[show abstract][hide abstract] ABSTRACT: The demarcation line between the cancerous lesion and the surrounding area could be easily recognized with flexible spectral imaging color enhancement (FICE) system compared with conventional white light images. The characteristic finding of depressed-type early gastric cancer (EGC) in most cases was revealed as reddish lesions distinct from the surrounding yellowish non-cancerous area without magnification. Conventional endoscopic images provide little information regarding depressed lesions located in the tangential line, but FICE produces higher color contrast of such cancers. Histological findings in depressed area with reddish color changes show a high density of glandular structure and an apparently irregular microvessel in intervening parts between crypts, resulting in the higher color contrast of FICE image between cancer and surrounding area. Some depressed cancers are shown as whitish lesion by conventional endoscopy. FICE also can produce higher color contrast between whitish cancerous lesions and surrounding atrophic mucosa. For nearly flat cancer, FICE can produce an irregular structural pattern of cancer distinct from that of the surrounding mucosa, leading to a clear demarcation. Most elevated-type EGCs are detected easily as yellowish lesions with clearly contrasting demarcation. In some cases, a partially reddish change is accompanied on the tumor surface similar to depressed type cancer. In addition, the FICE system is quite useful for the detection of minute gastric cancer, even without magnification. These new contrasting images with the FICE system may have the potential to increase the rate of detection of gastric cancers and screen for them more effectively as well as to determine the extent of EGC.
World journal of gastrointestinal endoscopy. 08/2012; 4(8):356-61.
[show abstract][hide abstract] ABSTRACT: Small-caliber endoscopy has lower resolution than normal-caliber endoscopy, limiting its use in routine outpatient practice. Flexible spectral imaging color enhancement (FICE) strengthens the color contrast of depressed-type early gastric cancer without magnification. The aim of the present study was to evaluate the detection of depressed-type early gastric cancer using small-caliber endoscopy with the FICE system.
Eighty-two patients diagnosed with depressed-type early gastric cancer by standard endoscopy and biopsy were evaluated by small-caliber endoscopy. FICE images and conventional images were compared. Color differences in all 82 lesions were measured between malignant lesions and the surrounding mucosa using the Commission Internationale de L'Eclairage (CIE) 1976 color space.
Most cancers were readily detected as reddish lesions on FICE images. Lines of demarcation between the malignant lesion and the surrounding mucosa were easily identified with FICE images, as such cancers could be clearly distinguished from the surrounding atrophic mucosa. Greater median color differences between malignant lesions and the surrounding mucosa were present in FICE images compared with conventional images, resulting in images with better contrast (27.2 vs 18.7, P<0.0001).
Small-caliber endoscopy with the FICE system provides better color contrast of depressed-type early gastric cancers than conventional small-caliber endoscopy, and the FICE system may facilitate the diagnosis of this type of cancer as a new endoscopic modality.
[show abstract][hide abstract] ABSTRACT: The endoscopic appearance of gastric antral vascular ectasia (GAVE) can be easily misinterpreted as inflammatory changes of
gastric mucosa. We report on a case of GAVE that had been missed by conventional transnasal endoscopy but was diagnosed by
flexible spectral imaging color enhancement (FICE) with a transnasal endoscope. A 45-year-old woman with severe anemia presented
with a 1-month history of increasing fatigue. She was previously diagnosed as having acute antral gastritis by conventional
transnasal endoscopy (EG 530N2) because of the presence of reddish mucosal changes on the entire antral rugal fold. However,
the FICE images produced using a combination of new processor system (VP4450) and new small-caliber endoscope (EG 530NW),
did not show reddish mucosal changes on the entire rugal fold, but gave a clear image of dilated vessels associated with GAVE
distinct from the surrounding normal mucosa on the same fold. These findings are useful to differentiate GAVE from ordinary
gastritis. The lesions of GAVE were managed with a combination of focal pulse and spray-painting techniques to obliterate
the bulk of the disease in two sessions of argon plasma coagulation therapy. Three months later, the patient recovered from
iron deficiency anemia with an oral medication of iron tablets.
