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ABSTRACT: BACKGROUND: Recently, some patients have been found to have superficial squamous cell carcinoma (SCC) of the head and neck region during GI endoscopy; however, endoscopic biopsy from a lesion in the head and neck region is troublesome. An endocytoscopy system has been reported to enable optical biopsy of an esophageal lesion. OBJECTIVE: To evaluate the feasibility of in vivo cellular imaging with an integrated endocytoscopy system for patients with superficial SCC of the head and neck. DESIGN: Experimental pilot study. SETTING: University hospital. PATIENTS: This study involved 12 patients who were found to have superficial SCC of the head and neck during GI endoscopy. INTERVENTION: Endocytoscopic images were taken of each lesion and of the surrounding mucosa. The images were later reviewed by 1 pathologist and 2 endoscopists who were unaware of any other findings. MAIN OUTCOME MEASUREMENTS: Correlation between endocytoscopy diagnosis and histologic diagnosis. RESULTS: Adequate endocytoscopic images could be obtained in 11 of the 12 patients (15 of 16 lesions). For endocytoscopic images of 15 lesions and 12 areas of surrounding mucosa, the overall accuracy of endocytoscopic diagnosis in differentiating between nonmalignant and malignant histopathology by the pathologist, endoscopist 1, and endoscopist 2 were 96%, 96%, and 96%, respectively. The kappa value for interobserver agreement was 0.77. LIMITATIONS: Single-center experience, small number of patients. CONCLUSION: An endocytoscopy system has the potential to be used as an optical biopsy for superficial head and neck lesions.
Gastrointestinal endoscopy 05/2013; · 6.71 Impact Factor
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ABSTRACT: BACKGROUND: Endoscopic submucosal dissection (ESD) has become the standard endoscopic treatment for gastric neoplasms because of its safety and high rate of curability; however, it is not easy for novice operators to learn the technique of ESD. In this study, predictive factors of gastric neoplasms in which novices could not finish ESD by self-completion were evaluated. METHODS: Eighty consecutive ESD procedures performed by four novice operators were retrospectively analyzed. Standard ESD procedures were performed using an insulation-tipped (IT) knife under supervision. Self-completion rates, procedure time, and complete resection rates were evaluated, and predictive factors for "not self-completion" were assessed. RESULTS: The overall self-completion rate and en bloc plus R0 resection rate were 87.5% (70/80) and 95.7 % (67/70), respectively. In "not self-completion" cases (n = 10), the procedure time was longer and resected specimens were larger than those in self-completion cases (83.7 ± 47.3 min vs. 189.5 ± 106.8 min, p < 0.05; 641.2 ± 487.8 vs. 1,116 ± 480.4 mm(2), p < 0.01). Predictive factors of "not self-completion" were tumor location in the middle or upper third of the stomach or in the greater curvature and size of resected specimens larger than 900 mm(2). The self-completion rate of ESD was decreased in cases with more than two predictive factors. CONCLUSIONS: For novice operators, tumor location and resected areas are predictive factors for failure to finish gastric ESD by self-completion. Selection of cancer lesions could be a key factor for effectiveness of ESD training.
