Updated on 2022/03/29

写真a

 
SAWADA Tsunaki
 
Organization
Nagoya University Hospital Diagnostic and Therapeutic Endoscopy Assistant professor of hospital
Title
Assistant professor of hospital
Contact information
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Degree 1

  1. 博士(医学) ( 2018.3   名古屋大学 ) 

Professional Memberships 3

  1. 日本内科学会

  2. 日本消化器病学会

  3. 日本消化器内視鏡学会

 

Papers 75

  1. Clinical characteristics of gastrointestinal immune-related adverse events of immune checkpoint inhibitors and their association with survival Reviewed

    Yamada Kentaro, Sawada Tsunaki, Nakamura Masanao, Yamamura Takeshi, Maeda Keiko, Ishikawa Eri, Iida Tadashi, Mizutani Yasuyuki, Kakushima Naomi, Ishikawa Takuya, Furukawa Kazuhiro, Ohno Eizaburo, Honda Takashi, Kawashima Hiroki, Ishigami Masatoshi, Furune Satoshi, Hase Tetsunari, Yokota Kenji, Maeda Osamu, Hashimoto Naozumi, Akiyama Masashi, Ando Yuichi, Fujishiro Mitsuhiro

    WORLD JOURNAL OF GASTROENTEROLOGY   Vol. 27 ( 41 ) page: 7190 - 7206   2021.11

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    Authorship:Corresponding author   Language:English   Publisher:World Journal of Gastroenterology  

    BACKGROUND Despite the popularity of immune checkpoint inhibitors (ICIs) in the treatment of advanced cancer, patients often develop gastrointestinal (GI) and non-GI immune- related adverse events (irAEs). The clinical characteristics and survival outcomes of GI-irAEs have not been fully elucidated in previous reports. This necessitates the evaluation of the impact of GI-irAEs on patients receiving ICI treatment. AIM To evaluate the clinical characteristics of GI-irAEs and their impact on survival in patients treated with ICIs. METHODS In this single-center, retrospective, observational study, we reviewed the records of 661 patients who received ICIs for various cancers at Nagoya University Hospital from September 2014 to August 2020. We analyzed the clinical characteristics of patients who received ICI treatment. We also evaluated the correlation between GI-irAE development and prognosis in non-small cell lung cancer (LC) and malignant melanoma (MM). Kaplan-Meier analysis was used to compare the median overall survival (OS). Multivariate Cox proportional hazards models were used to identify prognostic factors. A P value < 0.05 was considered statistically significant. RESULTS GI-irAEs occurred in 34 of 605 patients (5.6%) treated with an anti-programmed cell death-1/programmed death-ligand 1 (anti-PD-1/PD-L1) antibody alone and in nine of 56 patients (16.1%) treated with an anti-cytotoxic T-lymphocyte antigen 4 (CTLA-4) antibody alone or a combination of anti-PD-1 and anti-CTLA-4 antibodies. The cumulative incidence and median daily diarrhea frequency were significantly higher in patients receiving anti-CTLA-4 antibodies (P < 0.05). In 130 patients with MM, OS was significantly prolonged in the group that continued ICI treatment despite the development of GI-irAEs compared to the group that did not experience GI-irAEs (P = 0.035). In contrast, in 209 patients with non-small cell LC, there was no significant difference in OS between the groups. The multivariate analyses showed that a performance status of 2-3 (hazard ratio: 2.406; 95% confidence interval: 1.125-5.147; P = 0.024) was an independent predictive factor for OS in patients with MM. CONCLUSION Patients receiving anti-CTLA-4 antibodies develop GI-irAEs more frequently and with higher severity than those receiving anti-PD-1/PD-L1 antibodies. Continuing ICI treatment in patients with MM with GI-irAEs have better OS.

    DOI: 10.3748/wjg.v27.i41.7190

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  2. Clinical factors related to false-positive rates of patency capsule examination

    Sawada Tsunaki, Nakamura Masanao, Watanabe Osamu, Yamamura Takeshi, Ishikawa Takuya, Furukawa Kazuhiro, Funasaka Kohei, Ohno Elzaburo, Kawashima Hiroki, Miyahara Ryoji, Goto Hidemi, Hirooka Yoshiki

    THERAPEUTIC ADVANCES IN GASTROENTEROLOGY   Vol. 10 ( 8 ) page: 589 - 598   2017.8

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    Authorship:Lead author   Language:English   Publishing type:Research paper (scientific journal)  

    DOI: 10.1177/1756283X17722744

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

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

    GASTRIC CANCER   Vol. 25 ( 2 ) page: 382 - 391   2022.3

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    Language:Japanese   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

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  4. 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

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    Publisher:株式会社医学書院  

    DOI: 10.11477/mf.1403202660

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

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

    INTERNATIONAL JOURNAL OF CLINICAL ONCOLOGY     2022.2

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    Language:Japanese   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

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  6. Preliminary Comparison of Endoscopic Brush and Net Catheters as the Sampling Tool to Analyze the Intestinal Mucus in the Rectum with Ulcerative Colitis Patients

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

    DIGESTION     page: 1 - 12   2022.2

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    Language:Japanese   Publisher:Digestion  

    Background: The pathophysiology of ulcerative colitis (UC) remains unclear, but early lesions on the colorectal mucosal surface may play an important role in its etiology. Intestinal mucus samples, including inner and outer layers, are collected by net or brush catheters, but the quality of the samples obtained by each method has not been fully investigated. Objective: The purpose of this study was to compare the microbiome and protein content of intestinal mucus collected by net and brush catheters during colonoscopy. Methods: Intestinal mucus samples from the lower rectum of 4 patients with UC were collected using a net catheter, a brush catheter, and intestinal fluid suction. Microbiome and protein content were analyzed using 16S rRNA gene sequencing and mass spectrometry. Results: The patients demonstrated significant differences in microbiome alpha diversity (p < 0.05), but this difference was not observed between the sampling methods. Net catheter samples demonstrated higher total protein concentrations than brush catheter samples. The brush catheter group had more Lachnospira, a butyrate-producing bacterium, when compared to the net group. The brush catheter group also had more oral bacteria of Staphylococcus and Dialister in those with active phase when compared to the net group. Conclusions: Brush catheters are more likely to collect the intestinal mucus inner layer, whereas net catheters are more likely to collect larger samples that include the outer mucus layer, as well as the intestinal fluid. Two sampling methods with different types of collection of the mucosa may lead to different results among patients with mucosal vulnerabilities.

    DOI: 10.1159/000521929

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  7. Factors related to delayed adverse events of endoscopic submucosal dissection in the duodenum.

    Kawamura T, Hirose T, Kakushima N, Furukawa K, Furune S, Ishikawa E, Sawada T, Maeda K, Yamamura T, Ishikawa T, Ohno E, Nakamura M, Honda T, Ishigami M, Kawashima H, Fujishiro M

    Digestive diseases (Basel, Switzerland)     2022.2

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    DOI: 10.1159/000522362

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

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

    NAGOYA JOURNAL OF MEDICAL SCIENCE   Vol. 84 ( 1 ) page: 169 - 179   2022.2

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    Language:Japanese   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

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  9. Endoscopic direct clipping versus indirect clipping for colonic diverticular bleeding: A large multicenter cohort study

    Kishino Takaaki, Nagata Naoyoshi, Kobayashi Katsumasa, Yamauchi Atsushi, Yamada Atsuo, Omori Jun, Ikeya Takashi, Aoyama Taiki, Tominaga Naoyuki, Sato Yoshinori, Ishii Naoki, Sawada Tsunaki, Murata Masaki, Takao Akinari, Mizukami Kazuhiro, Kinjo Ken, Fujimori Shunji, Uotani Takahiro, Fujita Minoru, Sato Hiroki, Suzuki Sho, Narasaka Toshiaki, Hayasaka Junnosuke, Funabiki Tomohiro, Kinjo Yuzuru, Mizuki Akira, Kiyotoki Shu, Mikami Tatsuya, Gushima Ryosuke, Fujii Hiroyuki, Fuyuno Yuta, Gunji Naohiko, Toya Yosuke, Narimatsu Kazuyuki, Manabe Noriaki, Nagaike Koji, Kinjo Tetsu, Sumida Yorinobu, Funakoshi Sadahiro, Kawagishi Kana, Matsuhashi Tamotsu, Komaki Yuga, Miki Kuniko, Watanabe Kazuhiro, Kaise Mitsuru

    UNITED EUROPEAN GASTROENTEROLOGY JOURNAL   Vol. 10 ( 1 ) page: 93 - 103   2022.2

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    Language:Japanese   Publisher:United European Gastroenterology Journal  

    Background: Direct and indirect clipping treatments are used worldwide to treat colonic diverticular bleeding (CDB), but their effectiveness has not been examined in multicenter studies with more than 100 cases. Objective: We sought to determine the short- and long-term effectiveness of direct versus indirect clipping for CDB in a nationwide cohort. Methods: We studied 1041 patients with CDB who underwent direct clipping (n = 360) or indirect clipping (n = 681) at 49 hospitals across Japan (CODE BLUE-J Study). Results: Multivariate analysis adjusted for age, sex, and important confounding factors revealed that, compared with indirect clipping, direct clipping was independently associated with reduced risk of early rebleeding (<30 days; adjusted odds ratio [AOR] 0.592, p = 0.002), late rebleeding (<1 year; AOR 0.707, p = 0.018), and blood transfusion requirement (AOR 0.741, p = 0.047). No significant difference in initial hemostasis rates was observed between the two groups. Propensity-score matching to balance baseline characteristics also showed significant reductions in the early and late rebleeding rates with direct clipping. In subgroup analysis, direct clipping was associated with significantly lower rates of early and late rebleeding and blood transfusion need in cases of stigmata of recent hemorrhage with non-active bleeding on colonoscopy, right-sided diverticula, and early colonoscopy, but not with active bleeding on colonoscopy, left-sided diverticula, or elective colonoscopy. Conclusions: Our large nationwide study highlights the use of direct clipping for CDB treatment whenever possible. Differences in bleeding pattern and colonic location can also be considered when deciding which clipping options to use.