Clinical Journal of Gastroenterology 04/2012; 4(1):15-18.
[show abstract][hide abstract] ABSTRACT: Current conventional endoscopy often misses flat early gastric cancers (0–IIb) because they are sometimes invisible. We experienced
a case of small flat early gastric cancer that had been missed by normal-caliber conventional endoscopy. By small-caliber
endoscope, conventional endoscopy showed a subtle reddish change of gastric mucosa, but the image with flexible spectral imaging
color enhancement clearly showed a flat reddish lesion with 10mm diameter, distinct from the surrounding mucosa. Flat early
gastric cancer was suspected even though the lesion was not clearly described by conventional endoscopy. Histological examination
of biopsy specimen revealed atypical glands. Endoscopic submucosal dissection of the lesion was performed. Pathological examination
of the resected specimen confirmed well-differentiated adenocarcinoma localized in the mucosal layer without any depression
or protrusion compared with the surrounding mucosa, consistent with the endoscopic finding. The small flat early gastric cancer
became clearly visible with the new endoscopic technology.
KeywordsFICE-Flat early gastric cancer-Subtle mucosal change
Clinical Journal of Gastroenterology 04/2012; 3(2):88-91.
[show abstract][hide abstract] ABSTRACT: Esophageal lymphangioma is a very rare disease. We report a case of esophageal lymphangioma successfully treated with endoscopic
submucosal dissection (ESD), which yielded definitive histological diagnosis and symptom relief. ESD offers a better option
for definitive diagnosis as well as complete resection of large esophageal lymphangiomas with flat configuration.
KeywordsEsophageal lymphangioma-Endoscopic mucosal resection-Endoscopic submucosal dissection
Clinical Journal of Gastroenterology 04/2012; 3(3):140-143.
[show abstract][hide abstract] ABSTRACT: Endoscopic submucosal dissection has revolutionized endoscopic treatment for early gastrointestinal neoplasm. The technique has overcome the size and resection limitations of endoscopic mucosal resection with injection and standard snaring techniques.
Techniques in Gastrointestinal Endoscopy 01/2011; 13(1):79-83.
[show abstract][hide abstract] ABSTRACT: Endoscopic submucosal dissection (ESD) has emerged as a novel technique for achieving en bloc resection for superficial neoplasms limited to the mucosa. ESD was originally developed in Japan as a method of endoscopic resection of superficial gastric cancers. In our hospital, ESD has been used concurrently in other parts of the gastrointestinal tract, including the esophagus and colorectum from the beginning of its development. However, ESD in the duodenum is considered more challenging than other parts. From August 2005 to March 2008, a total of 15 superficial duodenal neoplastic lesions in 14 patients were treated with endoscopic resection. Of these, nine underwent ESD. We report our experience with duodenal ESD with a combination of ST hood and hook knife.
[show abstract][hide abstract] ABSTRACT: The diagnosis of endoscopic Barrett's esophagus (BE) has been under discussion for the past decade because palisade vessels may be obscured by inflammation or the location of upper end of gastric fold may be diversely changed. The flexible spectral imaging color enhancement (FICE) system can reconstruct improved spectral images decomposed from ordinary endoscopic images with free selection of three wavelengths, and can provide non-magnified images with high light intensity.
To evaluate whether the transnasal FICE system enables easier diagnosis of endoscopic BE, 72 patients with endoscopic BE were observed prospectively with a transnasal endoscope using both conventional images and FICE images. The visualization of palisade vessels and the identification of the demarcation between endoscopic BE mucosa and gastric mucosa were compared between FICE images and conventional endoscopic images, and the CIELAB color differences were calculated among palisade vessels, background BE mucosa and gastric folds.
Palisade vessels could be more clearly visualized in BE mucosa with transnasal FICE than with conventional endoscopy. Demarcation between whitish BE mucosa and the upper end of the brownish gastric mucosa could be clearly identified using transnasal FICE images. Greater color differences existed with FICE images between palisade vessels and background BE mucosa as well as between BE mucosa and gastric folds than with conventional images, leading to better contrasting images.
