Faculty Profiles - NAKAMURA, Masanao

Papers - NAKAMURA, Masanao

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COLOR INFORMATION FROM LINKED COLOR IMAGING IS ASSOCIATED WITH INVASION DEPTH AND VASCULAR DIAMETER IN SUPERFICIAL ESOPHAGEAL SQUAMOUS CELL CARCINOMA

KOBAYASHI Kenichi, MIYAHARA Ryoji, FUNASAKA Kohei, FURUKAWA Kazuhiro, SAWADA Tsunaki, MAEDA Keiko, YAMAMURA Takeshi, ISHIKAWA Takuya, OHNO Eizaburo, NAKAMURA Masanao, KAWASHIMA Hiroki, NAKAGURO Masato, OKUMURA Yuki, HIROOKA Yoshiki, FUJISHIRO Mitsuhiro

GASTROENTEROLOGICAL ENDOSCOPY Vol. 62 ( 9 ) page： 1624 - 1633 2020

Language：Japanese Publisher：Japan Gastroenterological Endoscopy Society

Objectives: Accurate diagnosis of invasion depth is important for reliable treatment of esophageal squamous cell carcinoma (ESCC), but it is limited to the muscularis mucosae to slight submucosal invasion (MM/SM1). The diagnostic accuracy of invasion depth is unsatisfactory and remains to be improved. We aimed to investigate the association between the color of the superficial ESCC and invasion depth using linked color imaging (LCI) under light-emitting diode (LED) light sources.Methods: Lesions diagnosed as superficial ESCC were observed using white light imaging and then by LCI. The color values were calculated using Commission Internationale de lʼEclariage - L＊a＊b＊ color space, and the color difference was calculated according to invasion depth. The vascular diameters and vascular angles of the intrapapillary capillary loops were pathologically analyzed. Their correlation with mucosal color was also investigated by LCI.Results: In all, 52 lesions from 48 patients were analyzed. On the basis of invasion depth, the color difference between the normal mucosa and the lesion was larger in the MM/SM1 or deeper group than in the epithelium and the lamina propria mucosa (EP/LPM) group using LCI (P=0.025). The vascular diameter was positively correlated with the b＊ color value (correlation coefficient=0.302, P=0.033).Conclusion: Observation using LCI under LED light sources may improve the endoscopic diagnosis of the invasion depth of superficial ESCC. Further research is needed to validate its usefulness. (UMIN000024615)

DOI： 10.11280/gee.62.1624

Scopus

CiNii Research

Refractory Ulcerative Colitis Improved by Scheduled Combination Therapy of Vedolizumab and Granulocyte and Monocyte Adsorptive Apheresis

Nakamura Masanao, Yamamura Takeshi, Maeda Keiko, Sawada Tsunaki, Mizutani Yasuyuki, Ishikawa Eri, Ohashi Ayako, Kajikawa Go, Furukawa Kazuhiro, Ohno Eizaburo, Honda Takashi, Kawashima Hiroki, Ishigami Masatoshi, Fujishiro Mitsuhiro

Internal Medicine Vol. 59 ( 23 ) page： 3009 - 3014 2020

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

Granulocyte and monocyte adsorptive apheresis (GMA) is occasionally introduced as an alternative combination therapy after loss of response to biologics in ulcerative colitis (UC) patients. However, there have been no reports of the concomitant use of vedolizumab (VDZ) and GMA for the initial induction of UC. A 20-year-old man with refractory UC was admitted for recrudescence. VDZ monotherapy had previously been introduced but was ineffective. Therefore, he received scheduled combination of VDZ and GMA and achieved clinical remission. The combination of two different approaches to inhibit the migration of leukocytes into the inflamed tissue led to satisfactory clinical outcomes.

