1007/s12328-020-01242-0

A Prospective Study Evaluating the Clinical Utility of the Tag-Less Patency Capsule with Extended Time for Confirming Functional Patency. International journal

Kenji Watanabe, Naoki Ohmiya, Masanao Nakamura, Yasuhiro Fujiwara

Digestion Vol. 102 ( 2 ) page： 180 - 187 2021.2

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

Background: Patency confirmation is useful for avoiding the retention of capsule endoscopy (CE). We first evaluated the clinical utility of the tag-less PillCamTM Patency Capsule (PPC) for up to 72 h after ingestion prospectively. Methods: Excretion of an intact capsule or intact body within 72 h, or positive PPC image in the colon or negative PPC image by abdominal X-ray at 30 h was defined as confirmed functional patency. In patients with unconfirmed functional patency, balloon-assisted enteroscopy was performed to evaluate the reason. Results: Functional patency was confirmed in 44 of 57 patients. Patency was confirmed in 38 patients (66.7%) at 30 h. In 6 of 19 patients (31.6%) in whom patency was not confirmed at 30 h, patency was confirmed within 72 h and no capsule retention (CR) occurred. The rate of pan-enteroscopy did not differ between patients whose patency was confirmed at 30 h and those whose patency was confirmed within 72 h. Excretion time of the PPC significantly correlated with that of the capsule (r = 0.650). Severe adhesions (>5 cm) interfered with PPC passage in 2 patients, despite the absence of critical stricture. The rate of no CR in patients with functional patency confirmed by prior PPC was 97.7%. Misjudgment of the location of the PPC is a risk for CR. Conclusions: Extending the time to confirm functional patency to 72 h may be acceptable and increase the possibility to perform CE safely in whom CE can perform intrinsically. University Hospital Medical Information Network registration No: 000002564.

DOI： 10.1159/000503027

Systematic review and meta-analysis of the diagnostic and therapeutic yield of small bowel endoscopy in patients with overt small bowel bleeding

Uchida Genta, Nakamura Masanao, Yamamura Takeshi, Furukawa Kazuhiro, Kawashima Hiroki, Honda Takashi, Ishigami Masatoshi, Fujishiro Mitsuhiro

DIGESTIVE ENDOSCOPY Vol. 33 ( 1 ) page： 66 - 82 2021.1

Language：English Publisher：Digestive Endoscopy

Background: Small bowel endoscopy, including small bowel capsule endoscopy (SBCE) and balloon-assisted endoscopy (BAE), is useful for small bowel bleeding (SBB) assessment. However, the specific management strategy for overt SBB is not well established. This meta-analysis aimed to evaluate the pooled diagnostic yields (DYs) and therapeutic yields (TYs) of small bowel endoscopy in overt SBB and to determine the optimal endoscopy timing. Methods: A comprehensive literature search was performed of studies examining the DY and/or TY of small bowel endoscopy in overt SBB. Data on the DY, TY, and timing of small bowel endoscopy were extracted, pooled, and analyzed. The pooled DY and TY of small bowel endoscopy for patients with overt SBB were calculated. Meta-regression and subgroup analysis were performed. Results: Twenty-two studies were included. The pooled DY was 65.2% and 74.0% for SBCE and BAE, respectively. The pooled TY of SBCE and BAE was 55.9% and 35.8%, respectively. A meta-regression model showed that the timing of endoscopy was significantly associated with the DY of BAE and the TY of SBCE and BAE. Conclusions: Small bowel capsule endoscopy and BAE would be useful diagnostic and therapeutic modalities in overt SBB. According to the subgroup analysis, in which the TY seemed to be higher within 2 days after bleeding for SBCE and BAE, the optimal timing of endoscopy would be within 2 days.