Surgical Endoscopy 04/2013; · 4.01 Impact Factor
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Tamotsu Hata,
Mototsugu Kato,
Takahiko Kudo,
Mutsumi Nishida,
Urara Nishida,
Aki Imai,
Takeshi Yoshida,
Jyojyo Hirota,
Go Kamada, Shouko Ono,
Manabu Nakagawa,
Soichi Nakagawa,
Yuichi Shimizu,
Hiroshi Takeda,
Masahiro Asaka
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ABSTRACT: Background: Functional dyspepsia (FD) is a heterogeneous disease characterized by various upper abdominal symptoms. The major mechanism of FD includes impaired fundic accommodation, delayed gastric emptying and visceral hypersensitivity. We developed a novel drinking-ultrasonography test to combine a drink test with ultrasonography to assess gastric motility and sensory function of FD patients. Method: Subjects were 20 healthy volunteers and 26 successive FD patients according to the Rome III criteria. The subjects ingested 200 ml of water at 2-min intervals 4 times (total 800 ml) through a straw. The maximum cross section of the proximal stomach was visualized before water intake, after each water intake, and 5 and 10 min after the completion of drinking using extracorporeal ultrasonography. Abdominal symptoms were evaluated using the visual analog scale (VAS) a total of 5 times. Results: The mean cross-sectional area of the fornix after 800 ml of water intake was significantly lower in the FD group compared with the control group. In the FD group, marked abdominal symptoms developed immediately after initiation of water intake, and VAS score differed significantly (p <0.01) between the control and FD groups at each time point. Conclusion: We developed the novel drinking-ultrasonography test which revealed abnormalities in gastric accommodation and sensation in patients with FD compared with healthy controls. This approach can be readily performed and allows the simultaneous evaluation of gastric accommodation, emptying and sensation.
Digestion 01/2013; 87(1):34-9. · 2.05 Impact Factor
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Gastrointestinal endoscopy 11/2012; 76(5):1073. · 6.71 Impact Factor
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Gastrointestinal endoscopy 08/2012; 76(2):464-5. · 6.71 Impact Factor
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ABSTRACT: The definition of Helicobacter pylori-negative gastric cancer depends on the accuracy of diagnosis of H. pylori infection. The aim of this study was to determine the frequency of H. pylori-negative gastric cancer and to clarify relationships with histological atrophy, endoscopic atrophy, and serological atrophy.
A total of 240 early gastric cancers were included in this study. The status of H. pylori infection was determined from the rapid urease test, (13)C-urea breath test, H. pylori culture, histopathological examination and examination of IgG antibodies. In H. pylori-negative gastric cancer, histological atrophy and intestinal metaplasia, endoscopic atrophy and serological atrophy were assessed by pepsinogen.
The rate of H. pylori infection was 77.9% and 19 patients (7.9%) had a history of eradication. 34 patients (14.2%) were diagnosed with H. pylori-negative gastric cancer using diagnostic tools of H. pylori. However, most of the patients with H. pylori-negative gastric cancer had histological atrophy and intestinal metaplasia. Only 1 gastric cancer (0.42%) occurred in the mucosa without histological atrophy, endoscopic atrophy or serological atrophy.
Early gastric cancers in the Japanese endoscopic submucosal dissection series were strongly related to current or past infection with H. pylori and to gastric mucosal atrophy.
Digestion 06/2012; 86(1):59-65. · 2.05 Impact Factor
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ABSTRACT: Background and Aim: Colonoscopy has the disadvantage of pain and discomfort for patients. It has been shown in randomized controlled trials that carbon dioxide (CO(2) ) insufflations significantly reduce pain and discomfort in patients undergoing colonoscopy. However, there have been no studies in which CO(2) insufflation in colonoscopy of patients with irritable bowel syndrome (IBS) was investigated. Methods: Randomized double-blind controlled study was conducted to assess the suffering from colonoscopy in patients with IBS and the efficacy of CO(2) insufflation in colonoscopy for patients with IBS. Patients with IBS and controls who received colonoscopy were randomized into an air or CO(2) insufflation group. Patients' symptoms such as distension and pain were compared using a 10-cm visual analog scale (VAS). Results: There were 18 patients in the IBS/air group, 19 patients in the IBS/CO(2) group, 25 patients in the control/air group and 26 patients in the control/CO(2) group. The mean value of severity of distension after colonoscopy and the mean value of severity of pain from during examination to one hour after the examination were higher in the IBS group than in the control group. The severity of these symptoms was reduced earlier in the CO(2) group. CO(2) insufflation in colonoscopy was more effective in the IBS group than in the control group from 15 min to one hour after the examination. Conclusion: Regarding colonoscopy-related suffering, IBS patients showed significant differences from non-IBS patients. CO(2) insufflation in colonoscopy is effective for IBS patients, particularly for patients who commence activities after colonscopy.