    DOI: 10.1002/ueg2.12197

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  10. Isotope effect of rovibrational distribution of hydrogen molecules desorbed from amorphous carbon

    Nakamura Hiroaki, Saito Seiki, Sawada Takumi, Sawada Keiji, Kawamura Gakushi, Kobayashi Masahiro, Hasuo Masahiro

    JAPANESE JOURNAL OF APPLIED PHYSICS   Vol. 61 ( SA )   2022.1

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    Language:Japanese   Publisher:Japanese Journal of Applied Physics  

    When the hydrogen isotope atom is injected into the amorphous carbon with the incident energies E in of 20, 50, and 80 eV, we obtain the following physical quantities of hydrogen isotope atoms/molecules emitted from the amorphous carbon using molecular dynamics and heat conduction hybrid simulation. The physical quantities are the time evolution of the emission rate, the depth distribution of the original location of the hydrogen emitted from the target, the polar angular dependence, and the translational, rotational, and vibrational energy distributions. In addition, the approximate analysis yields the emission distributions at the vibrational (v) and rotational (J) levels. Using these distributions, we evaluate the rotational temperature T rot for v = 0 and small J states. From the above, it is found that molecules with higher rotational levels J tend to be emitted as E in increases or as the mass of hydrogen isotope increases. Moreover, the isotope effect appears in the mass dependence of T rot.

    DOI: 10.35848/1347-4065/ac2435

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

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

    QUANTITATIVE IMAGING IN MEDICINE AND SURGERY   Vol. 12 ( 1 ) page: 618 - 626   2022.1

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    Language:Japanese   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

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  12. Treatment strategies for reducing early and late recurrence of colonic diverticular bleeding based on stigmata of recent hemorrhage: a large multicenter study.

    Gobinet MS, Nagata N, Kobayashi K, Yamauchi A, Yamada A, Omori J, Ikeya T, Aoyama T, Tominaga N, Sato Y, Kishino T, Ishii N, Sawada T, Murata M, Takao A, Mizukami K, Kinjo K, Fujimori S, Uotani T, Fujita M, Sato H, Suzuki S, Narasaka T, Hayasaka J, Funabiki T, Kinjo Y, Mizuki A, Kiyotoki S, Mikami T, Gushima R, Fujii H, Fuyuno Y, Gunji N, Toya Y, Narimatsu K, Manabe N, Nagaike K, Kinjo T, Sumida Y, Funakoshi S, Kawagishi K, Matsuhashi T, Komaki Y, Miki K, Watanabe K, Uemura N, Itawa E, Sugimoto M, Fukuzawa M, Kawai T, Kaise M, Itoi T

    Gastrointestinal endoscopy     2021.12

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    Language:English   Publisher:Gastrointestinal Endoscopy  

    Background and Aims: Treatment strategies for colonic diverticular bleeding (CDB) based on stigmata of recent hemorrhage (SRH) remain unstandardized, and no large studies have evaluated their effectiveness. We sought to identify the best strategy among combinations of SRH identification and endoscopic treatment strategies. Methods: We retrospectively analyzed 5823 CDB patients who underwent colonoscopy at 49 hospitals throughout Japan (CODE-BLUE J-Study). Three strategies were compared: find SRH (definitive CDB) and treat endoscopically, find SRH (definitive CDB) and treat conservatively, and without finding SRH (presumptive CDB) treat conservatively. In conducting pairwise comparisons of outcomes in these groups, we used propensity score–matching analysis to balance baseline characteristics between the groups being compared. Results: Both early and late recurrent bleeding rates were significantly lower in patients with definitive CDB treated endoscopically than in those with presumptive CDB treated conservatively (<30 days, 19.6% vs 26.0% [P < .001]; <365 days, 33.7% vs 41.6% [P < .001], respectively). In patients with definitive CDB, the early recurrent bleeding rate was significantly lower in those treated endoscopically than in those treated conservatively (17.4% vs 26.7% [P = .038] for a single test of hypothesis; however, correction for multiple testing of data removed this significance). The late recurrent bleeding rate was also lower, but not significantly, in those treated endoscopically (32.0% vs 36.1%, P = .426). Definitive CDB treated endoscopically showed significantly lower early and late recurrent bleeding rates than when treated conservatively in cases of SRH with active bleeding, nonactive bleeding, and in the right-sided colon but not left-sided colon. Conclusions: Treating definitive CDB endoscopically was most effective in reducing recurrent bleeding over the short and long term, compared with not treating definitive CDB or presumptive CDB. Physicians should endeavor to find and treat SRH for suspected CDB.

    DOI: 10.1016/j.gie.2021.12.023

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  13. Real-world local recurrence rate after cold polypectomy in colorectal polyps less than 10 mm using propensity score matching

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

    WORLD JOURNAL OF GASTROENTEROLOGY   Vol. 27 ( 47 ) page: 8182 - 8193   2021.12

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    Language:Japanese   Publisher:World Journal of Gastroenterology  

    BACKGROUND Cold polypectomy (CP) is a simple and safe procedure for polyps less than 10 mm in size; however, there is concern about local recurrence following CP because of unidentified margins of excised specimens and the lack of tumor suppression effect by coagulation. Some clinical trials have evaluated local persistent recurrence; their results suggest that a higher rate of local recurrence has not been documented so far. There were few reports that observed the course over long periods of time after CP in clinical practice. AIM To evaluate the presence of local recurrence following CP and hot polypectomy (HP) using propensity score matching. METHODS We analyzed 275 patients who underwent polypectomy for non-pedunculated colorectal polyps less than 10 mm (959 Lesions) between October 2016 and 2017 and underwent follow-up endoscopy subsequently. We divided them into the CP group (706 Lesions), wherein CP was performed, and the HP group (253 Lesions), wherein HP was performed. Using propensity score matching, we extracted 215 Lesions in each group and evaluated the local recurrence and content of CP in the real clinic and adverse events using medical records. RESULTS After propensity score matching, there were no significant differences in the patients’ and their endoscopic background (age, use of antithrombotics, indications, size, morphology, location of polyps, and polypectomy device) between the groups. The mean duration between colorectal polypectomy and the next follow-up colonoscopy was 17.5 ± 7.1 (range, 6-39) mo in the CP group and 15.7 ± 6.0 (range, 6-35) mo in the HP group, which was significantly longer in the CP group (P = 0.005). The local recurrence rate was 0.93% in the CP group and 0.93% in the HP group, without a significant difference (P = 0.688). Additionally, no differences were observed in the macroscopic en bloc resection rate, histopathological complete resection rate, and pathological results between the groups. Adverse events did not occur in either group. CONCLUSION Local recurrence after CP was equivalent to that following HP in clinical practice. CP is useful and safe in the treatment of non-pedunculated polyps of less than 10 mm.

    DOI: 10.3748/wjg.v27.i47.8182

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  14. 特集 Cold polypectomyの課題 4.症例からみえた課題(1)小腸ポリープに対するcold polypectomy

    山村 健史, 中村 正直, 前田 啓子, 澤田 つな騎, 石川 恵里, 角嶋 直美, 古川 和宏, 川嶋 啓揮

    臨床消化器内科   Vol. 37 ( 1 ) page: 93 - 96   2021.12

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    Publisher:日本メディカルセンター  

    DOI: 10.19020/cg.0000002065

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  15. Effectiveness and adverse events of endoscopic clipping versus band ligation for colonic diverticular hemorrhage: a large-scale multicenter cohort study.

    Kobayashi K, Nagata N, Furumoto Y, Yamauchi A, Yamada A, Omori J, Ikeya T, Aoyama T, Tominaga N, Sato Y, Kishino T, Ishii N, Sawada T, Murata M, Takao A, Mizukami K, Kinjo K, Fujimori S, Uotani T, Fujita M, Sato H, Suzuki S, Narasaka T, Hayasaka J, Kaise M, CODE BLUE-J study collaborators., Funabiki T, Kinjo Y, Mizuki A, Kiyotoki S, Mikami T, Gushima R, Fujii H, Fuyuno Y, Gunji N, Toya Y, Narimatsu K, Manabe N, Nagaike K, Kinjo T, Sumida Y, Funakoshi S, Kawagishi K, Matsuhashi T, Komaki Y, Miki K, Watanabe K, Kitano N, Kato S, Sakai S, Oshina E, Mochida T, Okura Y, Matsuoka M, Nozaka T, Sato A, Yauchi M, Matsumoto T, Asano T

    Endoscopy     2021.11

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    Background Prior studies have shown the effectiveness of both endoscopic band ligation (EBL) and clipping for colonic diverticular hemorrhage (CDH) but have been small and conducted at single centers. Therefore, we investigated which was the more effective and safe treatment in a multicenter long-term cohort study. Methods We reviewed data for 1679 patients with CDH who were treated with EBL (n=638) or clipping (n=1041) between January 2010 and December 2019at 49 hospitals across Japan (CODE BLUE-J study). Logistic regression analysis was used to compare outcomes between the two treatments. Results In multivariate analysis, EBL was independently associated with reduced risk of early rebleeding (adjusted odds ratio [OR] 0.46; P <0.001) and late rebleeding (adjusted OR 0.62; P <0.001) compared with clipping. These significantly lower rebleeding rates with EBL were evident regardless of active bleeding or early colonoscopy. No significant differences were found between the treatments in the rates of initial hemostasis or mortality. Compared with clipping, EBL independently reduced the risk of needing interventional radiology (adjusted OR 0.37; P =0.006) and prolonged length of hospital stay (adjusted OR 0.35; P <0.001), but not need for surgery. Diverticulitis developed in one patient (0.16%) following EBL and two patients (0.19%) following clipping. Perforation occurred in two patients (0.31%) following EBL and none following clipping. Conclusions Analysis of our large endoscopy dataset suggests that EBL is an effective and safe endoscopic therapy for CDH, offering the advantages of lower early and late rebleeding rates, reduced need for interventional radiology, and shorter length of hospital stay.

    DOI: 10.1055/a-1705-0921

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  16. Endocytoscopy Is Useful for the Diagnosis of Superficial Nonampullary Duodenal Epithelial Tumors

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

    DIGESTION   Vol. 102 ( 6 ) page: 895 - 902   2021.11

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    Introduction: Endoscopic criteria for the diagnosis of superficial nonampullary duodenal epithelial tumors (SNADETs) are lacking. The aim of this study was to explore the usefulness of endocytoscopy (ECS) in the duodenum. Methods: A total of 77 ECS images stained by methylene blue and 58 images with double staining of methylene blue and crystal violet were obtained from 20 patients. Images were classified into 3 grades based on nuclear and villi atypia: EC A, B, and C. Diagnostic performance of ECS classification to predict histology and interobserver agreement was evaluated. The performance was compared between staining methods and ×520 or ×936 zoom. Results: With methylene blue staining, high rates of accuracy, sensitivity, specificity, and positive predictive value (PPV) over 90% were achieved for tumor and nontumor diagnosis as assessed by EC A versus EC B. High rates of accuracy, sensitivity, PPV, and negative predictive value over 90% were achieved for the differentiation between the diagnosis of the Vienna category 3 and 4/5 as assessed by EC B versus C. The accuracy rate of interpreting ECS images with ×936 zoom among 10 endoscopists was 82%, and the interobserver agreement rate was 0.803 (Kendall's coefficient of concordance). In the ×936 zoom group, methylene blue staining was significantly associated with higher accuracy rate (odds ratio 1.76 [1.06-2.92], p value 0.0297). No benefit was observed by double staining. Conclusions: ECS diagnosis with methylene blue provides a high accuracy rate and good interobserver agreement to predict histology of SNADETs.