DOI： 10.1111/den.13669

Feasibility and usefulness of endoscopic ultrasonography-guided shear-wave measurement for assessment of autoimmune pancreatitis activity: a prospective exploratory study

OHNO Eizaburo, HIROOKA Yoshiki, KAWASHIMA Hiroki, ISHIKAWA Takuya, TANAKA Hiroyuki, SAKAI Daisuke, ISHIZU Yoji, KUZUYA Teiji, NAKAMURA Masanao, HONDA Takashi

Choonpa Igaku Vol. 48 ( 1 ) page： 35 - 44 2021.1

Language：Japanese Publisher：The Japan Society of Ultrasonics in Medicine

<p><b>Purpose</b>: To assess the feasibility and the clinical usefulness of a newly developed endoscopic ultrasonography (EUS) shearwave elastography technique (EUS shear-wave measurement: EUS-SWM) in the diagnosis and treatment of autoimmune pancreatitis (AIP). <b>Methods</b>: Tissue elasticity was measured in the pancreas in 160 patients. The success rate of EUS-SWMs, the velocity of the shear wave (Vs, m/s), and the reliability index of the Vs measurement (VsN) were evaluated, and the elasticity (median Vs) was compared between AIP patients (<I>n</I>=14) and normal controls. <b>Results</b>: A total of 3837 EUS-SWMs were performed without adverse events. Overall, 97.6% (3,743/3,837) were successful. The median VsN was 74%. The median Vs values of the pancreas were as follows: 2.22 m/s in the pancreatic head (push position), 2.36 m/s in the head (pull position), 1.99 m/s in the body, and 2.25 m/s in the tail. The median Vs of the AIP group (2.57 m/s) was significantly higher than that of the normal controls (1.89 m/s) (<I>P</I>=0.0185). The mean Vs significantly decreased from 3.32 m/s to 2.46 m/s after steroid therapy (<I>n</I>=6) (<I>P</I>=0.0234). <b>Conclusion</b>: EUS-SWM is feasible and generates credible results. EUS-SWM was a useful method for assessment of the effect of steroid therapy in AIP patients.</p>

DOI： 10.3179/jjmu.jjmu.k.22

Gastrointestinal tract metastasis of lung cancer: The PD-L1 expression and correlated clinicopathological variables. International journal

Eri Ishikawa, Masato Nakaguro, Masanao Nakamura, Takeshi Yamamura, Tsunaki Sawada, Yasuyuki Mizutani, Keiko Maeda, Kazuhiro Furukawa, Yoshie Shimoyama, Hiroki Kawashima, Mitsuhiro Fujishiro

Pathology international Vol. 71 ( 1 ) page： 33 - 41 2021.1

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

The gastrointestinal tract is a rare site for metastatic lung cancer. Programmed cell death-ligand 1 (PD-L1) expression in lung cancer is a biomarker for the response to anti-PD-1/PD-L1 therapy. We investigated clinicopathological features and PD-L1 expression in 25 gastrointestinal metastatic tumors from the lung and primary adenocarcinoma of the small bowel. The small bowel was the most common site (16/25; 64%) of gastrointestinal tract lung cancer metastasis. A total of 19 (76%) of the gastrointestinal metastasis showed PD-L1 expression in ≥5% of tumor cells, with 14 (56%) showing high expression levels (≥50%). In contrast, 21 (84%) expressed PD-L1 in ≥5% immune cells, including 4 (16%) showing a high expression levels (≥50%). The PD-L1 expression on tumor cells and immune cells in primary lung cancer and corresponding gastrointestinal metastasis was concordant in 13 (68%) and 11 (58%) of the 19 paired cases, respectively. Small-bowel metastasis of lung cancer was characterized by a higher incidence of perforation (31% vs. 0%), ulcerated mass (83% vs. 60%), and neoplastic PD-L1 expression (75% vs. 0%) compared to primary small-bowel adenocarcinoma. Gastrointestinal metastasis from lung cancer might be a potential target for immune checkpoint inhibitor therapy, given its high expression of PD-L1.

