Papers - SAWADA Tsunaki

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

Funasaka, K; Miyahara, R; Furukawa, K; Sawada, T; Maeda, K; Yamamura, T; Ishikawa, T; Ohno, E; Nakamura, M; Kawashima, H; Hirooka, Y; Ohmiya, N; Fujishiro, M

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

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Language：English   Publisher：Translational Oncology  

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.

DOI： 10.1016/j.tranon.2020.100848

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

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

GASTROENTEROLOGICAL ENDOSCOPY   Vol. 62 ( 9 ) page： 1624 - 1633   2020.9

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Language：Japanese   Publisher：Japan Gastroenterological Endoscopy Society  

<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^＊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.</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^＊ 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>

DOI： 10.11280/gee.62.1624

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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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Publisher：日本メディカルセンター  

DOI： 10.19020/cg.0000001326

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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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Publisher：日本メディカルセンター  

DOI： 10.19020/cg.0000001325

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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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Publisher：日本メディカルセンター  

DOI： 10.19020/int.0000000486

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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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Publisher：日本メディカルセンター  

DOI： 10.19020/cg.0000001205

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

Hosono, I; Miyahara, R; Furukawa, K; Funasaka, K; Sawada, T; Maeda, K; Yamamura, T; Ishikawa, T; Ohno, E; Nakamura, M; Kawashima, H; Yokoi, T; Hirooka, Y; Fujishiro, M; Tsukamoto, T

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

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Language：English   Publisher：BMC Gastroenterology  

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.

DOI： 10.1186/s12876-020-01319-7

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

Furukawa, K; Miyahara, R; Funasaka, K; Sawada, T; Keiko, M; Yamamura, T; Ishikawa, T; Ohno, E; Nakamura, M; Kawashima, H; Fujishiro, M

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

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Language：Japanese  

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EVALUATION OF RESECTABILITY BETWEEN ENDOSCOPIC TREATMENT METHODS FOR RECTAL NEUROENDOCRINE TUMOR

Toriyama, K; Yamamura, T; Nakamura, M; Keiko, M; Sawada, T; Mizutani, Y; Ishikawa, T; Furukawa, K; Ohno, E; Kawashima, H; Fujishiro, M

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

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Language：Japanese  

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

Esaki, M; Yamamura, T; Nakamura, M; Keiko, M; Sawada, T; Mizutani, Y; Kuno, T; Yamada, K; Hasegawa, I; Ishikawa, T; Furukawa, K; Ohno, E; Kawashima, H; Fujishiro, M

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

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Language：Japanese  

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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, T; Kawashima, H; Ohno, E; Nishio, R; Iida, T; Suzuki, H; Uetsuki, K; Yamada, K; Yashika, J; Yoshikawa, M; Gibo, N; Aoki, T; Kataoka, K; Mori, H; Keiko, M; Sawada, T; Yamamura, T; Furukawa, K; Nakamura, M; Fujishiro, M

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

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Language：Japanese  

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Clinical Factors Associated with Missing Colorectal Polyp on Colon Capsule Endoscopy

Yamada, K; Nakamura, M; Yamamura, T; Maeda, K; Sawada, T; Mizutani, Y; Ishikawa, T; Furukawa, K; Ohno, E; Miyahara, R; Kawashima, H; Hotta, N; Hirooka, Y

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

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Language：English   Publisher：Digestion  

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.

DOI： 10.1159/000498942

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

Nishio, R; Kawashima, H; Nakamura, M; Ohno, E; Ishikawa, T; Yamamura, T; Maeda, K; Sawada, T; Tanaka, H; Sakai, D; Miyahara, R; Ishigami, M; Hirooka, Y; Fujishiro, M

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

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Language：English   Publisher：World Journal of Gastroenterology  

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.

DOI： 10.3748/wjg.v26.i10.1056

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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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Language：Japanese   Publisher：Pancreas  

DOI： 10.1097/MPA.0000000000001481

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特集 ここまで明らかになった小腸疾患 小腸の各疾患　血管性病変

澤田 つな騎, 中村 正直, 藤城 光弘

診断と治療   Vol. 108 ( 1 ) page： 67 - 72   2020.1

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Publisher：(株)診断と治療社  

DOI： 10.34433/j00697.2020120530

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Color information from linked color imaging is associated with invasion depth and vascular diameter in superficial esophageal squamous cell carcinoma

Kobayashi, K; Miyahara, R; Funasaka, K; Furukawa, K; Sawada, T; Maeda, K; Yamamura, T; Ishikawa, T; Ohno, E; Nakamura, M; Kawashima, H; Nakaguro, M; Okumura, Y; Hirooka, Y; Fujishiro, M

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

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Language：English   Publisher：Digestive Endoscopy  

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).

DOI： 10.1111/den.13469

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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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Language：Japanese   Publisher：日本小腸学会  

<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>

DOI： 10.32264/shocho.4.0_39

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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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Language：Japanese   Publisher：The Japanese Society of Internal Medicine  

<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>

DOI： 10.2169/internalmedicine.4267-19

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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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Language：Japanese   Publisher：The Japanese Society of Internal Medicine  

<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>

DOI： 10.2169/internalmedicine.5302-20

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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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