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  17. Outcomes in high and low volume hospitals in patients with acute hematochezia in a cohort study

    Ishii Naoki, Nagata Naoyoshi, Kobayashi Katsumasa, Yamauchi Atsushi, Yamada Atsuo, Omori Jun, Ikeya Takashi, Aoyama Taiki, Tominaga Naoyuki, Sato Yoshinori, Kishino Takaaki, Sawada Tsunaki, Murata Masaki, Takao Akinari, Mizukami Kazuhiro, Kinjo Ken, Fujimori Shunji, Uotani Takahiro, Fujita Minoru, Sato Hiroki, Suzuki Sho, Narasaka Toshiaki, Hayasaka Junnosuke, Funabiki Tomohiro, Kinjo Yuzuru, Mizuki Akira, Kiyotoki Shu, Mikami Tatsuya, Gushima Ryosuke, Fujii Hiroyuki, Fuyuno Yuta, Gunji Naohiko, Toya Yosuke, Narimatsu Kazuyuki, Manabe Noriaki, Nagaike Koji, Kinjo Tetsu, Sumida Yorinobu, Funakoshi Sadahiro, Kawagishi Kana, Matsuhashi Tamotsu, Komaki Yuga, Miki Kuniko, Watanabe Kazuhiro, Omata Fumio, Shiratori Yasutoshi, Imamura Noriatsu, Yano Takahiko, Kaise Mitsuru

    SCIENTIFIC REPORTS   Vol. 11 ( 1 ) page: 20373   2021.10

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    Outcomes of acute lower gastrointestinal bleeding have not been compared according to hospital capacity. We aimed to perform a propensity score-matched cohort study with path and mediation analyses for acute hematochezia patients. Hospitals were divided into high- versus low-volume hospitals for emergency medical services. Rebleeding and death within 30 days were compared. Computed tomography, early colonoscopy (colonoscopy performed within 24 h), and endoscopic therapies were included as mediators. A total of 2644 matched pairs were yielded. The rebleeding rate within 30 days was not significant between high- and low-volume hospitals (16% vs. 17%, P = 0.44). The mortality rate within 30 days was significantly higher in the high-volume cohort than in the low-volume cohort (1.7% vs. 0.8%, P = 0.003). Treatment at high-volume hospitals was not a significant factor for rebleeding (odds ratio [OR] = 0.91; 95% confidence interval [CI], 0.79–1.06; P = 0.23), but was significant for death within 30 days (OR = 2.03; 95% CI, 1.17–3.52; P = 0.012) on multivariate logistic regression after adjusting for patients’ characteristics. Mediation effects were not observed, except for rebleeding within 30 days in high-volume hospitals through early colonoscopy. However, the direct effect of high-volume hospitals on rebleeding was not significant. High-volume hospitals did not improve the outcomes of acute hematochezia patients.

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  18. Endoscopic Ultrasound Elastography as a Novel Diagnostic Method for the Assessment of Hardness and Depth of Invasion in Colorectal Neoplasms

    Esaki Masaya, Yamamura Takeshi, Nakamura Masanao, Maeda Keiko, Sawada Tsunaki, Mizutani Yasuyuki, Ishikawa Eri, Suzuki Hiroto, Kuno Takeshi, Yamada Kentaro, Hasegawa Issei, Ishikawa Takuya, Kakushima Naomi, Furukawa Kazuhiro, Ohno Eizaburo, Kawashima Hiroki, Hirooka Yoshiki, Fujishiro Mitsuhiro

    DIGESTION   Vol. 102 ( 5 ) page: 701 - 713   2021.9

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    Introduction: We aimed to compare the efficacy of endoscopic ultrasound elastography (EUS-EG) with that of magnifying chromoendoscopy (MCE) and endoscopic ultrasonography (EUS) for the diagnosis of the depth of invasion in colorectal neoplasms. This is an important clinical issue as the depth of invasion is associated with the risk of metastasis. Methods: Consecutive patients with suspected superficial colorectal neoplasms, evaluated by MCE, EUS, and EUS-EG, for whom endoscopic submucosal dissection was considered, were enrolled in 2018 (derivation study) and in 2019-2020 (validation study). The primary clinical endpoint was the diagnostic yield differentiating intramucosal and shallow submucosal neoplasms from deep submucosal (dSM) and advanced colorectal cancers. In addition, inter- and intra-observer agreements of the elastic score of colorectal neoplasm (ES-CRN) were evaluated by 2 expert and 2 non-expert endoscopists. Results: Thirty-one (33 lesions) and 50 (55 lesions) patients were enrolled in the derivation and validation studies, respectively. Sensitivity, specificity, positive, and negative predictive values, and accuracy of assessment of the depth of submucosal or deeper invasion in the derivation and validation groups were as follows: EUS-EG, 100/88.2/86.7/100/93.3% and 77.8/86.1/73.7/88.6/83.3%; MCE, 66.7/94.4/90.9/77.3/81.8% and 84.2/91.4/84.2/91.4/88.9%; and EUS, 93.3/77.8/77.8/93.3/84.8% and 89.5/65.7/58.6/92.0/74.1%, respectively. For the 2 expert endoscopists, interobserver agreement for the ES-CRN (first and second assessments) in the derivation group was 0.84 and 0.78, respectively; these values were 0.73 and 0.49, respectively, for the 2 non-expert endoscopists. Discussion/Conclusion: All 3 modalities presented similar diagnostic yield. Inter- and intra-observer agreements of the ES-CRN were substantial, even for non-expert endoscopists. Therefore, EUS-EG may be a useful modality in determining the depth of invasion in colorectal neoplasms.

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  19. Detection of Colorectal Neoplasms Using Linked Color Imaging: A Prospective, Randomized, Tandem Colonoscon Trial

    Hasegawa Issei, Yamamura Takeshi, Suzuki Hiroto, Maeda Keiko, Sawada Tsunaki, Mizutani Yasuyuki, Ishikawa Eri, Ishikawa Takuya, Kakushima Naomi, Furukawa Kazuhiro, Ohno Eizaburo, Kawashima Hiroki, Nakamura Masanao, Fujishiro Mitsuhiro

    CLINICAL GASTROENTEROLOGY AND HEPATOLOGY   Vol. 19 ( 8 ) page: 1708 - +   2021.8

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    Background and aims: A higher adenoma detection rate (ADR) has been shown to be related to a lower incidence and mortality of colorectal cancer. We analyzed the efficacy of linked color imaging (LCI) by assessing the detection, miss, and visibility of various featured adenomas as compared with white light imaging (WLI). Methods: This was a prospective, randomized, tandem trial. The participants were randomly assigned to 2 groups: first observation by LCI, then second observation by WLI (LCI group); or both observations by WLI (WLI group). Suspected neoplastic lesions were resected after magnifying image-enhanced endoscopy. The primary outcome was to compare the ADR during the first observation. Secondary outcomes included evaluation of adenoma miss rate (AMR) and visibility score. Results: A total of 780 patients were randomized, 700 of whom were included in the final analysis. The ADR was 69.6% and 63.2% in the LCI and WLI groups, respectively, with no significant difference. However, LCI improved the average ADR in low-detectors compared with high-detectors (76.0% vs 55.1%; P < .001). Total AMR was 20.6% in the LCI group, which was significantly lower than that in the WLI group (31.1%) (P < .001). AMR in the LCI group was significantly lower, especially for diminutive adenomas (23.4% vs 35.1%; P < .001) and nonpolypoid lesions (25.6% vs 37.9%; P < .001) compared with the WLI group. Conclusion: Although both methods provided a similar ADR, LCI had a lower AMR than WLI. LCI could benefit endoscopists with lower ADR, an observation that warrants additional study. (UMIN Clinical Trials Registry, Number: UMIN000026359).

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  20. A forward-viewing radial-array echoendoscope is useful for diagnosing the depth of colorectal neoplasia invasion

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

    SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES   Vol. 35 ( 8 ) page: 4389 - 4398   2021.8

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    Background: It is important to accurately diagnose the depth of colorectal neoplasia invasion. We aimed to evaluate the usefulness of a new forward-viewing radial-array echoendoscope (FRE), relative to the pit pattern method. Methods: In this prospective study, the invasion depth of suspected early-stage carcinoma was diagnosed using the pit pattern and FRE methods. The diagnoses were classified as T1a (submucosal invasion distance < 1,000 μm) or shallower and T1b (≥ 1,000 μm) or deeper. Pathological diagnoses were used to compare the diagnostic capabilities of the two methods. Results: The final analyses included 110 lesions. The FRE was successfully inserted to the lesion in all cases. There were no significant differences between the two methods regarding the correct prediction rate (79.1% vs. 75.5%, P = 0.57), accuracy (81.3% vs. 79.0%, P = 0.68), specificity (81.3% vs. 70.8%, P = 0.135), positive predictive value (65.0% vs. 60.4%, P = 0.649), negative predictive value (91.0% vs. 98.1%, P = 0.108), or frequency of unevaluable cases (2.7% vs. 4.5%, P = 0.471). The correct prediction rate was calculated by adding the number of unevaluable cases to the denominator of accuracy. Relative to the pit pattern method, the FRE method offered significantly higher sensitivity for predicting T1b or deeper invasion (81.3% vs. 97.0%, P = 0.048). The pit pattern method had significantly poorer accuracy for large lesions (> 36 mm) than for smaller lesions (≤ 36 mm). In contrast, the accuracy of the FRE method did not differ significantly with lesion size. When using the FRE method, no cases were unevaluable because of attenuation. The FRE method provided correct diagnoses in 2 of 3 cases that were unevaluable using the pit pattern method. Conclusions: The pit pattern and FRE methods offered similar diagnostic performance for invasion depth. Furthermore, the FRE method may be used to correctly diagnose cases that are unevaluable using the pit pattern method.

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  21. Feasibility of patency capsule and colon capsule endoscopy in patients with suspected gastrointestinal stenosis: a prospective study.