The transnasal FICE system enables clear visualization of palisade vessels and provides better contrasting images of the demarcation between the BE mucosa and the gastric mucosa, and thus contributes to easier diagnosis of endoscopic BE.
Journal of Gastroenterology 09/2009; 44(11):1125-32. · 3.79 Impact Factor
[show abstract][hide abstract] ABSTRACT: The diagnostic accuracy of conventional endoscopy for small colonic polyps is not satisfactory. Optimal band imaging (OBI) enhances the contrast of the mucosal surface without the use of dye.
To evaluate the diagnostic accuracy for the differentiation of neoplastic and non-neoplastic colorectal polyps by using magnified OBI colonoscopy.
An open prospective study.
Jichi Medical University, Japan.
A total of 133 colonoscopy cases.
A comparative study of the overall accuracy, sensitivity, and specificity for the differentiation of neoplastic and non-neoplastic colorectal polyps < or =5 mm in size by capillary-pattern diagnosis by using conventional colonoscopy, capillary-pattern diagnosis in OBI, and pit-pattern diagnosis in chromoendoscopy with low magnification.
A total of 107 polyps, composed of 80 neoplastic and 27 non-neoplastic polyps, were evaluated. OBI clearly showed the capillary network of the surface mucosa of neoplastic polyps at low magnification, whereas the surface mucosa of non-neoplastic polyps showed up as a pale lesion. The capillary pattern in conventional colonoscopy had 74% accuracy, 71% sensitivity, and 81% specificity for neoplastic polyps. The accuracy and sensitivity were significantly lower than those that used the capillary pattern in OBI (accuracy 87% and sensitivity 93%) and the pit pattern in chromoendoscopy (accuracy 86% and sensitivity 90%). There were no significant differences in specificity (OBI 70% and chromoendoscopy 74%). The kappa analysis indicated good agreement in both OBI and chromoendoscopy.
Capillary-pattern diagnosis in OBI is superior to that in conventional endoscopy and is not significantly different from pit-pattern diagnosis for predicting the histology of small colorectal polyps.
[show abstract][hide abstract] ABSTRACT: The endoscopic diagnosis of an elevated-type early gastric cancer is often difficult. The optimal band imaging (OBI) system can reconstruct the best spectral images decomposed from ordinary endoscopic images with free selection of 3 wavelengths and provide unmagnified images with high light intensity as well as magnified images.
To evaluate whether the OBI system facilitates detection of the demarcation lines between an elevated-type early gastric cancer and surrounding tissue and thus is more helpful for performing endoscopic therapy.
A prospective study.
Jichi Medical University, Japan.
Seventy-five patients, 81 lesions with an elevated-type early gastric cancer.
A comparison between OBI images and conventional endoscopic images in the identification of the demarcation lines of an elevated-type early gastric cancer without magnification and the rate of success in identifying the abnormal surface structure of cancer by using low-magnified OBI images.
Demarcation lines were easily identified in OBI images, even without magnification, because such cancers could be clearly distinguished from the surrounding whitish atrophic mucosa. Inexperienced endoscopists could determine demarcation lines with significantly greater accuracy with unmagnified OBI images than with conventional images. With 40-fold magnification, irregular microstructural or nonstructural patterns were also found within cancer lesions in all cases studied but in none of the cases in the surrounding noncancerous mucosa.
The new contrast images obtained with the OBI system enable better determination of the demarcation lines of elevated-type early gastric cancers, and this system may be useful for performing endoscopic therapy of this type of cancer as a new endoscopic modality.
