Fabian Emura

Universidad de La Sabana, Chía, Cundinamarca, Colombia

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Publications (39)90.99 Total impact

  • Fabian Emura, Todd H Baron, Ian M Gralnek
    Gastrointestinal endoscopy 04/2013; · 6.71 Impact Factor
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    ABSTRACT: Despite extensive worldwide use of standard esophagogastroduodenoscopy (EGD) examinations, gastric cancer (GC) is one of the most common forms of cancer and ranks as the most common malignant tumor in East Asia, Eastern Europe and parts of Latin America. Current limitations of using non systematic examination during standard EGD could be at least partially responsible for the low incidence of early GC diagnosis in countries with a high prevalence of the disease. Originally proposed by Emura et al., systematic alphanumeric-coded endoscopy (SACE) is a novel method that facilitates complete examination of the upper GI tract based on sequential systematic overlapping photo-documentation using an endoluminal alphanumeric-coded nomenclature comprised of eight regions and 28 areas covering the entire surface upper GI surface. For precise localization or normal or abnormal areas, SACE incorporates a simple coordinate system based on the identification of certain natural axes, walls, curvatures and anatomical endoluminal landmarks. Efectiveness of SACE was recently demonstrated in a screening study that diagnosed early GC at a frequency of 0.30% (2/650) in healthy, average-risk volunteer subjects. Such a novel approach, if uniformly implemented worldwide, could significantly change the way we practice upper endoscopy in our lifetimes.
    Revista de gastroenterologia del Peru: organo oficial de la Sociedad de Gastroenterologia del Peru 01/2013; 33(1):52-58.
  • Gastrointestinal endoscopy 07/2012; 76(4):838-59. · 6.71 Impact Factor
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    ABSTRACT: La cromoendoscopia de magnificación es una nueva y atractiva herramienta que permite un análisis detallado de la arquitectura morfológica de los orificios de las criptas de la mucosa. En esta revisión describimos, principalmente, la eficacia de la cromoendoscopia de magnificación y de la colonoscopia de magnificación con NBI para el diagnóstico diferencial de las lesiones colorrectales, incluyendo una distinción entre lesiones neoplásicas y no-neoplásicas y también entre cáncer temprano tratable endoscópicamente o no, basados en una revisión de la literatura. Hemos conducido un estudio prospectivo mostrando que una combinación de la colonoscopia de magnificación y la cromoendoscopia es actualmente un método más confiable que la colonoscopia convencional y la cromoendoscopia para la distinción entre lesiones neoplásicas y no-neoplásicas del colon y del recto. La colonoscopia de magnificación con NBI es tan precisa como la cromoendoscopia de magnificación. Nosotros utilizamos colonoscopia de magnificación con NBI más que la cromoendoscopia para distinguir de rutina los pólipos neoplásicos de los no-neoplásicos. Los colonoscopistas pueden predecir la profundidad de la invasión del cáncer colorrectal por medio de la cromoendoscopia de magnificación, la colonoscopia de magnificación con NBI y a través del signo de no-levantamiento. Entre estos métodos, la cromoendocopia de magnificación es el más confiable, con una exactitud, sensibilidad y especificidad de 98,8%, 85,6% y 99,4%, respectivamente. Aunque su confiabilidad depende de la habilidad del que hace la observación, la difusión de las aplicaciones de la técnica de magnificación podría influir en las indicaciones de biopsias de muestreo durante la colonoscopia y en las de mucosectomía.
    Revista Colombiana de Gastroenterologia 03/2011; 26(1):43-57.
  • Gastrointestinal Endoscopy - GASTROINTEST ENDOSCOP. 01/2011; 73(4).