Journal of Gastroenterology and Hepatology 06/2012; 27(10):1623-8. · 2.87 Impact Factor
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Helicobacter 06/2012; 17(3):238; author reply 239. · 3.15 Impact Factor
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Shotaro Nakamura,
Toshiro Sugiyama,
Takayuki Matsumoto,
Katsunori Iijima, Shouko Ono,
Masahiro Tajika,
Akira Tari,
Yasuhiko Kitadai,
Hiroshi Matsumoto,
Tadanobu Nagaya,
Toshiro Kamoshida,
Norihiko Watanabe,
Toshimi Chiba,
Hideki Origasa,
Masahiro Asaka
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ABSTRACT: A multicentre cohort follow-up study of a large number of patients with gastric mucosa-associated lymphoid tissue (MALT) lymphoma was conducted to elucidate the long-term outcome of the disease after Helicobacter pylori eradication.
420 patients with gastric low-grade MALT lymphoma who had undergone successful H pylori eradication and been followed up for at least 3 years were registered from 21 participating institutes. Responders to treatment were defined as patients whose post-treatment biopsies showed complete histological response (ChR) or probable minimal residual disease (pMRD). Treatment failure was defined as the status of progressive disease or lymphoma relapse after ChR/pMRD.
323 patients (77%) responded to H pylori eradication. A logistic regression analysis showed that absence of H pylori, submucosal invasion determined by endoscopic ultrasonography and t(11;18)/API2-MALT1 were independent predictors of resistance to H pylori eradication. During the follow-up periods ranging from 3.0 to 14.6 years (mean 6.5 years, median 6.04 years), the disease relapsed in 10 of 323 responders (3.1%) while progressive disease was found in 27 of 97 non-responders (27%). Thus, 37 of 420 patients (8.8%) were regarded as treatment failures. Of these 37 patients, transformation into diffuse large B cell lymphoma occurred in nine patients. Among the non-responders and relapsed patients, 17 patients were subjected to a 'watch and wait' strategy while 90 patients underwent second-line treatments including radiotherapy (n=49), chemotherapy (n=26), surgical resection (n=6), chemoradiotherapy (n=5), antibiotic treatment (n=2), rituximab monotherapy (n=1) or endoscopic resection (n=1). Probabilities of freedom from treatment failure, overall survival and event-free survival after 10 years were 90%, 95% and 86%, respectively. Cox multivariate analysis revealed endoscopic non-superficial type to be an independent prognostic factor for adverse freedom from treatment failure, overall survival and event-free survival.
The excellent long-term outcome of gastric MALT lymphoma after H pylori eradication was confirmed by this large-scale follow-up study.
Gut 09/2011; 61(4):507-13. · 10.11 Impact Factor
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Gastrointestinal endoscopy 08/2011; 75(5):1108-10. · 6.71 Impact Factor
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ABSTRACT: The significance of H. pylori eradication for NSAIDs induced gastroduodenal ulcer has not been clarified. NSAIDs and H. pylori infection are independent causal factors for gastroduodenal mucosal injuries. However, the interaction between these two factors is complicated. H. pylori eradication can reduce the risk of NSAIDs induced ulcer in NSAIDs naive patients. However, H. pylori eradication is not recommended in NSAIDs user because of no ulcer suppression and ulcer healing delay. In prevention of NSAIDs induced ulcer recurrence, H. pylori eradication plus PPI treatment is necessary.
Nippon rinsho. Japanese journal of clinical medicine 06/2011; 69(6):1049-56.