    Otsuka H, Nakamura M, Yamamura T, Maeda K, Sawada T, Mizutani Y, Ishikawa E, Ishikawa T, Kakushima N, Furukawa K, Ohno E, Kawashima H, Honda T, Ishigami M, Fujishiro M

    Nagoya journal of medical science   Vol. 83 ( 3 ) page: 419 - 430   2021.8

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    Patency capsule (PC) can evaluate the patency of gastrointestinal (GI) tract. We hypothesized preceding patient selection using PC would improve the successful rate of colon capsule endoscopy (CCE). Therefore, a prospective single-arm study using PC followed by CCE was conducted with a control group of CCE alone. Patients with suspected or known GI stenosis scheduled for CCE were enrolled. CCE was performed only when the PC was excreted out of the body within 33 hours of ingestion. Primary endpoint was the rate of observation of the entire GI tract within the duration of examination. The secondary endpoints were complications and CCE findings. Twenty-three patients (17 men) were enrolled. The mean age was 50.5±19.8 years. Suspected stenotic sites were 8, 5, and 10 in the small, large, and small and large bowel, respectively. Sixteen, 12, and 10 patients had abdominal pain, active inflammatory bowel disease, and history of surgery for suspected stenosis, respectively. Patency of GI tract was confirmed in 96% (22/23) of the patients by administered PC. Of the 22 patients who underwent CCE, the entire GI tract was observed in 86% (19/22). No complications were observed. The median transit times in the small bowel and colon were 99 (21–682) and 160 (5–328) minutes, respectively. CCE findings revealed ulcers, erosions, and diverticula in 5, 9, and 4 patients, respectively. In conclusion, CCE with PC might be a safer and useful modality to observe the large colon for patients with suspected GI stenosis.

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  22. 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

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

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

    DIGESTIVE ENDOSCOPY   Vol. 34 ( 3 ) page: 526 - 534   2021.7

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    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.

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

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

    JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   Vol. 36 ( 7 ) page: 1851 - 1858   2021.7

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    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.

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  25. Subjective Symptoms in Patients with Eosinophilic Esophagitis Are Related to Esophageal Wall Thickness and Esophageal Body Pressure

    Muroi Koichi, Kakushima Naomi, Furukawa Kazuhiro, Ishikawa Eri, Sawada Tsunaki, Ishikawa Takuya, Maeda Keiko, Yamamura Takeshi, Ohno Eizaburo, Nakamura Masanao, Kawashima Hiroki, Funasaka Kohei, Miyahara Ryoji, Fujishiro Mitsuhiro

    DIGESTIVE DISEASES AND SCIENCES   Vol. 66 ( 7 ) page: 2291 - 2300   2021.7

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    Background: Endoscopic ultrasonography (EUS) and high-resolution manometry (HRM) can be used in the evaluation of eosinophilic esophagitis (EoE) for frequent symptoms such as dysphagia. However, the role of these examinations is not clear. Aims: The aim of this study was to objectively evaluate the subjective symptoms of EoE patients with EUS and HRM. Methods: Patients who had endoscopic findings indicative of EoE and matched the number of eosinophil infiltrates used as diagnostic criteria were recruited between September 2018 and August 2019. Evaluable subjects underwent EUS and HRM and completed the Gastrointestinal Symptom Rating Scale (GSRS) questionnaire. The esophageal wall thickness (evaluated with EUS) and HRM parameters between patients with and without symptoms were retrospectively compared. Symptomatic patients were re-examined using EUS and HRM 6 months after treatment. Results: A total of 35 patients (29 males, median age of 49 years) were divided into symptomatic (20 patients) and asymptomatic groups (15 patients). The esophageal wall was thicker, and the distal contractile integral (DCI) values were higher in the symptomatic group (P < 0.001). In addition, DCI values were positively correlated with esophageal wall thickness. After treatment, the GSRS scores showed an improving trend for each item. Esophageal wall thickness and DCI values were significantly decreased (Ps < 0.001). Conclusions: Esophageal wall thickening and increased esophageal body pressure may be involved in subjective symptoms. In addition, treatment may reduce esophageal thickness and pressure along with improvement of subjective symptoms.

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  26. Comparison of High-Resolution Manometry in Patients Complaining of Dysphagia among Patients with or without Diabetes Mellitus

    Muroi Koichi, Miyahara Ryoji, Funasaka Kohei, Furukawa Kazuhiro, Sawada Tsunaki, Maeda Keiko, Yamamura Takeshi, Ishikawa Takuya, Ohno Eizaburo, Nakamura Masanao, Kawashima Hiroki, Onoue Takeshi, Arima Hiroshi, Hirooka Yoshiki, Fujishiro Mitsuhiro

    DIGESTION   Vol. 102 ( 4 ) page: 554 - 562   2021.6

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    Introduction: Dysphagia is a common symptom that occurs in patients with diabetes mellitus (DM). There have been few prospective observational studies on esophageal motility disorders in DM using high-resolution manometry (HRM). This study aimed to clarify the characteristics of esophageal motility disorders using HRM in patients with dysphagia and compare them between DM and non-DM patients. Methods: Patients with dysphagia were prospectively recruited between October 2018 and July 2019. Patients (n = 89) underwent esophagogastroduodenoscopy and HRM and completed the Gastrointestinal Symptom Rating Scale (GSRS) questionnaire. Manometry parameters and motility disorder classifications were compared between DM and non-DM patients. We also investigated the differences in clinical backgrounds and questionnaire scores among DM patients with normal and abnormal manometry results. Results: A higher prevalence of esophageal motility disorder was observed in DM patients (60%, 21/35) compared to non-DM patients (29.6%, 16/54) (p = 0.001). The prevalence of minor disorders such as ineffective esophageal motor disorder and fragmented peristalsis was significantly higher (45 vs. 11%), and the distal contractile integral, integrated relaxation pressure, and contractile front velocity values were lower in the DM group. Among DM patients, those with abnormal esophageal motility had a significantly higher prevalence of neuropathy, retinopathy, and nephropathy, as well as higher reflux or constipation scores on the GSRS, than those with normal results. Conclusions: Among patients with dysphagia, the frequency of minor esophageal motility disorders was higher in DM patients than in non-DM patients. Abnormal esophageal motility related to poor esophageal clearance was associated with higher prevalence of diabetic complications.

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  27. Long-Term Prognostic Predictors of Esophageal Squamous Cell Carcinoma Potentially Indicated for Endoscopic Submucosal Dissection

    Suzuki Tomohiko, Furukawa Kazuhiro, Funasaka Kohei, Ishikawa Eri, Sawada Tsunaki, Maeda Keiko, Yamamura Takeshi, Ishikawa Takuya, Ohno Eizaburo, Nakamura Masanao, Kawashima Hiroki, Miyahara Ryoji, Fujishiro Mitsuhiro

    DIGESTION   Vol. 102 ( 4 ) page: 563 - 571   2021.6

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    Introduction: Patients with esophageal squamous cell carcinoma (ESCC) have various comorbidities. Thus, it is necessary to determine the appropriateness of performing treatment based on the patient's general condition. Aim: This study aimed to clarify the prognostic predictors of ESCC indicated for endoscopic submucosal dissection (ESD). Methods: This retrospective study enrolled 241 patients with superficial ESCC endoscopically diagnosed as ESD-indicated lesions at the Nagoya University Hospital between January 2007 and December 2017. We evaluated the 3- and 5-year overall survival (OS) rates and prognostic predictors, such as the Prognostic Nutritional Index (PNI), Charlson Comorbidity Index (CCI), Psoas Muscle Index, and Controlling Nutritional Status score. Furthermore, we created a score-based classification using the prognostic predictors identified by multivariate analysis, and the 3- and 5-year OS rates were compared among the calculated scores. Results: In the multivariate analysis, PNI < 45 (hazard ratio [HR]: 2.39; 95% confidence interval [CI]: 1.28-4.46; p = 0.006) and CCI ≥ 3 (HR: 4.42; 95% CI: 2.40-8.12; p < 0.001) were significantly associated with the OS. Based on the HR, 0 and 1 were assigned to PNI and 0, 2, and 4 were assigned to CCI, and the score classification of 0-5 points was created. The 3- and 5-year OS rates in patients with a score 3 were significantly higher than in those with scores 4 and 5. As a result of scoring, the prognosis was stratified; the 3- and 5-year OS rates in patients with scores 4 and 5, that is, CCI ≥ 6, were clearly low, at approximately 10%. Conclusions: CCI and PNI can be prognostic predictors of patients with superficial ESCC indicated for ESD. Observation without ESD might be an acceptable strategy among patients with CCI ≥ 6.

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

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

    ARAB JOURNAL OF GASTROENTEROLOGY   Vol. 22 ( 2 ) page: 104 - 110   2021.6

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    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.

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  29. New modality for the quantitative evaluation of tissue elasticity using a forward-viewing radial-array echoendoscope for colorectal neoplasms

    Esaki Masaya, Yamamura Takeshi, Nakamura Masanao, Maeda Keiko, Sawada Tsunaki, Mizutani Yasuyuki, Ishikawa Eri, Furukawa Kazuhiro, Kawashima Hiroki, Hirooka Yoshiki, Fujishiro Mitsuhiro

    INTERNATIONAL JOURNAL OF COLORECTAL DISEASE   Vol. 36 ( 5 ) page: 919 - 927   2021.5

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    Purpose: Sound speed correction (SSC) is a non-invasive modality that quantifies the hardness of neoplasms. The aim of our study was to evaluate the usefulness of SSC for the diagnostic accuracy of colorectal neoplasms and to differentiate the depth of invasion. Methods: Forty colorectal neoplasms, contributed by 40 patients, were included in the analysis. The primary outcome was the diagnostic ability of SSC for the depth of invasion of colorectal neoplasms, with the secondary endpoint being the clinical efficacy of SSC to distinguish between a neoplasm and normal mucosa. Results: The median sound speeds for colorectal neoplasms and normal mucosa were 1580 m/s and 1515 m/s, respectively (p < 0.001), with a median sound speed of 1583 m/s for lesions with a depth shallower than that of the muscularis propria and 1610 m/s for depths deeper than that of the muscularis propria (p = 0.002). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 80.0%, 100%, 100%, 83.3%, 90.0%, and 100%, respectively, for the diagnosis of neoplasms (using a cut-off sound speed of 1557 m/s) and 100%, 77.8%, 33.3%, 100%, 80.0%, respectively, for the diagnosis of the depth of invasion (using a cut-off of 1590 m/s). Conclusion: We identified absolute sound speeds for colorectal neoplasms and the depth of invasion of neoplasms which yielded a good diagnostic performance. SSC provides an objective evaluation of colorectal neoplasms and the depth of invasion of neoplasms and, thus, might be a useful modality in practice. Trial registration : UMIN000038235, Date of registration; October 8, 2019

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

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

    CANADIAN JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   Vol. 2021   page: 8875564   2021.4

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    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.