[show abstract][hide abstract] ABSTRACT: Ghrelin is primarily secreted from the stomach and has been implicated in the coordination of eating behavior and weight regulation. Ghrelin also plays an essential role in the mechanism of gastric mucosal defense. Thus, it is important to clarify which diseases primarily influence changes in plasma ghrelin concentrations. Helicobacter pylori (H pylori) infection is involved in the pathogenesis of gastritis, gastric and duodenal ulcer, gastric carcinoma, and mucosa-associated lymphoid tissue lymphoma. H pylori eradication is related to body weight change. Compared, H pylori infected and negative subjects with normal body mass index, plasma ghrelin concentration, gastric ghrelin mRNA, and the number of ghrelin producing cells in gastric mucosa are significantly lower in H pylori infected subjects than in H pylori-negative controls. Plasma ghrelin concentration decreases with the progression of gastric atrophy. Impaired gastric ghrelin production in association with atrophic gastritis induced by H pylori infection accounts for the decrease in plasma ghrelin concentration. However, the ratio of plasma acylated ghrelin to total ghrelin levels is higher in patients with chronic atrophic gastritis than in healthy subjects. This may result from the compensatory increase in plasma active ghrelin concentration in response to gastric atrophy. After H pylori eradication, gastric preproghrelin mRNA expression is increased nearly 4-fold in most cases. However, changes in plasma ghrelin concentrations before and after H pylori cure are not associated with the gastric ghrelin production. Plasma ghrelin changes are inversely correlated with both body weight change and initial plasma ghrelin levels.
World Journal of Gastroenterology 12/2008; 14(41):6327-33. · 2.55 Impact Factor
[show abstract][hide abstract] ABSTRACT: Background: Magnifying narrow band imaging system is useful for the diagnosis of early gastric cancer. However, it is difficult for the operator of the scope to maintain the correct distance between the tip of the endoscope and the gastric mucosa for appropriate visualization. The newly developed optimal band imaging system can reconstruct good spectral images derived from ordinary endoscopic images and enhance the mucosal surface without magnification as well as with low magnification. This imaging technique is based on narrowing the bandwidth of the conventional image arithmetically, using spectral estimation technology.Methods: We evaluated endoscopic features of 30 lesions with elevated-type, 32 lesions with depressed-type and two lesions with flat-type early gastric cancer using this new system.Results: We found the best images in all cases of early gastric cancers by using a specific combination of the following three wavelengths available in this system: 470 nm for blue, 500 nm for green and 550 nm for red. The optimal band images showed the depressed-type early gastric cancer as reddish lesions distinct from the surrounding yellowish non-cancerous area, leading to a clear demarcation line between the cancerous and non-cancerous mucosa without magnification. Moreover, 30–40-fold magnified optimal band images showed a clearly irregular microvascular pattern or a microstructure pattern of the mucosal surface in all types of gastric cancers.Conclusion: This new system can provide useful information for diagnosing various types of early gastric cancers without and with low magnification.
[show abstract][hide abstract] ABSTRACT: A 74-year-old man with diabetic nephropathy developed epigastric pain and high fever after endoscopic submucosal dissection (ESD) for early gastric cancer. Gastroscopy, endoscopic ultrasonography and computed tomography showed ulceration with a purulent lake, thickened entire gastric mucosal layers suggesting focal abscess formation, leading to the diagnosis of phlegmonous gastritis. He underwent total gastrectomy as an emergency. Histological findings of the resected specimen showed severe inflammatory cell infiltration and multiple focal abscess formation spreading to the entire gastric wall. In patients with poorer general conditions, phlegmonous gastritis should be considered as a serious complication after ESD, indicating a requirement of antibiotic prophylaxis.
Therapeutic Advances in Gastroenterology 09/2008; 1(2):91-5.