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    ABSTRACT: The electrosurgical knives required to perform endoscopic submucosal dissection (ESD) have recently passed the 510(k) premarketing evaluation by the U.S. Food and Drug Administration and are now available for purchase in the United States. Challenges to ESD being more widely performed in the United States include the lack of intensive hands-on training programs and a low incidence of appropriate, highly dysplastic gastric lesions on which an ESD-trained endoscopist can begin performing this procedure in patients. Furthermore, there are no guidelines regarding the safety of continuing antiplatelet therapy in patients undergoing ESD. To report on the first gastric ESD performed in the United States by using recently approved electrosurgical knives on a patient who was maintained on aspirin therapy. Case report. Large academic medical center. One patient with a 2-cm high-grade dysplasia (HGD) lesion in the posterior antrum who had indwelling coronary stents and was maintained on aspirin therapy throughout the periprocedural period. High-definition white-light and narrow-band imaging endoscopy, endosonography, and ESD by using recently approved electrosurgical knives. Complete resection of the HGD gastric lesion. En bloc complete resection of the HGD gastric lesion was achieved without any immediate or delayed bleeding or perforation. No residual or recurrent dysplasia was found on 1- or 3-month follow-up endoscopies. Generalizations cannot be made from this single case. After receiving intensive hands-on training in both ex vivo and in vivo animal models, gastric ESD was successfully performed by 2 U.S. endoscopists by using recently approved electrosurgical knives in a patient maintained on aspirin therapy without any complications.
    Gastrointestinal endoscopy 11/2010; 72(5):1066-71. · 6.71 Impact Factor
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    ABSTRACT: The presence of meshed capillary (MC) vessels is highly sensitive (96%) and specific (92%) for diagnosing colorectal neoplasia on colonoscopy by using narrow-band imaging (NBI) with optical magnification, which is not available in North America. However, the efficacy of NBI to identify an MC pattern without optical magnification has not been determined. To determine the diagnostic capabilities of NBI colonoscopy without optical magnification in differentiating neoplastic from non-neoplastic colorectal polyps by using the MC pattern. Retrospective comparison of prospectively collected colorectal polyp data. Large, academic medical center. This study involved 126 consecutive colorectal polyps (median size 3 mm) that were found in 52 patients (33 men) with a median age of 59.5 years. All lesions identified by white-light colonoscopy were prospectively diagnosed in real-time by using the MC pattern as determined on high-definition NBI, with 1.5x zoom but without true optical magnification, and then endoscopically excised. Surgical pathology was used as the criterion standard. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of identifying neoplastic polyps were calculated. NBI without optical magnification was found to have a sensitivity of 93%, specificity of 88%, positive predictive value of 90%, negative predictive value of 91%, and diagnostic accuracy of 91% when all polyp sizes were considered. For lesions < or =5 mm, sensitivity was 87%, specificity was 93%, positive predictive value was 89%, negative predictive value was 91%, and diagnostic accuracy was 90%. Single-center, single-endoscopist experience. Use of the MC pattern on NBI colonoscopy without optical magnification effectively distinguishes neoplastic from non-neoplastic colorectal polyps. NBI colonoscopy without optical magnification for neoplastic polyp diagnosis appears to be comparable with NBI with optical magnification when the MC pattern is used. A large, prospective trial is needed for further validation.
    Gastrointestinal endoscopy 04/2010; 72(1):118-26. · 6.71 Impact Factor
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    ABSTRACT: Introducción: El cáncer gástrico es la malignidad más común en América del Sur y Asia oriental. En Colombia, aparte del grave problema de mortalidad, una limitante es la escasez de datos de prevalencia de lesiones tempranas y premalignas.
    Revista Colombiana de Gastroenterologia 03/2010; 25(1):19-30.