DOI： 10.2169/internalmedicine.5302-20

単発性小腸Peutz-Jeghers型ポリープに関する臨床的検討

鳥山和浩, 中村正直, 山村健史, 前田啓子, 澤田つな騎, 水谷泰之, 石川恵里, 梶川豪, 村手健太郎, 喜田裕一, 江崎正哉, 濱崎元伸, 角嶋直美, 古川和宏, 藤城光弘

日本小腸学会学術集会プログラム・抄録集 Vol. 4 ( 0 ) page： 39 - 39 2020

Language：Japanese Publisher：日本小腸学会

【背景】Peutz-Jeghers症候群（PJS）は食道を除く全消化管において上皮の過形成と粘膜筋板のポリープ内への樹枝状増生を特徴とする過誤腫性ポリポーシスと皮膚、粘膜の色素斑を特徴とする常染色体優性遺伝性疾患である。一方、家族歴や皮膚、粘膜の色素沈着を伴わない単発性のPeutz-Jeghers型ポリープ（PJP）を認めることがあるが、その臨床的特徴に関する報告は少ないのが現状である。【目的】単発性小腸PJPにおける臨床的特徴を明らかにする。【対象】2007年4月から2020年5月までに当院で内視鏡治療を施行し、病理組織学的にPJPと診断された単発性小腸PJP16症例。【結果】レトロスペクティブにカルテ、内視鏡画像をレビューした。性別は男性10例、女性6例、診断時年齢中央値（範囲）は61（18-82）歳。診断契機は貧血7例、黒色便5例、腹痛1例、イレウス症状1例、他疾患精査時の偶発的発見が2例。原発部位は空腸14例、回腸2例で、腫瘍径中央値（範囲）は25（4-35）mm。切除したPJP全病変で病変内に悪性腫瘍の併存は認めなかった。癌の既往歴を有したのは6例（前立腺癌2例、舌癌1例、大腸癌1例、胃癌1例、子宮体癌1例）。観察期間中央値（範囲）は4.6（0.1-53.7）ヶ月で再発並びに関連死は認めなかった。【考察】単発性小腸PJPにおいては診断時の年齢が高く、発見契機としては出血関連症状が多く、病変部位は空腸に多い特徴があった。【結語】当院で経験した単発性小腸PJPの臨床的特徴を検討した。今後更なる症例の蓄積が必要である。

DOI： 10.32264/shocho.4.0_39

CiNii Research

A Prospective Study of Factors Associated with Abdominal Pain in Patients during Unsedated Colonoscopy Using a Magnifying Endoscope

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

Internal Medicine Vol. 59 ( 15 ) page： 1795 - 1801 2020

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

Objective With the advent of endoscopic treatment, the detailed diagnosis of colorectal neoplasms made using magnifying colonoscopy has become increasingly important. However, insertion difficulty causes pain in unsedated colonoscopy. The aim of this prospective observational study was to clarify the factors associated with a patient's pain in unsedated colonoscopy using a magnifying endoscope. Methods Patient pain was assessed using a numerical rating scale (0-10) immediately after the procedure. We defined 5 as mild enough pain that patients would not be reluctant to undergo another colonoscopy. Acceptable pain was defined as 5 or less and severe pain was defined as 8 to 10. Univariate and multivariate linear regression analyses were performed using the pain scale score as a dependent variable. Results A total of consecutive 600 patients undergoing unsedated colonoscopies were evaluated to assess their abdominal pain. The completion rate was 99.5% (597/600). The mean pain scale score was 3.88±2.38. The rate of acceptable pain was 80.5% (483/600). The rate of severe pain was 6.7% (40/600) including the incomplete cases. A comparison of polyp-positive and polyp-negative cases revealed no marked difference in patient pain (3.82±2.24 vs. 3.94±2.49, respectively; p=0.590) or insertion time (6.62±3.98 vs. 6.29±4.21, p=0.090), while more observation time was needed in polyp-positive cases than in polyp-negative ones (16.30±4.95 vs. 13.08±4.69, p<0.01). Univariate and multivariate linear regression analyses revealed that an older age, colectomy, antispasmodic agent use, and a small-diameter endoscope were significant factors associated with less patient pain. In particular, a small-diameter endoscope induces significantly more acceptable pain than a non-small diameter endoscope [85.63% (274/320) vs. 73.93% (207/280), p=0.00003]. Conclusion Unsedated colonoscopy using a magnifying endoscope by an expert may result in acceptable pain levels. The use of an antispasmodic agent, particularly hyoscine N-butyl bromide, and a small-diameter endoscope are recommended for reducing abdominal pain during unsedated colonoscopy.