[show abstract][hide abstract] ABSTRACT: Indian hedgehog (Ihh) is a member of hedgehog peptides family that exerts diverse effects on multiple cellular functions. Since Ihh expression is elevated in the pancreas of chronic pancreatitis patients, Ihh has been assumed to participate in the chronic pancreatic injury, especially in pancreatic fibrosis. However, its function in pancreatic fibrosis is still unknown. We thus examined Ihh effects on rat activated pancreatic stellate cells (PSCs) that play a central role in pancreatic fibrosis. Activated PSCs express both patched-1 and smoothened that are essential components of hedgehog receptor system. Ihh did not alter the PSC expression of collagen-1 or alpha-smooth muscle actin, a parameter of PSC transformation, or did not change PSC proliferation. However, Ihh enhanced PSC migration in both chemotactic and chemokinetic manners. Furthermore, Ihh increased the amount of membrane-type 1 matrix metalloproteinase (MT1-MMP) and altered its localization on the plasma membrane, which plays a stimulatory role in cellular migration. In addition, tissue inhibitor of metalloproteinase-2 (TIMP-2) attenuated Ihh-stimulated PSC migration. Since most hedgehog intracellular signals are mediated by Gli-1 transcription factor, we investigated its contribution to Ihh-enhancement of PSC migration. Ihh induced Gli-1 nuclear accumulation in PSCs, indicating that Ihh stimulates Gli-1-dependent signaling pathway in PSCs. Unexpectedly, however, adenovirus-mediated Gli-1 overexpression blocked the Ihh enhancement of both MT1-MMP localization on the plasma membrane and PSC migration. Furthermore, reduction of Gli-1 expression with RNA interference augmented Ihh-stimulated PSC migration. These data indicate that Ihh promotes PSC migration by enhancing MT1-MMP localization on the plasma membrane but is negatively regulated by Gli-1.
Journal of Cellular Physiology 08/2008; 216(1):38-46. · 4.22 Impact Factor
[show abstract][hide abstract] ABSTRACT: An international group of gastroenterologists and pathologists (Operative Link for Gastritis Assessment (OLGA)) proposed the staging system of atrophy. The aim of this study was to assess the severity of atrophic gastritis using the OLGA system.
The subjects comprised 163 H. pylori-positive patients: 18 with early gastric cancers of the intestinal type (GC), 55 with atrophic gastritis (AG), 49 with gastric ulcers or scars (GU), and 41 with duodenal ulcers or scars (DU). Biopsies were taken from the lesser and greater curvatures of the antrum and middle body. The OLGA gastritis stage (0-IV) (the severity and topography of atrophy) was obtained by combining antral with body atrophy scores. The gastritis grade (the severity and topography of inflammation) was obtained by combining antral and body inflammation scores.
Most (84%) of patients with GC showed stage III or IV. Gastritis stages were significantly higher in patients with GC than in those with AG, GU, and DU. Gastritis stage became higher with age. Gastritis grades were slightly higher in patients with AG than in others.
Our results indicate that higher stages are found in patients with GC using the OLGA staging system and that the high risk of GC can be recognized. It is simple to use and useful for the assessment of the severity of atrophic gastritis.
[show abstract][hide abstract] ABSTRACT: Laparoscopic treatment has been recommended for gastric prolapse in Morgagni hernia. We describe a 92-year-old woman diagnosed with gastric prolapse in Morgagni hernia. Endoscopic treatment was chosen because surgical or laparoscopic treatment was not tolerable for her. We successfully replaced gastric prolapse by aspirating air and fluid in the prolapsed antrum and subsequently advanced the endoscope to the duodenum. This new endoscopic technique is relatively simple, non-invasive and useful as an alternative method of surgical or laparoscopic treatment, especially in patients with high risk for these invasive treatments.
[show abstract][hide abstract] ABSTRACT: Sulfatides highly expressed in the normal gastric mucosa play important roles in gastric mucosal protection. However, it is unknown whether the sulfatides expression changes in chronic gastritis.
Sulfatides expression levels were examined with immunohistochemical staining in 77 specimens obtained from resected human stomachs, followed by the measurement of optical density of the staining under digital microscopy. For mRNA expression analysis of GalCer (galactosylceramide)-sulfotransferase and arylsulfatase A using a quantitative real time reverse transcription-polymerase chain reaction, 64 biopsy specimens were endoscopically taken from the gastric corpus of out patients. Mucosal changes were scored under microscopic observations according to the updated Sydney System classification.