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  31. Filtrated Adipose Tissue-Derived Mesenchymal Stem Cell Lysate Ameliorates Experimental Acute Colitis in Mice

    Nishikawa Takahiro, Maeda Keiko, Nakamura Masanao, Yamamura Takeshi, Sawada Tsunaki, Mizutani Yasuyuki, Ito Takanori, Ishikawa Takuya, Furukawa Kazuhiro, Ohno Eizaburo, Miyahara Ryoji, Kawashima Hiroki, Honda Takashi, Ishigami Masatoshi, Yamamoto Tokunori, Matsumoto Seiji, Hotta Yuji, Fujishiro Mitsuhiro

    DIGESTIVE DISEASES AND SCIENCES   Vol. 66 ( 4 ) page: 1034 - 1044   2021.4

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    Background: Inflammatory bowel disease (IBD) is a chronic, persistent, and intractable enteritis; however, an effective treatment strategy is yet to be established. Mesenchymal stem cells (MSCs) and their paracrine factors exhibit anti-inflammatory actions and have been proposed as a new therapeutic candidate for IBD treatment, although the efficacy of MSC lysate on enteritis is unclear. Aims: Here, we examined the efficacy and appropriate regimen of filtrated murine adipose-derived mesenchymal stem cell lysate (FADSTL) in an acute colitis mouse model as a novel cell-free MSC therapy. Methods: To confirm the clinical effects of FADSTL, survival rate, body weight, and disease activity index (DAI) were investigated in the DSS-induced colitis mouse model. Further, differences in efficacy with dosing frequency were assessed to optimize the proper regimen. Colon length, histological findings, gene expression of inflammatory mediators and tight junction proteins in colon tissues, and anti-apoptotic effects were also compared in 3-day continuous FADSTL administration and PBS groups. Results: Three-day continuous FADSTL administration significantly improved weight loss and DAI score compared to those in the PBS-treated group, whereas the effect was not observed with single administration. Additionally, colon shortening and histological inflammation were suppressed in the FADSTL-treated group. Further, this treatment decreased gene expression of inflammatory mediators, maintained expression of tight junction proteins in the colon, and showed anti-apoptotic effects. Conclusions: FADSTL effects were dependent on its administration frequency, suggesting the requirement of continuous FADSTL administration. FADSTL improved colitis by maintaining the intestinal barrier function through its anti-inflammatory and anti-apoptotic actions.

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

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

    BMC GASTROENTEROLOGY   Vol. 21 ( 1 ) page: 75   2021.2

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    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.

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

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

    CLINICAL JOURNAL OF GASTROENTEROLOGY   Vol. 14 ( 1 ) page: 129 - 135   2021.2

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    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.

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

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

    PATHOLOGY INTERNATIONAL   Vol. 71 ( 1 ) page: 33 - 41   2021.1

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    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.

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  35. The microbiome can predict mucosal healing in small intestine in patients with Crohn's disease

    Hattori Shun, Nakamura Masanao, Yamamura Takeshi, Maeda Keiko, Sawada Tsunaki, Mizutani Yasuyuki, Yamamoto Kenta, Ishikawa Takuya, Furukawa Kazuhiro, Ohno Eizaburo, Honda Takashi, Kawashima Hiroki, Ishigami Masatoshi, Hirooka Yoshiki, Fujishiro Mitsuhiro

    JOURNAL OF GASTROENTEROLOGY   Vol. 55 ( 12 ) page: 1138 - 1149   2020.12

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    Background: Mucosal healing is the main treatment goal for Crohn’s disease. In this situation, some patients have difficulty with endoscopic evaluation of the entire small intestine. Crohn’s disease is closely associated with the gut microbiota, but the relationship between the microbiome and disease activity in the small intestine remains unclear. We examined the association between the microbiome and endoscopic findings in the small intestine and determined whether the microbiome can predict mucosal healing. Methods: The patients with Crohn’s disease who were scheduled for capsule or balloon-assisted endoscopy were included in this prospective study. Patients whose entire small intestine was evaluated were divided into two groups based on ulcerative findings. The microbiomes in the fecal samples were analyzed using 16S rRNA sequencing. Results: The 38 enrolled patients were divided into the ulcer group (24) and mucosal healing group (14). The ulcer group exhibited lower α diversity. Six genera, namely Faecalibacterium (P = 0.008), Lachnospira (P = 0.009), Paraprevotella (P = 0.01), Dialister (P = 0.012), Streptococcus (P = 0.025), and Clostridium (P = 0.028) were enriched in the mucosal healing group. A predictive score for mucosal healing was defined using these six genera. The area under the curve was 0.795 and the sensitivity and specificity for predicting mucosal healing were 0.643 and 0.917, respectively. Conclusions: Fecal microbiome is corelated with disease activity in the entire small intestine in Crohn’s disease patients. The predictive score proposed by microbiota characteristics was a potential biomarker for mucosal healing in the small intestine.

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  36. Accuracy of carbon dioxide insufflation for endoscopic retrograde cholangiopancreatography using double-balloon endoscopy

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

    WORLD JOURNAL OF GASTROENTEROLOGY   Vol. 26 ( 42 ) page: 6669 - 6678   2020.11

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    BACKGROUND Retrograde cholangiopancreatography using double-balloon endoscopic retrograde cholangiography (DBERC) is a valuable technique to treat biliary stone and jejunobiliary anastomotic stenosis in patients with altered gastrointestinal anatomy. The accurate selection of the route at the anastomosis branch is one of the most important factors in reaching the target in a timely manner. AIM To determine the accuracy of carbon dioxide insufflation enterography (CDE) at the branch for selecting the correct route during DBERC. METHODS We enrolled 52 consecutive patients scheduled for DBERC at our institution from June 2015 to November 2017. Route selection via two methods (visual observation and CDE) was performed in each patient. We determined the correct rate of route selection using CDE. RESULTS Thirty-three patients had a jejunojejunal anastomosis and 19 patients had a gastrojejunal anastomosis. The therapeutic target region was reached in 50 patients. The mean procedure times from the teeth to the target (total insertion time), from the teeth to the branch, and from the branch to the target, and the mean total examination time were 15.2, 5.0, 8.2, and 60.3 min, respectively. The rate of correct route selection using visual observation and CDE were 36/52 (69.2%) and 48/52 (92.3%), respectively (P = 0.002). The rate of correct route selection using CDE in patients with a jejunojejunal anastomosis was 29/33 (87.8%), and the rate in patients with a gastrojejunal anastomosis was 19/19 (100%). CONCLUSION CDE is helpful in selecting the route at the branch in the anastomosis for more timely access to the target in patients with altered gastrointestinal anatomy undergoing DBERC.

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  37. Endoscopic Activity and Serum TNF-alpha Level at Baseline Are Associated With Clinical Response to Ustekinumab in Crohn's Disease Patients

    Murate Kentaro, Maeda Keiko, Nakamura Masanao, Sugiyama Daisuke, Wada Hirotaka, Yamamura Takeshi, Sawada Tsunaki, Mizutani Yasuyuki, Ishikawa Takuya, Furukawa Kazuhiro, Ohno Eizaburo, Honda Takashi, Kawashima Hiroki, Miyahara Ryoji, Ishigami Masatoshi, Nishikawa Hiroyoshi, Fujishiro Mitsuhiro

    INFLAMMATORY BOWEL DISEASES   Vol. 26 ( 11 ) page: 1669 - 1681   2020.11

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    Background and Aims: The therapeutic efficacy and safety of ustekinumab for Crohn's disease (CD) have been reported from randomized controlled trials and real-world data. However, there are few studies describing the identification of patients most suitable for ustekinumab therapy. The aim of this study was to prospectively evaluate the patients receiving ustekinumab and identify predictors of the treatment efficacy. Methods: Patients with moderate to severe active CD scheduled to receive ustekinumab were enrolled. The responders and nonresponders were compared at weeks 0, 8, 24, and 48 by evaluating patient demographics, simple endoscopic scores (SES-CD), ustekinumab and cytokine concentrations, and cellular fractions. Results: The clinical response and clinical remission rates in the 22 enrolled patients were 59.1% and 31. 8% at week 8, 68.2% and 45.5% at week 24, and 54.4% and 40.9% at week 48, respectively. There were no significant differences in patients' demographic and disease characteristics at baseline between responders and nonresponders. A combination of low SES-CD and high serum TNF-α concentration at baseline showed a good correlation with the clinical response. Serum TNF-α concentration was decreased because of the therapy. The ratio of CD4+TNF-α cells at baseline was significantly higher in responders than in nonresponders; however, the ratios of CD45+CD11b+TNF-α and CD45+CD11c+TNF-α cells were not different. The ratio of CD4+ TNF-α cells decreased with the treatment in the responders but not in the nonresponders. Conclusions: The combination of 2 factors, namely higher serum TNF-α concentration and lower SES-CD at baseline, may assist clinicians in selecting the appropriate therapy for patients with moderate to severe CD.

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  38. Mutation analysis of gastrointestinal stromal tumors using RNA obtained via endoscopic ultrasound-guided fine-needle aspiration

    Funasaka Kohei, Miyahara Ryoji, Furukawa Kazuhiro, Sawada Tsunaki, Maeda Keiko, Yamamura Takeshi, Ishikawa Takuya, Ohno Eizaburo, Nakamura Masanao, Kawashima Hiroki, Hirooka Yoshiki, Ohmiya Naoki, Fujishiro Mitsuhiro

    TRANSLATIONAL ONCOLOGY   Vol. 13 ( 11 ) page: 100848   2020.11

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    Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA) is useful for pathologically diagnosing gastrointestinal stromal tumor (GIST) before surgery. However, its role in mutation analysis remains unclear. To examine the feasibility of analyzing GIST mutations using mRNA obtained with EUS-FNA, we prospectively enrolled 41 patients with subepithelial lesion from which EUS-FNA was successfully acquired tissue sample. Thirty-two, 5, and 4 subepithelial lesions were diagnosed as GISTs, schwannomas, and leiomyomas, respectively. After RNA was extracted from FNA sample, RNA was converted to cDNA. Full-length sequence of the KIT cDNA amplified via the polymerase chain reaction (PCR) was successful in 31 (96.9%) out of 32 GIST and three out of 9 non-GIST (33.3%). The KIT mutation statuses of 31 GISTs in which KIT cDNA was amplified were successfully determined through directional sequencing. Furthermore, 15 of 16 surgically excised GISTs exhibited the same mutation status in both the EUS-FNA and resected samples. In vitro experiment, the minimum number of cells required to amplify full-length of KIT cDNA from RNA was one-tenth of that required to amplify KIT exon11 gene from DNA. This study clarifies that mutation analysis using RNA obtained with EUS-FNA is feasible and reliable. Moreover, our data would support that RNA-based mutation is superior to DNA-based mutation analysis in GIST.