DOI： 10.2169/internalmedicine.4267-19

カプセル内視鏡内服不可能および内視鏡的挿入補助具に関する全国多施設共同調査（AdvanCE-J study）

大宮直木, 岡志郎, 中村正直, 中山佳子, 岩間達, 田中信治, 田尻久雄

日本小腸学会学術集会プログラム・抄録集 Vol. 4 ( 0 ) page： 45 - 45 2020

Language：Japanese Publisher：日本小腸学会

【背景・目的】カプセル内視鏡は乳児・年少児や稀に成人でも内服困難で、また長時間食道内や胃内に停滞することもある。その際、上部消化管内視鏡下でネットやスネア、挿入補助器具のAdvanCE®（US Endoscopy社製、国内販売：富士フイルムメディカル）を用いて十二指腸に誘導する必要がある。AdvanCEは2013年に薬事承認されたが、現在保険未承認である。本邦小児例におけるAdvanCEの有用性については、すでにIwamaらが2013～2017年に18歳未満でAdvanCEによる挿入補助を行った154例を対象に、90％で十二指腸への誘導が可能であり、89％でカプセル内視鏡による全小腸観察が可能で重篤な有害事象の発生はなかったと報告している（Eur J Gastroenterol Hepatol 2019; 31:1502-1507）。ただ、これまで成人例でのカプセル内視鏡の内服困難例、食道・胃内での停滞例での挿入補助具の使用報告は少ない。そこで、本研究ではAdvanCEの手技料加算承認を目標とし、本邦小児・成人例におけるカプセル内視鏡挿入補助器具の使用実態について調査し、その有効性および安全性を遡及的に多施設共同で検討する（課題名：カプセル内視鏡内服不可能および内視鏡的挿入補助具に関する全国多施設共同調査、Multicenter survey of impossible swallowing of capsule endoscopy and use of capsule delivery system including AdvanCE system in Japan：AdvanCE-J study）。【方法】小腸・大腸カプセル内視鏡検査、パテンシーカプセルによる消化管通過性検査を行った症例を対象に以下の項目を調査する。今後倫理委員会承認後に藤田医科大学のREDCap®を用いたオンライン登録で入力を行う予定である。1．検査数（導入開始～直近）、2．そのうちカプセル内服不可または不可と予測された件数、3．内服不可（予測含む）および挿入補助具使用した各症例の内訳：性別、年齢、身長、体重、検査契機、病名、既往歴、カプセル内視鏡前のパテンシーカプセルによる消化管通過性検査の有無、カプセル嚥下可能・不可・不可（予測）、嚥下不可（予測含む）であった理由、対応（カプセル検査中止、使用機材種類）、補助具使用の理由、鎮静の有無、補助具挿入の施行場所、デリバリー時間、カプセル留置部位、有害事象、全小腸（大腸）観察の有無、カプセル内視鏡所見、各施設の補助具使用ルール。

DOI： 10.32264/shocho.4.0_45

CiNii Research

Endoscopic screening for gastric cancer

FURUKAWA Kazuhiro, NAKAMURA Masanao, FUJISHIRO Mitsuhiro

Nippon Shokakibyo Gakkai Zasshi Vol. 117 ( 6 ) page： 469 - 476 2020

A Case Where Administration of Ustekinumab Maintained the Intestinal Patency After Balloon Dilation for Small Intestinal Stenosis Caused by Crohn's Disease

Murate Kentaro, Nakamura Masanao, Fujishiro Mitsuhiro

INFLAMMATORY BOWEL DISEASES Vol. 25 ( 11 ) page： E140 - E140 2019.11