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ABSTRACT: Low-dose acetylsalicylic acid has been widely used. We evaluated small bowel and gastric injuries during acetylsalicylic acid administration using video capsule endoscopy and gastroduodenal endoscopy. We also investigated blood flow using contrast-enhanced ultrasonography. Six healthy volunteers were enrolled in this preliminary study. The subjects were administered 100 mg of enteric-coated aspirin daily for 14 days. Video capsule endoscopy and gastroduodenal endoscopy were simultaneously performed before administration and on days 1, 3, 7 and 14. Contrast-enhanced ultrasonography was performed before administration and on day 2, and 8. Video capsule endoscopy after administration of low-dose acetylsalicylic acid revealed small bowel mucosal damages of petechiae and erythema in all cases, and denuded area in one case. The total number of lesions in the small bowel increased according to duration of low-dose acetylsalicylic acid administration. However, the total number of lesions in the stomach peaked on day 3. Contrast-enhanced ultrasonography showed that the time-intensity curve peak value and Areas under the curves after acetylsalicylic acid administration were reduced. We observed not only gastric mucosal injuries but also small intestinal injuries with short-term low-dose acetylsalicylic acid administration. Acetylsalicylic acid administration also caused a decrease in small intestinal blood flow. Contrast-enhanced ultrasonography is useful for evaluation blood flow in the small bowel mucosa.
Journal of Clinical Biochemistry and Nutrition 05/2011; 48(3):245-50. · 1.98 Impact Factor
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ABSTRACT: We have reported the characteristics of magnified endoscopic images of gastric mucosa-associated lymphoid tissue (MALT) lymphoma before and after treatment. In this study, we investigated the diagnostic efficacy of magnified endoscopic images for target biopsy and evaluation of clinical remission.
Twenty-one patients diagnosed with localized gastric MALT lymphoma were enrolled. Magnified endoscopy was performed prior to treatment and at a mean period of 1.8 months (1-6 months) after therapy (Helicobacter pylori eradication in 19 patients and radiation therapy in two patients). Microstructural pattern and abnormal vessels in the lesions were assessed, and corpus mucosa without lymphoma was divided into H. pylori-negative mucosa and H. pylori-positive mucosa. Biopsy was the gold standard in this study.
Nonstructural areas with abnormal vessels were observed in all patients before treatment. Fifteen patients achieved pathological complete remission. Disappearance of nonstructural areas and abnormal vessels after therapy was associated with pathological remission. Sensitivities of these findings for diagnosis were 76.9% and 85.7%, respectively, and the specificities were 87.5% and 85.7%, respectively. H. pylori eradication therapy was invalid in three patients with H. pylori-negative mucosa in magnified images.
Magnifying endoscopy may be useful for target biopsy of superficial gastric MALT lymphoma in clinical management.
Journal of Gastroenterology and Hepatology 03/2011; 26(7):1133-8. · 2.87 Impact Factor
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ABSTRACT: To investigate the relationship between low-dose aspirin-induced small bowel mucosal damage and blood flow, and the effect of rebamipide.
Ten healthy volunteers were enrolled in this study. The subjects were divided into two groups: a placebo group given low-dose aspirin plus placebo and a rebamipide group given low-dose aspirin plus rebamipide for a period of 14 d. Capsule endoscopy and contrast-enhanced ultrasonography were performed before and after administration of drugs. Areas under the curves and peak value of time-intensity curve were calculated.
Absolute differences in areas under the curves were -1102.5 (95% CI: -1980.3 to -224.7, P = 0.0194) in the placebo group and -152.7 (95% CI: -1604.2 to 641.6, P = 0.8172) in the rebamipide group. Peak values of time intensity curves were -148.0 (95% CI: -269.4 to -26.2, P = 0.0225) in the placebo group and 28.3 (95% CI: -269.0 to 325.6, P = 0.8343) in the rebamipide group. Capsule endoscopy showed mucosal breaks only in the placebo group.
Short-term administration of low-dose aspirin is associated with small bowel injuries and blood flow.
World Journal of Gastroenterology 01/2011; 17(2):226-30. · 2.47 Impact Factor
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ABSTRACT: Recently, the incidence of gastric ulcer in Japanese elderly people has been increasing and the number of deaths associated with gastric ulcer has not decreased. Helicobacter pylori infection rates in elderly patients with gastric ulcer are lower than those in non-elderly patients. NSAIDs including aspirin and many other factors influence the development of gastric ulcer. Gastric ulcers occur in the upper part of the stomach and often bleed. In addition, elderly patients tend to have no abdominal symptoms other than bleeding. According to guidelines, endoscopic hemostasis is performed in cases with active bleeding. Eradication therapy is recommended for elderly patients as for as non-elderly patients, and antacids are administered to patients who are negative for H. pylori or have a relapse of ulcers.