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  39. 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   2020.9

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    <p>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.</p><p>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<sup>*</sup>a<sup>*</sup>b<sup>*</sup> 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.</p><p>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 (<i>P</i>=0.025). The vascular diameter was positively correlated with the b<sup>*</sup> color value (correlation coefficient=0.302, <i>P</i>=0.033).</p><p>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)</p>

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  40. 特集 分子標的時代のIBD 診療 -IBD の寛解導入,寛解維持の実践 3.IBD 治療における寛解導入と寛解維持に関するトピック(6)IBD センターの構想と効果,社会的役割

    中村 正直, 中山 吾郎, 山村 健史, 服部 憲史, 澤田 つな騎, 佐藤 雄介, 藤城 光弘

    臨床消化器内科   Vol. 35 ( 10 ) page: 1275 - 1279   2020.8

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    DOI: 10.19020/cg.0000001326

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  41. 特集 分子標的時代のIBD 診療 -IBD の寛解導入,寛解維持の実践 3.IBD 治療における寛解導入と寛解維持に関するトピック(5)UC 関連腫瘍の早期診断と治療

    山村 健史, 中村 正直, 前田 啓子, 澤田 つな騎, 石川 恵里, 喜田 裕一, 古川 和宏, 川嶋 啓揮, 藤城 光弘

    臨床消化器内科   Vol. 35 ( 10 ) page: 1267 - 1273   2020.8

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    DOI: 10.19020/cg.0000001325

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  42. 特集 クローン病小腸狭窄病変に対する内視鏡的バルーン拡張術─基本からピットフォールまで Ⅱ.クローン病小腸狭窄病変に対するバルーン拡張術(4)クローン病におけるバルーン拡張術のコツ a.ダブルバルーン内視鏡の立場から

    中村 正直, 山村 健史, 前田 啓子, 澤田 つな騎, 水谷 泰之, 石川 恵里, 古川 和宏, 角嶋  直美, 藤城 光弘

    INTESTINE   Vol. 24 ( 3 ) page: 197 - 202   2020.8

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    DOI: 10.19020/int.0000000486

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  43. 特集 薬剤性消化器疾患の診療 4 .その他の薬剤性消化器疾患(4)免疫チェックポイント阻害薬による消化器障害

    伊藤 隆徳, 澤田 つな騎, 中村 正直, 本多 隆, 石上 雅敏, 藤城 光弘

    臨床消化器内科   Vol. 35 ( 7 ) page: 759 - 765   2020.6

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  44. Use of Immunostaining for the diagnosis of Lymphovascular invasion in superficial Barrett's esophageal adenocarcinoma

    Hosono Isao, Miyahara Ryoji, Furukawa Kazuhiro, Funasaka Kohei, Sawada Tsunaki, Maeda Keiko, Yamamura Takeshi, Ishikawa Takuya, Ohno Eizaburo, Nakamura Masanao, Kawashima Hiroki, Yokoi Takio, Hirooka Yoshiki, Fujishiro Mitsuhiro, Tsukamoto Tetsuya

    BMC GASTROENTEROLOGY   Vol. 20 ( 1 ) page: 175   2020.6

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    Background: The prevalence of Barrett's esophageal adenocarcinoma (BEA) is increasing in Japan. Accurate assessment of lymphovascular invasion (LVI) after endoscopic resection or surgery is essential in evaluating treatment response. This study aimed to assess the usefulness of immunostaining in determining the extent of LVI in superficial BEA. Methods: We retrospectively included 41 patients who underwent endoscopic resection or surgery between January 2007 and July 2018. In all cases, 3-μm serial sections from paraffin-embedded resected specimens were used for hematoxylin and eosin (H-E) staining and immunostaining for D2-40 and CD31. Two specialized gastrointestinal pathologists (T.Y. and T.T.), blinded to clinical information, independently evaluated the extent of LVI from these specimens. The LVI-positivity rate was evaluated with respect to the depth of invasion, changes in the positivity rate on immunostaining, pathological characteristics of patients with LVI, lymph node metastasis or relapse, and course after treatment. Results: H-E staining alone identified LVI in 7 patients (positivity rate: 17.1%). Depths of invasion were categorized based on extension to the submucosa (SM) or deeper. On immunostaining for D2-40 and CD31, additional positivity was detected in 2 patients with SM1 and 1 SM3, respectively; LVI was detected in 10 patients (positivity rate: 24.4%). LVI-positivity rates with invasion of the superficial muscularis mucosa (SMM)/lamina propria mucosa (LPM)/deep muscularis mucosa (DMM), SM 1, 2, and 3 were 0, 75, 28.6, and 55.6%, respectively. Conclusions: Combined H-E staining and immunostaining is useful in diagnosing LVI in superficial BEA, particularly in endoscopically resected specimens.

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  45. ENDOSCOPIC DIAGNOSIS USING MAGNIFYING IMAGE-ENHANCED ENDOSCOPY FOR SUPERFICIAL NON-AMPULLARY DUODENAL EPITHELIAL TUMORS

    Furukawa Kazuhiro, Miyahara Ryoji, Funasaka Kohei, Sawada Tsunaki, Keiko Maeda, Yamamura Takeshi, Ishikawa Takuya, Ohno Eizaburo, Nakamura Masanao, Kawashima Hiroki, Fujishiro Mitsuhiro

    GASTROINTESTINAL ENDOSCOPY   Vol. 91 ( 6 ) page: AB618 - AB618   2020.6

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  46. EVALUATION OF RESECTABILITY BETWEEN ENDOSCOPIC TREATMENT METHODS FOR RECTAL NEUROENDOCRINE TUMOR

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

    GASTROINTESTINAL ENDOSCOPY   Vol. 91 ( 6 ) page: AB101 - AB101   2020.6

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  47. PROSPECTIVE MULTICENTER STUDY ON THE USEFULNESS OF EUS-GUIDED FINE NEEDLE BIOPSY FOR THE DIAGNOSIS OF AUTOIMMUNE PANCREATITIS USING A 22-GAUGE FRANSEEN NEEDLE

    Ishikawa Takuya, Kawashima Hiroki, Ohno Eizaburo, Nishio Ryo, Iida Tadashi, Suzuki Hirotaka, Uetsuki Kota, Yamada Kenta, Yashika Jun, Yoshikawa Masakatsu, Gibo Noriaki, Aoki Toshinori, Kataoka Kunio, Mori Hiroshi, Keiko Maeda, Sawada Tsunaki, Yamamura Takeshi, Furukawa Kazuhiro, Nakamura Masanao, Fujishiro Mitsuhiro

    GASTROINTESTINAL ENDOSCOPY   Vol. 91 ( 6 ) page: AB172 - AB172   2020.6

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  48. NOVEL METHOD TO DETERMINE THE DEPTH OF INVASION IN COLORECTAL NEOPLASMS WITH ULTRASOUND ELASTOGRAPHY USING A FORWARD-VIEWING RADIAL-ARRAY ECHOENDOSCOPE

    Esaki Masaya, Yamamura Takeshi, Nakamura Masanao, Keiko Maeda, Sawada Tsunaki, Mizutani Yasuyuki, Kuno Takeshi, Yamada Kentaro, Hasegawa Issei, Ishikawa Takuya, Furukawa Kazuhiro, Ohno Eizaburo, Kawashima Hiroki, Fujishiro Mitsuhiro

    GASTROINTESTINAL ENDOSCOPY   Vol. 91 ( 6 ) page: AB430 - AB430   2020.6

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  49. Clinical Factors Associated with Missing Colorectal Polyp on Colon Capsule Endoscopy

    Yamada Keisaku, Nakamura Masanao, Yamamura Takeshi, Maeda Keiko, Sawada Tsunaki, Mizutani Yasuyuki, Ishikawa Takuya, Furukawa Kazuhiro, Ohno Eizaburo, Miyahara Ryoji, Kawashima Hiroki, Hotta Naoki, Hirooka Yoshiki

    DIGESTION   Vol. 101 ( 3 ) page: 316 - 322   2020.5

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    Background: There are a number of reports that demonstrate the high diagnostic accuracy of colon capsule endoscopy (CCE) for polyp detection. However, some colorectal polyps are missed on CCE, and the clinical factors influencing those missed polyps are still unknown. Objective: The aim of this study was to elucidate the clinical factors related to missing colorectal polyp on CCE by using per-polyp analysis. Methods: We performed a retrospective multi-center study of 53 consecutive patients who underwent both CCE and colonoscopy (CS) within 3 months from January 2014 to-December 2017. Of those patients, we analyzed 151 polyps detected on CCE, and 149 polyps detected on CS diagnosed as neoplasm according to histopathological result. Results: The capsule excretion rate was 81%. One hundred three polyps were detected on both CS and CCE, 46 polyps (31%) were missed on CCE, and 48 polyps were considered false positive on CCE when CS result was considered as the gold standard. Per-polyp sensitivity and positive predictive value on CCE were 69.1 and 68%. On multiple logistic analysis, only the segmental transit time on CCE was identified as the independent factor influencing missed polyp on CCE. Conclusions: The clinical factor related to missing colorectal polyp on CCE was the segmental transit time.

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  50. Double-balloon endoscopic retrograde cholangiopancreatography for patients who underwent liver operation: A retrospective study

    Nishio Ryo, Kawashima Hiroki, Nakamura Masanao, Ohno Eizaburo, Ishikawa Takuya, Yamamura Takeshi, Maeda Keiko, Sawada Tsunaki, Tanaka Hiroyuki, Sakai Daisuke, Miyahara Ryoji, Ishigami Masatoshi, Hirooka Yoshiki, Fujishiro Mitsuhiro

    WORLD JOURNAL OF GASTROENTEROLOGY   Vol. 26 ( 10 ) page: 1056 - 1066   2020.3

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    BACKGROUND Double-balloon endoscopic retrograde cholangiography (DB-ERC) is widely performed for biliary diseases after reconstruction in gastrointestinal surgery, but there are few reports on DB-ERC after hepatectomy or living donor liver transplantation (LDLT). AIM To examine the success rates and safety of DB-ERC after hepatectomy or LDLT. METHODS The study was performed retrospectively in 26 patients (45 procedures) who underwent hepatectomy or LDLT (liver operation: LO group) and 40 control patients (59 procedures) who underwent pancreatoduodenectomy (control group). The technical success (endoscope reaching the choledochojejunostomy site), diagnostic success (performance of cholangiography), therapeutic success (completed interventions) and overall success rates, insertion and procedure (completion of DB-ERC) time, and adverse events were compared between these groups. RESULTS There were no significant differences between LO and control groups in the technical [93.3% (42/45) vs 96.6% (57/59), P = 0.439], diagnostic [83.3% (35/42) vs 83.6% (46/55), P = 0.968], therapeutic [97.0% (32/33) vs 97.7% (43/44), P = 0.836], and overall [75.6% (34/45) vs 79.7% (47/59), P = 0.617] success rates. The median insertion time (22 vs 14 min, P < 0.001) and procedure time (43.5 vs 30 min, P = 0.033) were significantly longer in the LO group. The incidence of adverse events showed no significant difference [11.1% (5/45) vs 6.8% (4/59), P = 0.670]. CONCLUSION DB-ERC after liver operation is safe and useful but longer time is required, so should be performed with particular care.