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    ABSTRACT: Capillary patterns (CP) observed by magnifying Narrow Band Imaging (NBI) are useful for differentiating non-adenomatous from adenomatous colorectal polyps. However, there are few studies concerning the effectiveness of magnifying NBI for determining the depth of invasion in early colorectal neoplasms. We aimed to determine whether CP type IIIA/IIIB identified by magnifying NBI is effective for estimating the depth of invasion in early colorectal neoplasms. A series of 127 consecutive patients with 130 colorectal lesions were evaluated from October 2005 to October 2007 at the National Cancer Center Hospital East, Chiba, Japan. Lesions were classified as CP type IIIA or type IIIB according to the NBI CP classification. Lesions were histopathologically evaluated. Inter and intraobserver variabilities were assessed by three colonoscopists experienced in NBI. There were 15 adenomas, 66 intramucosal cancers (pM) and 49 submucosal cancers (pSM): 16 pSM superficial (pSM1) and 33 pSM deep cancers (pSM2-3). Among lesions diagnosed as CP IIIA 86 out of 91 (94.5%) were adenomas, pM-ca, or pSM1; among lesions diagnosed as CP IIIB 28 out of 39 (72%) were pSM2-3. Sensitivity, specificity and diagnostic accuracy of the CP type III for differentiating pM-ca or pSM1 (<1000 microm) from pSM2-3 (>or=1000 microm) were 84.8%, 88.7 % and 87.7%, respectively. Interobserver variability: kappa = 0.68, 0.67, 0.72. Intraobserver agreement: kappa = 0.79, 0.76, 0.75 Identification of CP type IIIA/IIIB by magnifying NBI is useful for estimating the depth of invasion of early colorectal neoplasms.
    BMC Gastroenterology 03/2010; 10:33. · 2.11 Impact Factor
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    Fabián Emura, Ichiro Oda
    Revista Colombiana de Gastroenterologia 03/2010; 25(1):99-100.
  • Gastrointestinal Endoscopy - GASTROINTEST ENDOSCOP. 01/2010; 71(5).
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    Fabián Emura, Ichiro Oda
    Revista Colombiana de Gastroenterologia 12/2009; 24(4):333-335.
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    ABSTRACT: To clarify the clinicopathological characteristics of small and large early invasive colorectal cancers (EI-CRCs), and to determine whether malignancy grade depends on size. A total of 583 consecutive EI-CRCs treated by endoscopic mucosal resection or surgery at the National Cancer Center Hospital between 1980 and 2004 were enrolled in this study. Lesions were classified into two groups based on size: small (<or= 10 mm) and large (> 10 mm). Clinicopathological features, incidence of lymph node metastasis (LNM) and risk factors for LNM, such as depth of invasion, lymphovascular invasion (LVI) and poorly differentiated adenocarcinoma (PDA) were analyzed in all resected specimens. There were 120 (21%) small and 463 (79%) large lesions. Histopathological analysis of the small lesion group revealed submucosal deep cancer (sm: >or= 1000 microm) in 90 (75%) cases, LVI in 26 (22%) cases, and PDA in 12 (10%) cases. Similarly, the large lesion group exhibited submucosal deep cancer in 380 (82%) cases, LVI in 125 (27%) cases, and PDA in 79 (17%) cases. The rate of LNM was 11.2% and 12.1% in the small and large lesion groups, respectively. Small EI-CRC demonstrated the same aggressiveness and malignant potential as large cancer.
    World Journal of Gastroenterology 07/2009; 15(22):2708-13. · 2.55 Impact Factor
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    ABSTRACT: La colonoscopia total ha sido, es, y probablemente seguirá siendo el método más seguro y eficaz no solo para resecar los pólipos adenomatosos sino para diagnosticar y tratar (en estado temprano) el cáncer colorrectal (CCR). No obstante, un reciente estudio pone en entredicho la eficacia de la colonoscopia proponiendo que la relación colonoscopia-CCR está limitada primariamente a la disminución de muertes por CCR localizados en el lado izquierdo del colon.
    Revista Colombiana de Gastroenterologia 03/2009; 24(1):51-59.
  • Gastrointestinal Endoscopy - GASTROINTEST ENDOSCOP. 01/2009; 69(5).