The sulfatides expression decreased along with the progression of mucosal atrophy and lymphocytes infiltration, and was barely observed in intestinal metaplasia. The mRNA expression of GalCer-sulfotransferase, a biosynthetic enzyme for sulfatides, also decreased along with the progression of mucosal atrophy and lymphocytes infiltration. In contrast, mRNA expression of arylsulfatase A, which degrades sulfatides, was not altered.
Expression of sulfatides and GalCer-sulfotransferase in the gastric mucosa of chronic gastritis is selectively reduced according to the mucosal atrophy and inflammation. Decreased expression of sulfatides may attribute to the deterioration of mucosal protection in chronic gastritis.
Journal of Clinical Gastroenterology 02/2008; 42(1):23-8. · 3.20 Impact Factor
[show abstract][hide abstract] ABSTRACT: The endoscopic diagnosis of depressed-type early gastric cancers is difficult because these cancers manifest as subtle changes in color and shape. The newly developed optimal band imaging (OBI) system can reconstruct the best spectral images derived from ordinary endoscopic images and enhances the mucosal surface without the use of dyes. This imaging technique is based on narrowing the bandwidth of conventional image arithmetically by using spectral estimation technology.
Evaluation of the usefulness of the OBI system for identifying the demarcation line of depressed-type early gastric cancers.
Jichi Medical University in Japan.
Twenty-seven cases with depressed-type early gastric cancer.
Comparative study for the success rate of identifying the demarcation line of depressed-type early gastric cancer by using optimal band images and conventional endoscopic images.
Demarcation of the depressed-type early gastric cancer was easily identified by optimal band images without magnification in 26 of 27 cases (96%), because distinct demarcation was observed endoscopically between the reddish images of the cancerous lesion and the yellowish images of the surrounding noncancerous area. With 40-fold magnification of optimal band images, the demarcation was also clearly recognized in all cases. Medical students could point out the demarcation line with significantly greater accuracy by observing the new nonmagnified optimal band images than by the conventional images (P< .0001).
Small sample size.
The new contrasting images of the OBI system can delineate the depressed-type early gastric cancer more easily than conventional endoscopy.
[show abstract][hide abstract] ABSTRACT: Cyclooxygenase-2 (COX-2) mediates various inflammatory responses and is expressed in pancreatic tissue from patients with chronic pancreatitis. To examine the role of COX-2 in chronic pancreatitis, we investigated its participation in regulating functions of pancreatic stellate cells (PSCs), using isolated rat PSCs. COX-2 was expressed in culture-activated PSCs but not in freshly isolated quiescent PSCs. TGF-beta1, IL-1beta, and IL-6 enhanced COX-2 expression in activated PSCs, concomitantly increasing the expression of alpha-smooth muscle actin (alpha-SMA), a parameter of PSC activation. The COX-2 inhibitor NS-398 blocked culture activation of freshly isolated quiescent PSCs. NS-398 also inhibited the enhancement of alpha-SMA expression by TGF-beta1, IL-1beta, and IL-6 in activated PSCs. These data indicate that COX-2 is required for the initiation and promotion of PSC activation. We further investigated the mechanism by which cytokines enhance COX-2 expression in PSCs. Adenovirus-mediated expression of dominant negative Smad2/3 inhibited the increase in expression of COX-2, alpha-SMA, and collagen-1 mediated by TGF-beta1 in activated PSCs. Moreover, dominant negative Smad2/3 expression attenuated the expression of COX-2 and alpha-SMA enhanced by IL-1beta and IL-6. Anti-TGF-beta neutralizing antibody also attenuated the increase in COX-2 and alpha-SMA expression caused by IL-1beta and IL-6. IL-6 as well as IL-1beta enhanced TGF-beta1 secretion from PSCs. These data indicate that Smad2/3-dependent pathway plays a central role in COX-2 induction by TGF-beta1, IL-1beta, and IL-6. Furthermore, IL-1beta and IL-6 promote PSC activation by enhancing COX-2 expression indirectly through Smad2/3-dependent pathway by increasing TGF-beta1 secretion from PSCs.