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  51. Usefulness of Endoscopic Ultrasound Elastography Combined With the Strain Ratio in the Estimation of Treatment Effect in Autoimmune Pancreatitis

    Ishikawa Takuya, Kawashima Hiroki, Ohno Eizaburo, Tanaka Hiroyuki, Maeda Keiko, Sawada Tsunaki, Yamamura Takeshi, Furukawa Kazuhiro, Nakamura Masanao, Miyahara Ryoji, Ishigami Masatoshi, Fujishiro Mitsuhiro

    PANCREAS   Vol. 49 ( 2 ) page: E21 - E22   2020.2

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  52. 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

    DIGESTIVE ENDOSCOPY   Vol. 32 ( 1 ) page: 65 - 73   2020.1

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    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 l'Eclariage – 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).

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  53. 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

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    <p>【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。</p><p>【目的】単発性小腸PJPにおける臨床的特徴を明らかにする。</p><p>【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。</p><p>【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。</p><p>【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。</p><p>【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。</p>

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  54. 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

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    <p><b>Objective </b>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. </p><p><b>Methods </b>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. </p><p><b>Results </b>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]. </p><p><b>Conclusion </b>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. </p>

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  55. 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

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    <p>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. </p>

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  56. 4. その他の薬剤性消化器疾患 (4) 免疫チェックポイント阻害薬による消化器障害

    澤田 つな騎

    臨牀消化器内科   Vol. 35   page: 759 - 765   2020

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  57. Objective evaluation of the therapeutic effect of ustekinumab on Crohn's disease

    Yamamura T., Nakamura M., Murate K., Maeda K., Sawada T., Mizutani Y., Nishikawa T., Hattori S., Yamamoto K., Pu L. Zorron Cheng Tao, Ishikawa T., Furukawa K., Ohno E., Miyahara R., Kawashima H., Fujishiro M.

    JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   Vol. 34   page: 145 - 145   2019.9

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  58. Specific members of gut microbiota predict mucosal healing in Crohn's disease

    Hattori S., Nakamura M., Yamamura T., Maeda K., Sawada T., Mizutani Y., Yamamoto K., Pu L. Zorron Cheng Tao, Honda T., Ishikawa T., Furukawa K., Ohno E., Miyahara R., Kawashima H., Fujishiro M.

    JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   Vol. 34   page: 152 - 152   2019.9

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  59. CLINICAL SIGNIFICANCE OF THE PATENCY OF GASTROINTESTINAL TRACT IN CROHN'S DISEASE EVALUATED BY PATENCY CAPSULE

    Nakamura Masanao, Yamamura Takeshi, Maeda Keiko, Sawada Tsunaki, Mizutani Yasuyuki, Kuno Takeshi, Yamada Keisaku, Ishikawa Takuya, Furukawa Kazuhiro, Ohno Eizaburo, Miyahara Ryoji, Kawashima Hiroki, Hirooka Yoshiki

    GASTROINTESTINAL ENDOSCOPY   Vol. 89 ( 6 ) page: AB333 - AB333   2019.6

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  60. FACTORS RELATED TO MISSED COLORECTAL POLYPS ON COLON CAPSULE ENDOSCOPY IN CLINICAL PRACTICE

    Yamada Keisaku, Nakamura Masanao, Yamamura Takeshi, Maeda Keiko, Sawada Tsunaki, Mizutani Yasuyuki, Niwa Yoshiki, Ishikawa Eri, Otsuka Hiroyuki, Suzuki Hiroto, Ishikawa Takuya, Furukawa Kazuhiro, Ohno Eizaburo, Miyahara Ryoji, Kawashima Hiroki, Hotta Naoki, Pu Leonardo Zorron Cheng Tao, Hirooka Yoshiki

    GASTROINTESTINAL ENDOSCOPY   Vol. 89 ( 6 ) page: AB155 - AB155   2019.6

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  61. USEFULNESS OF THE FORWARD-VIEWING RADIAL-ARRAY ECHOENDOSCOPE IN THE DIAGNOSIS OF INVASION DEPTH OF COLORECTAL NEOPLASIA

    Kuno Takeshi, Yamamura Takeshi, Nakamura Masanao, Maeda Keiko, Sawada Tsunaki, Mizutani Yasuyuki, Suzuki Hiroto, Esaki Masaya, Ishikawa Takuya, Furukawa Kazuhiro, Ohno Eizaburo, Kawashima Hiroki, Miyahara Ryoji, Hirooka Yoshiki

    GASTROINTESTINAL ENDOSCOPY   Vol. 89 ( 6 ) page: AB324 - AB324   2019.6

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  62. 今月の主題 知っておきたい小腸疾患 主題 小腸の非腫瘍性疾患-小腸リンパ管拡張症

    中村 正直, 山村 健史, 前田 啓子, 澤田 つな騎, 水谷 泰之, 丹羽 慶樹, 石川 恵里, 大塚 裕之, 鈴木 悠土, 西川 貴広, 石田 哲也, 久野 剛史, 服部 峻, 山田 啓策, 廣岡 芳樹, 藤城 光弘

    胃と腸   Vol. 54 ( 4 ) page: 532 - 536   2019.4

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    DOI: 10.11477/mf.1403201630

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  63. Utility of linked color imaging for endoscopic diagnosis of early gastric cancer

    Fujiyoshi Toshihisa, Miyahara Ryoji, Funasaka Kohei, Furukawa Kazuhiro, Sawada Tsunaki, Maeda Keiko, Yamamura Takeshi, Ishikawa Takuya, Ohno Eizaburo, Nakamura Masanao, Kawashima Hiroki, Nakaguro Masato, Nakatochi Masahiro, Hirooka Yoshiki

    WORLD JOURNAL OF GASTROENTEROLOGY   Vol. 25 ( 10 ) page: 1248 - 1258   2019.3

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    BACKGROUND: Linked color imaging (LCI) is a method of endoscopic imaging that emphasizes slight differences in red mucosal color. AIM: To evaluate LCI in diagnostic endoscopy of early gastric cancer and to compare LCI and pathological findings. METHODS: Endoscopic images were obtained for 39 patients (43 lesions) with early gastric cancer. Three endoscopists evaluated lesion recognition with white light imaging (WLI) and LCI. Color values in Commission Internationale de l'Eclairage (CIE) 1976 L*a*b* color space were used to calculate the color difference (ΔE) between cancer lesions and non-cancer areas. After endoscopic submucosal dissection, blood vessel density in the surface layer of the gastric epithelium was evaluated pathologically. The identical region of interest was selected for analyses of endoscopic images (WLI and LCI) and pathological analyses. RESULTS: LCI was superior for lesion recognition (P < 0.0001), and ΔE between cancer and non-cancer areas was significantly greater with LCI than WLI (29.4 vs 18.6, P < 0.0001). Blood vessel density was significantly higher in cancer lesions (5.96% vs 4.15%, P = 0.0004). An a* cut-off of ≥ 24 in CIE 1976 L*a*b* color space identified a cancer lesion using LCI with sensitivity of 76.7%, specificity of 93.0%, and accuracy of 84.9%. CONCLUSION: LCI is more effective for recognition of early gastric cancer compared to WLI as a result of improved visualization of changes in redness. Surface blood vessel density was significantly higher in cancer lesions, and this result is consistent with LCI image analysis.

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  64. 腸リンパ管拡張症の診断と治療

    中村 正直, 山村 健史, 前田 啓子, 澤田 つな騎, 水谷 泰之, 藤城 光弘

    日本小腸学会学術集会プログラム・抄録集   Vol. 3 ( 0 ) page: 34_2 - 34_2   2019

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    <p>【背景・目的】 小腸内視鏡診断の進歩により腸リンパ管拡張症(Intestinal lymphangiectasia:IL)を含む蛋白漏出性腸症の小腸精査が可能になった。本研究の目的はILの臨床経過を後ろ向きに評価し、その特徴を明らかにしたうえでより良い治療法を模索することであった。</p><p>【対象と方法】 対象は2003年6月から2019年6月までにILと診断された17例(男性9例、女性8例、発症年齢は中央値37歳、0-75歳)であった。ILの診断は蛋白漏出性腸症と診断され且つ内視鏡下生検もしくは剖検にて病理学的に腸リンパ管拡張を認めたもので、他疾患が否定的であったものとした。白色絨毛、散布性白点を有する白色絨毛群(WV)と、異常なしもしくは軽度絨毛腫大、ケルクリング襞腫大を認める非白色絨毛群(NWV)に分けて臨床成績を比較検討した。</p><p>【結果】 WV、NWVは10例、7例であった。平均血清アルブミン値(g/dl)はWV:NWV = 2.0:1.2でNWVにおいて有意に低かった(P = 0.0061)。平均<i>α</i>1アンチトリプシンクリアランスはWV:NWV = 132:284(P = 0.0509)であった。ステロイド治療への反応はWV:NWV = 2/7:6/6 例でみられた。平均観察期間48箇月において1例のILが影響した死亡例を経験したが、重篤な真菌感染症によるものであった。</p><p>【結論】 NWV群は蛋白漏出は多いがステロイドへの反応がWV群よりも良好であった。治療のゴールドスタンダードは存在せず可能な可能で効果があるものを続けることが現状であった。</p>

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  65. A CASE OF MULTIPLE HEMANGIOMAS OF THE SMALL INTESTINE TREATED BY SCLEROTHERAPY USING DOUBLE-BALLOON ENTEROSCOPY

    YAMADA Keisaku, YAMAMURA Takeshi, NAKAMURA Masanao, SAWADA Tsunaki, MIZUTANI Yasuyuki, MAEDA Keiko, FURUKAWA Kazuhiro, MIYAHARA Ryoji, YOKOI Takio, HIROOKA Yoshiki

    GASTROENTEROLOGICAL ENDOSCOPY   Vol. 61 ( 6 ) page: 1231 - 1236   2019

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    <p>A 70-year-old male was referred to our department due to melena which began one month previously. Esophagogastroduodenoscopy and colonoscopy were performed, but no signs of active bleeding were found. Therefore, capsule endoscopy was performed to check for small intestinal lesions. Capsule endoscopy revealed multiple protruded lesions and bloody intestinal fluid in a lesion in the upper ileum. Double-balloon enteroscopy revealed multiple protruded lesions suspicious of being hemangioma. Endoscopic mucosal resection of a lesion was performed, and it was finally diagnosed as capillary hemangioma. Sclerotherapy was performed by injecting polidocanol in the multiple hemangiomas. After this treatment, there was no melena and the follow-up endoscopy showed decreased size of the lesions. Thus, sclerotherapy was found to be useful in the treatment of multiple hemangiomas in the small intestine.</p>