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    ABSTRACT: During colonoscopy, estimation of the depth of invasion in early colorectal lesions is crucial for an adequate therapeutic management and for such task, magnifying chromoendoscopy (MCE) has been proposed as the best in vivo method. However, validation in large-scale studies is lacking. The aim of this prospective study was to clarify the effectiveness of MCE in the diagnosis of the depth of invasion of early colorectal neoplasms in a large series. A total of 4,215 neoplastic lesions were evaluated using MCE from October 1998 to September 2005 at the National Cancer Center Hospital, Tokyo, Japan. Lesions were prospectively classified according to the clinical classification of the pit pattern: invasive pattern or non-invasive pattern. All lesions were histopathologically evaluated. There were 3,371 adenomas, 612 intramucosal cancers (m-ca), 232 submucosal cancers (sm-ca): 52 sm superficial (sm1) and 180 sm deep cancers (sm 2-3). Among lesions diagnosed as invasive pattern, 154 out of 178 (86.5%) were sm2-3, while among lesions diagnosed as non-invasive pattern, 4,011 out of 4,037 (99.4%) were adenomas, m-ca, or sm1. Sensitivity, specificity and diagnostic accuracy of the invasive pattern to differentiate m-ca or sm1 (< 1000 microm) from sm2-3 (> or = 1000 microm) were 85.6%, 99.4%, and 98.8%, respectively. The determination of invasive or non-invasive pattern by MCE is a highly effective in vivo method to predict the depth of invasion of colorectal neoplasms.
    The American Journal of Gastroenterology 10/2008; 103(11):2700-6. · 7.55 Impact Factor
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    ABSTRACT: Endoscopic resection (ER) is indicated for patients with early gastric cancer who have a negligible risk of lymph node metastasis (LNM). Histological examination of the resected specimen may indicate a possible risk of LNM or a positive resection margin. These patients are considered to have undergone non-curative ER. The aim of this study was to determine the appropriate treatment strategy for such patients. A total of 298 patients who had non-curative ER were classified into those with a positive lateral margin only (group 1; 72 patients) and those with a possible risk of LNM (group 2; 226 patients). Surgery was performed within 6 months of non-curative ER in 19 patients in group 1 and 144 in group 2. In group 1, nine patients were found to have local residual tumours, all limited to the mucosal layer without LNM. In Group 2, 13 patients had residual disease, including four local tumours without LNM, two local tumours with LNM and seven cases of LNM alone. The rate of LNM after surgery was 6.3 per cent in group 2. Surgery remains the standard treatment after non-curative ER in patients with a possible risk of LNM.
    British Journal of Surgery 10/2008; 95(12):1495-500. · 4.84 Impact Factor
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    ABSTRACT: Although microvascular vessels on the surface of colorectal polyps are observed by narrow-band imaging (NBI) with magnification, its clinical usefulness is still uncertain. Our purpose was to evaluate the usefulness of meshed capillary (MC) vessels observed by NBI magnification for differentiating between nonneoplastic and neoplastic colorectal lesions. Prospective polyp study. National Cancer Center Hospital East, Chiba, Japan. A total of 702 consecutive patients who underwent total colonoscopy between September and December 2004 were prospectively evaluated. Patients with polyps >10 mm and those with polyps previously evaluated by histologic examination or colonoscopy were excluded. Lesions were classified into 2 groups: polyps with invisible or faintly visible MC vessels as nonneoplastic and polyps with clearly visible MC vessels as neoplastic. Lesions judged as nonneoplastic were subjected to biopsy and those as neoplastic were removed endoscopically. Histologic analysis was performed in all lesions. Visible or invisible surface MC vessels, prediction of histologic diagnosis. Of 92 eligible patients enrolled in this study, 150 lesions, including 39 (26%) hyperplastic polyps and 111 (74%) adenomatous polyps, were detected. Observation of MC vessels detected 107 of 111 neoplastic polyps and 36 of 39 nonneoplastic polyps. The overall diagnostic accuracy, sensitivity, and specificity were 95.3%, 96.4%, and 92.3%, respectively. MC vessel judgment performed by a single colonoscopist with extensive experience in magnifying NBI. Observation of surface MC vessels by magnifying NBI is a useful and simple method for differentiating colorectal nonneoplastic and neoplastic polyps.