Nippon rinsho. Japanese journal of clinical medicine 11/2010; 68(11):1978-82.
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ABSTRACT: Although treatment and prevention for low-dose aspirin (LDA) induced gastrointestinal mucosal injury is important problem, significance of H. pylori eradication has not been clarified. NSAIDs including LDA and H. pylori infection are independent causal factors for gastroduodenal ulcer. However, the interaction between these factors is complicated. H. pylori eradication can reduce the risk of NSAIDs induced ulcer in NSAIDs naive patients. However, H. pylori eradication is not recommended in NSAIDs user because of no ulcer suppression and ulcer healing delay. In prevention of LDA induced ulcer recurrence, H. pylori eradication plus PPI treatment are necessary.
Nippon rinsho. Japanese journal of clinical medicine 11/2010; 68(11):2089-95.
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Mototsugu Kato,
Go Kamada,
Keiko Yamamoto,
Urara Nishida,
Aki Imai,
Takeshi Yoshida, Shouko Ono,
Manabu Nakagawa,
Soichi Nakagawa,
Yuichi Shimizu,
Masahiro Asaka
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ABSTRACT: The concomitant use of non-steroidal anti-inflammatory drugs is a risk factor for low-dose aspirin (LDA)-associated upper gastrointestinal toxicity. Lafutidine is an H2-receptor antagonist with gastroprotective activity, produced by acting on capsaicin-sensitive afferent neurons. To evaluate the preventive effect of lafutidine on gastric damage caused by LDA alone and by the combination of both LDA and loxoprofen, we conducted a clinical study using healthy volunteers.
A randomized, double-blinded, placebo-controlled, crossover study was carried out. Sixteen healthy volunteers without Helicobacter pylori infection were randomly assigned to two groups. Both groups received 81 mg of aspirin once daily for 14 days (on days 1 to 14) and 60 mg of loxoprofen three times daily for the last 7 days (on days 8 to 14). Placebo or 10 mg of lafutidine was administered twice daily for 14 days in each group. After a 2-week washout period, placebo and lafutidine were crossed over. Endoscopic findings of gastric mucosal damage were evaluated according to the modified Lanza score.
The mean modified Lanza score was 2.19 ± 1.06 (SD) for aspirin plus placebo as compared with 0.50 ± 0.77 for aspirin plus lafutidine (P < 0.001), and 3.00 ± 1.56 for aspirin plus loxoprofen and placebo as compared with 1.25 ± 1.37 for aspirin plus loxoprofen and lafutidine (P < 0.01).
The addition of loxoprofen to LDA increases gastric mucosal damage. Standard-dose lafutidine significantly prevents gastric mucosal damage induced by LDA alone or LDA plus loxoprofen in H. pylori-negative volunteers. Larger controlled studies are needed to strengthen these findings.
Journal of Gastroenterology and Hepatology 10/2010; 25(10):1631-5. · 2.87 Impact Factor
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ABSTRACT: According to a few recent reports on the long-term clinical outcome of gastric marginal zone B-cell mucosa associated lymphoid tissue lymphoma (MALT lymphoma); localized gastric MALT lymphoma generally has a favorable prognosis. However, the risk of metachronous gastric cancer has not been evaluated. In this study, we analyzed long-term outcomes of localized gastric MALT lymphoma including the incidence of metachronous gastric cancer.
Between April 1996 and May 2008, 60 patients (31 men and 29 women; mean age 58.1 years) with localized gastric MALT lymphoma (stage I and II(1) according to Lugano classification) were analyzed retrospectively.