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  66. Lewis Score on Capsule Endoscopy as a Predictor of the Risk for Crohn's Disease-Related Emergency Hospitalization and Clinical Relapse in Patients with Small Bowel Crohn's Disease

    Nishikawa Takahiro, Nakamura Masanao, Yamamura Takeshi, Maeda Keiko, Sawada Tsunaki, Mizutani Yasuyuki, Ishikawa Takuya, Furukawa Kazuhiro, Ohno Eizaburo, Miyahara Ryoji, Kawashima Hiroki, Hirooka Yoshiki

    GASTROENTEROLOGY RESEARCH AND PRACTICE   Vol. 2019   page: 4274257   2019

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    Background. Small bowel capsule endoscopy (CE) is a useful tool for evaluating the mucosal changes in patients with Crohn’s disease (CD). The Lewis score (LS) on CE could be used to objectively assess the inflammatory activity of the small bowel mucosa. However, only few reports on the correlation between the LS and CD prognosis exist. This study is aimed at evaluating the clinical significance of the LS by determining the cutoff value of the LS that could predict CD-related emergency hospitalization. Methods. This retrospective single-center study included 125 patients who underwent CE for small bowel CD. Eighty-six patients whose treatment was not changed after CE were analyzed. Inflammatory activity was assessed with the LS. We examined the clinical course of the patients who could be observed for 1 year after CE and investigated the LS cutoff value that could predict CD-related emergency hospitalization within 1 year. We also examined the hospitalization-free and clinical relapse-free rates using the LS cutoff value and evaluated the factors related to emergency hospitalization. Results. The LS cutoff value that could predict CD-related emergency hospitalization within 1 year was 264 (area under the curve, 0.92 (P < 0 001); sensitivity, 0.80; and specificity, 0.94). The cumulative hospitalization-free rate and cumulative clinical relapse-free rate were significantly higher in patients with a LS < 264 (P < 0 001). Multivariate analysis showed that a LS < 264 was a statistically significant factor (P = 0 001; 95% CI, 0.010–0.308). Conclusion. A LS of 264 is a useful cutoff value that could predict CD-related emergency hospitalization. This LS cutoff value may help determine treatment strategies for CD.

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  67. Validity of Capsule Endoscopy in Monitoring Therapeutic Interventions in Patients with Crohn's Disease

    Nakamura Masanao, Yamamura Takeshi, Maeda Keiko, Sawada Tsunaki, Mizutani Yasuyuki, Ishikawa Takuya, Furukawa Kazuhiro, Ohno Eizaburo, Kawashima Hiroki, Miyahara Ryoji, Koulaouzidis Anastasios, Hirooka Yoshiki

    JOURNAL OF CLINICAL MEDICINE   Vol. 7 ( 10 )   2018.10

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  68. THE DIAGNOSTIC ABILITY AND PITFALL OF JNET(JAPAN NBI EXPERT TEAM)CLASSIFICATION IN TRAINEES

    Suzuki Hiroto, Yamamura Takeshi, Watanabe Osamu, Nakamura Masanao, Matsushita Masanobu, Sawada Tsunaki, Mizutani Yasuyuki, Ishikawa Eri, Niwa Yoshiki, Uchida Genta, Otsuka Hiroyuki, Nishikawa Takahiro, Ishida Tetsuya, Yamada Keisaku, Hattori Shun, Kajikawa Go, Hashiguchi Hiroki, Suhara Hiroki, Ishikawa Takuya, Furukawa Kazuhiro, Funasaka Kohei, Ohno Eizaburo, Kawashima Hiroki, Miyahara Ryoji, Hirooka Yoshiki, Goto Hidemi

    GASTROINTESTINAL ENDOSCOPY   Vol. 87 ( 6 ) page: AB489-AB490   2018.6

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  69. EVALUATION OF LOCAL RECURRENCE AFTER COLD POLYPECTOMY COMPARED WITH CONVENTIONAL HOT POLYPECTOMY IN A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL

    Yamamura Takeshi, Saito Masashi, Watanabe Osamu, Nakamura Masanao, Matsushita Masanobu, Sawada Tsunaki, Mizutani Yasuyuki, Niwa Yoshiki, Ishikawa Eri, Suzuki Hiroto, Otsuka Hiroyuki, Uchida Genta, Nishikawa Takahiro, Ishida Tetsuya, Kuno Takeshi, Yamada Keisaku, Hattori Shun, Hashiguchi Hiroki, Suhara Hiroki, Ishikawa Takuya, Furukawa Kazuhiro, Funasaka Kohei, Ohno Eizaburo, Miyahara Ryoji, Kawashima Hiroki, Hirooka Yoshiki, Goto Hidemi

    GASTROINTESTINAL ENDOSCOPY   Vol. 87 ( 6 ) page: AB478 - AB478   2018.6

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  70. Making decision to treat with infliximab by the result of periodic surveillance with double-balloon endoscopy after ilectomy can obtain mucosal healing and avoid re-operation on patients with Crohn's disease for a long-term follow-up study

    Watanabe Osamu, Nakamura Masanao, Yamamura Takeshi, Matsushita Masanobu, Saito Masashi, Matsuura Rinzaburou, Sawada Tsunaki, Mizutani Yasuyuki, Niwa Yoshiki, Ishikawa Eri, Uchida Genta, Otsuka Hiroyuki, Suzuki Hiroto, Nishikawa Takahiro, Ishida Tetsuya, Yamada Keishi, Kuno Takeshi, Hattori Shun, Ishikawa Takuya, Furukawa Kazuhiro, Funasaka Kohei, Ohno Eizaburo, Miyahara Ryoji, Kawashima Hiroki, Hirooka Yoshiki, Goto Hidemi

    JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   Vol. 32   page: 287-287   2017.9

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  71. One Year Follow-Up After Cold Polypectomy Compared With Hot Polypectomy for Small Colorectal Polyps - a Prospective Randomized Controlled Trial

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    GASTROINTESTINAL ENDOSCOPY   Vol. 85 ( 5 ) page: AB365-AB366   2017.5

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  72. Establishment of a New Scoring System for Predicting the Necessity of Double-Balloon Endoscopy in Obscure Gastrointestinal Bleeding

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  73. Clinical Factors Related to False Positive Rates of Patency Capsule Examination

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    GASTROINTESTINAL ENDOSCOPY   Vol. 85 ( 5 ) page: AB305-AB305   2017.5

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  74. The Study of Diagnostic Ability for the Colorectal Neoplasms by Imaged Enhanced Endoscopy Using by JNET (Japan NBI Expert Team) Classification

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  75. Novel EMR Technique for Preoperative Diagnosis and Treatment of Submucosal Tumor in the Small Bowel at Double-Balloon Endoscopy

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    GASTROINTESTINAL ENDOSCOPY   Vol. 85 ( 5 ) page: AB300 - AB300   2017.5

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KAKENHI (Grants-in-Aid for Scientific Research) 1

  1. 腸管分泌型IgA抗体に着目したirAE腸炎発症原因を探索する研究

    Grant number:20K17046  2020.4 - 2023.3

    科学研究費助成事業  若手研究

    澤田 つな騎

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    Authorship:Principal investigator 

    Grant amount:\2340000 ( Direct Cost: \1800000 、 Indirect Cost:\540000 )

    免疫チェックポイント阻害薬による有害事象(irAE)は治療継続の可否にも関わることから重大な問題である。irAE腸炎の発症と、腸内細菌叢との関連が注目されている。この関連を検討するに当たり、腸管分泌型IgA抗体と粘膜関連細菌叢に着目した。腸管分泌型IgA抗体はPD-1の発現と関連して細菌への親和性が変化し、PD-1を遮断すると親和性が低下し、dysbiosisをもたらすと考えられる。また、粘膜関連細菌叢は腸粘膜と直接クロストークすることで糞便細菌叢よりも病態に直結する情報を含むと考えられる。この研究は、irAEの発症と腸内細菌叢、およびIgA腸管免疫との関連を解明することを目的とする。
    GI-irAEのReal world dataを取得するために、当院における肺癌239例、悪性黒色腫149例について臨床像を検討した。Gi-irAEを発症後に、ICIをそのまま投与継続またはGi-irAE改善後にICI投与を再開した投与継続群とGi-irAE発症後に永続的にICIを中止した投与中止群に分類し予後の検討を行った。肺癌患者では、OSについて3群間での有意差は認めなかった。悪性黒色腫では、投与継続群とその他(投与中止群、非発症群)とで比較すると、投与継続群でOSの有意な延長を認めた。このことから、GI-irAEの発症と予後の相関が示唆され、GI-irAE発症の機序を探ることはICI治療の効果予測とも関連する重要な課題であることが確認された。
    粘膜関連細菌叢の手技を確立するために、採取方法を検討した。GI-irAE症例の発症例が少なく、病態が類似しているとされる潰瘍性大腸炎症例において当院IRB承認のもと検体採取を行って検討した。胆管生検用ブラシ鉗子、ポリペクトミー用スネア鉗子、病変回収用ネット鉗子を用いて、大腸粘膜に付着した粘液を回収して解析した。DNA抽出はDNeasy PowerSoil Kit(Qiagen、Hilden、Germany)を使用してDNAを単離した。ブラシ鉗子で回収した検体から最も単離できるDNA量が豊富であることが判明した。DNAはユニバーサルプライマーを使用し細菌のV3-4領域をターゲットにして増幅し、AMPure XP磁気精製ビーズ(Beckman Coulter、Brea、CA、USA)を使用して精製した。2回目のPCRサイクルを通じてバーコードを付し、産物をプールしてシーケンスライブラリを構築し、Illumina MiSeqシーケンサーを使用してシーケンスした。これらの手技により大腸粘膜関連細菌叢の解析手技を確立した。
    IgA-SeqのためIgAを経口ラベル抗体標識した糞便検体懸濁液のFACSを検討していたが、当組織の共有機器の感染制御が困難であり施行後に機器のクリーニングが必要であったが、その費用が賄えないことが判明した。また閉鎖路で施行できるフローサイトメーターも検討したが、こちらも予算の関係から断念した。
    igA-Seqは、フローサイトメトリーによるIgAコーティング細菌の分離は断念し、磁気細胞分離法 (MACS)による分離が可能か検討中している。
    GI-irAE症例の粘膜関連細菌叢を解析するために症例集積を行う。