    Gastrointestinal endoscopy 10/2008; 69(2):278-83. · 6.71 Impact Factor
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    ABSTRACT: Narrow-band imaging (NBI) is an innovative optical technology that modifies the center wavelength and bandwidth of an endoscope's light into narrow-band illumination of 415 +/- 30 nm. NBI markedly improves capillary pattern contrast and is an in vivo method for visualizing microvessel morphological changes in superficial neoplastic lesions. The scientific basis for NBI is that short wavelength light falls within the hemoglobin absorption band, thereby facilitating clearer visualization of vascular structures. Several studies have reported advantages and limitations of NBI colonoscopy in the colorectum. One difficulty in evaluating results, however, has been non-standardization of NBI systems (Sequential and non-sequential). Utilization of NBI technology has been increasing worldwide, but accurate pit pattern analysis and sufficient skill in magnifying colonoscopy are basic fundamentals required for proficiency in NBI diagnosis of colorectal lesions. Modern optical technology without proper image interpretation wastes resources, confuses untrained endoscopists and delays inter-institutional validation studies. Training in the principles of "optical image-enhanced endoscopy" is needed to close the gap between technological advancements and their clinical usefulness. Currently available evidence indicates that NBI constitutes an effective and reliable alternative to chromocolonoscopy for in vivo visualization of vascular structures, but further study assessing reproducibility and effectiveness in the colorectum is ongoing at various medical centers.
    World Journal of Gastroenterology 09/2008; 14(31):4867-72. · 2.55 Impact Factor
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    ABSTRACT: Endoscopic submucosal dissection (ESD) is accepted as a minimally invasive treatment for early gastric cancer; however, it is not widely used in the colorectum because of its technical difficulty. To determine the feasibility of using ESD for treating large superficial colorectal tumors and to evaluate the clinical outcome. Case series conducted at the National Cancer Center Hospital in Tokyo. A total of 198 consecutive patients were treated for 200 lesions. Procedures were performed, before July 2004, by using a monopolar needle knife or an insulation-tipped knife (IT knife). After July 2004, the procedures were performed by using a bipolar needle knife or an IT knife. After injection of glycerol and sodium hyaluronate acid into the submucosal (sm) layer, a circumferential incision was made and sm dissection was performed endoscopically. The en bloc resection rate was 84% and the curative resection rate was 83%. Among the 200 ESDs, 51 involved tubular adenomas, 99 intramucosal cancers, 22 minute sm cancers, and 28 sm deep cancers. The median operation time was 90 minutes, and the mean size of resected specimens was 38 mm (range, 20-150 mm). Perforations occurred in 10 cases (5%) and postoperative bleeding in 4 cases (2%), but only 1 perforation case needed emergency surgery, because endoscopic clipping was ineffective. No long-term outcome data yet. ESD is a feasible technique for treating large superficial colorectal tumors, because it provides a higher en bloc resection rate and is less invasive than surgical resection.
    Gastrointestinal Endoscopy 12/2007; 66(5):966-73. · 5.21 Impact Factor

Publication Stats

964 Citations
90.99 Total Impact Points

Institutions

  • 2012–2013
    • Universidad de La Sabana
      Chía, Cundinamarca, Colombia
  • 2004–2010
    • National Cancer Center
      • Endoscopy Division
      Edo, Tōkyō, Japan
  • 2006–2007
    • Mitsui Memorial Hospital
      Edo, Tōkyō, Japan
    • El Bosque University
      Μπογκοτά, Bogota D.C., Colombia