DOI： 10.1111/pin.13048

A CASE OF A SUBTYPE OF EOSINOPHILIC ESOPHAGITIS WITH MINOR EPITHELIAL CHANGES AND THICKENED MUSCLE LAYER

MUROI Koichi, FURUKAWA Kazuhiro, SUZUKI Tomohiko, HIROSE Takashi, ITO Nobuhito, FURUNE Satoshi, KAKUSHIMA Naomi, NAKAMURA Masanao, OOBAYASHI Tomohiko, FUJISHIRO Mitsuhiro

GASTROENTEROLOGICAL ENDOSCOPY Vol. 63 ( 3 ) page： 279 - 286 2021

Language：Japanese Publisher：Japan Gastroenterological Endoscopy Society

<p>Eosinophilic esophagitis (EoE) is a chronic inflammatory disease, clinically characterized by symptoms related to esophageal dysfunction and histologically characterized by eosinophil-predominant inflammation. In rare cases, there have been reports of subepithelial eosinophilic esophagitis or eosinophilic esophageal myositis, both of which are difficult to diagnose because the eosinophils are deeply infiltrated.</p><p>A 74-year-old male underwent esophagogastroduodenoscopy (EGD) to find the cause of dysphagia, but no abnormalities were observed. Although he started to take esomeprazole, his symptoms persisted. Six months later, he was hospitalized because of difficulty in oral feeding. EGD revealed mucosal cloudy edema around the middle and lower esophagus and a ring-shaped stenosis, which resulted in obstruction of passage. We suspected EoE by various examinations, but biopsies showed no eosinophil infiltration in the esophageal epithelium. Endoscopic ultrasound (EUS) showed thickening of the esophageal wall including the muscle layer. We diagnosed EoE with deep infiltration of eosinophils by repeated biopsies. We herein report a case of an EoE subtype in which severe obstruction of the esophagus occurred in six months and evaluation of the esophageal wall by EUS was useful for diagnosis.</p>

DOI： 10.11280/gee.63.279

DIAGNOSIS AND TREATMENT OF HAMARTOMATOUS POLYPOSIS SYNDROMES

OHMIYA Naoki, NAKAMURA Masanao, SHIBATA Tomoyuki

GASTROENTEROLOGICAL ENDOSCOPY Vol. 63 ( 7 ) page： 1323 - 1335 2021

Language：Japanese Publisher：Japan Gastroenterological Endoscopy Society

<p>The hamartomatous polyposis syndromes are a group of inherited disorders that include Peutz-Jeghers syndrome (PJS), juvenile polyposis syndrome, Cowden syndrome, and tuberous sclerosis complex (TSC). PJS, Cowden syndrome, and TSC are characterized by phenotypic manifestations, which may be a clue to their diagnosis. The most frequent complications of PJS are intussusception and chronic anemia. Earlier entire small bowel examination with capsule endoscopy and balloon-assisted enteroscopy enabling accurate diagnosis and subsequent endoscopic polyp removal obviates the need for unnecessary multiple surgeries. Patients with a hamartomatous polyposis syndrome are at an elevated risk for gastrointestinal and extragastrointestinal malignancies; therefore periodic surveillance is needed. Here, we describe the clinical features, diagnostics, and therapeutics of hamartomatous polyposis syndromes.</p>

DOI： 10.11280/gee.63.1323

Survey of chemotherapy-induced nausea and vomiting in patients with urothelial carcinoma

Yoshimi A., Shiroma Y., Iwata M., Nakamura M., Torii-Goto A., Hida H., Tanaka N., Miyazaki M., Yamada K., Noda Y.