Forty-eight patients (82.6%) achieved complete remission by eradication therapy. Radiation therapy was conducted on eight patients as second-line treatment, and all of them achieved remission. The median follow-up period was 76 months (range, 12-157 months). One patient had local relapse after remission for 5 years and three patients developed early gastric cancer without recurrence of lymphoma (5%). All of the three gastric cancers appeared in the same areas where MALT lymphoma had been eradicated.
Eradication therapy and radiation therapy for localized gastric MALT lymphoma have a favorable long-term outcome, though regular follow-up endoscopy should be performed for detecting metachronous early gastric cancer.
Journal of Gastroenterology and Hepatology 04/2010; 25(4):804-9. · 2.87 Impact Factor
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Mototsugu Kato,
Urara Nishida,
Mutsumi Nishida,
Tamotsu Hata,
Rumiko Asaka,
Masahira Haneda,
Keiko Yamamoto,
Aki Imai,
Takeshi Yoshida, Shouko Ono,
Yuichi Shimizu,
Masahiro Asaka
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ABSTRACT: Functional dyspepsia (FD) is a heterogeneous disease characterized by various upper abdominal symptoms. The major mechanism of FD symptoms includes impaired fundic accommodation, delayed gastric emptying, and visceral hypersensitivity. We developed a novel drinking-ultrasonography test to combine a drink test with ultrasonography to assess gastric motility and sensory function of FD patients.
Subjects were 60 successive FD patients according to the Rome III criteria. A drinking-ultrasonography test was performed after subjects had fasted. The subjects ingested 200 ml of water at 2-min intervals 4 times (total 800 ml) through a straw. The maximum cross section of the proximal stomach was visualized before water intake, after each water intake, and 5 and 10 min after the completion of drinking using extracorporeal ultrasonography. Abdominal symptoms were evaluated using the visual analog scale (VAS) a total of 5 times. The normal range of cross-sectional area and VAS were set using average +/- standard deviations of 33 healthy volunteers. Cases outside the normal range were diagnosed with a motor or sensory disorder.
The drinking-ultrasonography test classified FD patients into four groups without adverse effect or trouble. The distribution of each group was 27% in the normal group, 15% in the impaired relaxation group, 10% in the delayed emptying group, and 48% in the visceral hypersensitivity group. There was no significant correlation between the pathophysiological classification and subtypes of FD defined by the Rome III criteria.
We developed a novel drinking-ultrasonography test that was effective in classifying FD patients according to pathophysiological features.
Digestion 01/2010; 82(3):162-6. · 2.05 Impact Factor
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ABSTRACT: It has not been determined whether low-grade squamous dysplasia (LGD) of the esophagus is a precancerous lesion or not. If LGD progresses to squamous cell carcinoma, early carcinoma lesions that have such a natural history might contain a remaining LGD component.
The lesions in the 68 patients with early invasive squamous cell carcinoma who underwent endoscopic mucosal resection were examined for the presence of an LGD component. If LGD components were observed, the degrees of architectural and cytological abnormalities of LGD components and those of tumor invasive fronts in the same lesions were studied. The degrees of abnormalities of 28 small LGD lesions were also studied.
Histological examination of resected specimens confirmed LGD components in 43% of the squamous cell carcinoma lesions. The lesions of lamina propria mucosae (m2) cancer contained a significantly broader area of LGD component than did the lesions of muscularis mucosae (m3) and submucosal layer (sm) cancer (P = 0.037). Mean score for the degrees of cytological abnormalities of LGD component was similar to that of tumor invasive front (P = 0.457) and significantly higher than that of small LGD lesions (P < 0.001).
Our results indicate the possibility that the lesion was formed by a combination of small lesions that arose as a multicentric occurrence of squamous cell carcinoma and dysplasia. Our results also suggest that an LGD component would transform to carcinoma along with tumor progression. However, the concept of 'basal cell layer type carcinoma in situ' may be suitable for squamous cell lesions with a high degree of cytological abnormalities confined to the lower half of the epithelium.
Journal of Gastroenterology and Hepatology 11/2009; 25(2):314-8. · 2.87 Impact Factor