Molecular and Clinical Oncology Vol. 15 ( 4 ) 2021

Language：Japanese Publisher：Molecular and Clinical Oncology

Chemotherapy-induced nausea and vomiting (CINV) can cause anorexia, weight loss and deterioration of patient quality of life. It is one of the most unpleasant adverse effects of chemotherapy treatment regimens. For the optimal treatment of gastrointestinal symptoms during urothelial carcinoma chemotherapy, the present study investigated the association between gastrointestinal symptoms and therapeutic effects of gemcitabine plus platinum [cisplatin (GC) or carboplatin (GCa)] therapies. The incidence and frequency of nausea/vomiting with GC split therapy (gemcitabine, 1,000 mg/m2 on days 1 and 8; split-dose cisplatin, 35 mg/m2 on days 1 and 8; 21-day schedule) and GCa therapy [gemcitabine, 750-1,000 mg/m2 on days 1, 8 and 15; carboplatin, area under the blood concentration-time curve=5 mg min/ml (Calvert formula) on day 2; 28-day schedule] were lower compared with those of GC therapy (gemcitabine, 1,000 mg/m2 on days 1, 8 and 15; single-dose cisplatin 70 mg/m2 on day 2; 28-day schedule). However, no differences in therapeutic outcomes were observed among therapies. GCa therapy, regardless of renal function, and GC split therapy demonstrated significant increases compared with GC therapy in alleviating gastrointestinal symptoms associated with cancer chemotherapy in patients with urothelial carcinoma. Overall, these results suggested that split-dose cisplatin administration or the use of carboplatin instead of cisplatin may be useful in patients who experience CINV without compromising treatment effectiveness.

DOI： 10.3892/mco.2021.2384

SYSTEMATIC REVIEW AND META-ANALYSIS OF THE DIAGNOSTIC AND THERAPEUTIC YIELD OF SMALL BOWEL ENDOSCOPY IN PATIENTS WITH OVERT SMALL BOWEL BLEEDING

UCHIDA Genta, NAKAMURA Masanao, YAMAMURA Takeshi, FURUKAWA Kazuhiro, KAWASHIMA Hiroki, HONDA Takashi, ISHIGAMI Masatoshi, FUJISHIRO Mitsuhiro

GASTROENTEROLOGICAL ENDOSCOPY Vol. 63 ( 9 ) page： 1649 - 1665 2021

Language：Japanese Publisher：Japan Gastroenterological Endoscopy Society

<p>Background: Small bowel endoscopy, including small bowel capsule endoscopy (SBCE) and balloon-assisted endoscopy (BAE), is useful for small bowel bleeding (SBB) assessment. However, the specific management strategy for overt SBB is not well established. This meta-analysis aimed to evaluate the pooled diagnostic yields (DYs) and therapeutic yields (TYs) of small bowel endoscopy in overt SBB and to determine the optimal endoscopy timing.</p><p>Methods: A comprehensive literature search was performed of studies examining the DY and/or TY of small bowel endoscopy in overt SBB. Data on the DY, TY, and timing of small bowel endoscopy were extracted, pooled, and analyzed. The pooled DY and TY of small bowel endoscopy for patients with overt SBB were calculated. Meta-regression and subgroup analysis were performed.</p><p>Results: Twenty-two studies were included. The pooled DY was 65.2% and 74.0% for SBCE and BAE, respectively. The pooled TY of SBCE and BAE was 55.9% and 35.8%, respectively. A meta-regression model showed that the timing of endoscopy was significantly associated with the DY of BAE and the TY of SBCE and BAE.</p><p>Conclusions: Small bowel capsule endoscopy and BAE would be useful diagnostic and therapeutic modalities in overt SBB. According to the subgroup analysis, in which the TY seemed to be higher within 2 days after bleeding for SBCE and BAE, the optimal timing of endoscopy would be within 2 days.</p>

DOI： 10.11280/gee.63.1649

Impact of SARS-CoV-2 Pandemic on Colorectal Cancer Screening Delay：Effect on Stage Shift and Increased Mortality<sup> 1）</sup>.

GASTROENTEROLOGICAL ENDOSCOPY Vol. 63 ( 12 ) page： 2525 - 2525 2021

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