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Naohisa Yoshida,
Yuji Naito,
Yutaka Inada,
Munehiro Kugai,
Nobuaki Yagi,
Ken Inoue,
Takashi Okuda,
Daisuke Hasegawa,
Kazuyuki Kanemasa,
Kassai Kyoichi,
Kiichi Matsuyama,
Takashi Ando,
Toshiki Takemura,
Seiji Shimizu, Naoki Wakabayashi,
Akio Yanagisawa,
Toshikazu Yoshikawa
[show abstract]
[hide abstract]
ABSTRACT: PURPOSE: Endoscopic mucosal resection (EMR) of colorectal polyps should be curative and safe. This study aimed to determine the efficacy and safety of colorectal EMR using 0.13 % hyaluronic acid (HA) solution. METHODS: This was a single-armed multicenter prospective open trial conducted at 11 Japanese institutions. Lesion characteristics and various measures of clinical outcome, including en bloc resection, histopathologically complete resection, and postoperative bleeding were analyzed for 624 consecutive patients who underwent EMR of colorectal polyps at ≤20 mm in size from August 2010 to September 2011. RESULTS: En bloc and complete resection were achieved in 93.3 and 78.3 % of 624 lesions. The median EMR procedure time was 2.1 ± 1.5 min. The rates of postoperative bleeding and perforation were 1.1 and 0 %. The rate of en bloc resection was higher for polyps at 5-10 mm than for polyps at 11-20 mm (95.1 vs. 85.1 %; P < 0.001) and was higher for protruding polyps than for superficial polyps (94.5 vs. 87.1 %; P < 0.05). The rate of en bloc resection was also higher for polyps in the left-side colon than for those in the right-side colon or rectum (96.7 vs. 91.6 vs. 90.8 %; P < 0.05). Multivariate analysis showed that polyp at 11-20 mm in size and location not on the left-side colon was significantly independent risk factors for failure of en bloc resection. CONCLUSION: EMR using 0.13 % HA of colorectal polyps less than 20 mm in size had high rates of en bloc and complete resection and few complications.
International Journal of Colorectal Disease 12/2012; · 2.38 Impact Factor
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Naohisa Yoshida,
Nobuaki Yagi,
Yutaka Inada,
Munehiro Kugai,
Kazuhiro Kamada,
Kazuhiro Katada,
Kazuhiko Uchiyama,
Takeshi Ishikawa,
Tomohisa Takagi,
Osamu Handa,
Hideyuki Konishi,
Satoshi Kokura,
Ken Inoue, Naoki Wakabayashi,
Yasuhisa Abe,
Akio Yanagisawa,
Yuji Naito
[show abstract]
[hide abstract]
ABSTRACT: PURPOSE: Colorectal endoscopic submucosal dissection (ESD) has not been standardized due to technical difficulties and requires extensive training for reliability. Ex vivo animal model is convenient, but has no blood flow. The objective of this study is to evaluate the characteristics of various ex vivo animal models including a blood flow model for colorectal ESD training and the usefulness of practicing endoscopic hemostasis and closure using an animal model. METHODS: Harvested porcine cecum, rectum, and stomach and bovine cecum and rectum were analyzed regarding ease of mucosal injection, degree of submucosal elevation, and status of the proper muscle layer. Ex vivo animal model with blood flow was made using the bovine cecum. The vessel around the cecum was detached, and red ink was injected. Endoscopic hemostasis for perioperative hemorrhage and endoscopic closure for perforation were performed in this model. RESULTS: Mucosal injection was easily performed in the bovine cecum and rectum. Submucosal elevation was low in the bovine cecum, while the proper muscle layer was not tight in the porcine rectum and bovine cecum. Endoscopic hemostasis were accomplished in six (60 %) out of ten procedures of the ex vivo blood flow model. In two non-experts, the completion rates of endoscopic closure were 40 and 60 % in the first five procedures. These rates became 100 % in the last five procedures. CONCLUSIONS: We have evaluated the characteristics of various ex vivo animal models and shown the possibility of training for endoscopic hemostasis and endoscopic closure in the ex vivo animal model.
International Journal of Colorectal Disease 07/2012; · 2.38 Impact Factor
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[show abstract]
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ABSTRACT: During catheter exchange for percutaneous endoscopic gastrostomy (PEG), endoscopic or radiological observation is widely used to confirm that the catheter is placed correctly. However, to carry out these procedures in all patients at every catheter exchange costs time and money. It is therefore important to develop a reliable and safe method, which can also be used outside the clinic, to check the exchanged catheter. We examined the usefulness and safety of intragastric observation using a small-diameter rigid telescope, which can be inserted through the catheter lumen of a PEG tube.
Before and after catheter exchange, observation was carried out using the rigid telescope E02700 (external diameter: 2.7 mm; Nisco Co., Tokyo, Japan). After air insufflation by the novel air-supplying adaptor, the rigid telescope was inserted through the button catheter for observation of the fistula and gastric lumen with guidewire introduction. Next, the old gastrostomy catheter was replaced by a new one, using the guidewire technique. Subsequently, the telescope was re-inserted to check the fistula and gastric lumen.
With this technique, observation inside the stomach as well as inside the fistula was achieved without any complication during all 80 exchange trials in the 55 patients studied. A homemade adaptor was used effectively to convey air and water into the stomach during the observation.
It is suggested that observation inside the stomach using a small-diameter rigid telescope at the time of gastrostomy exchange is useful and safe for checking the location of the newly fixed catheter.
Digestive Endoscopy 07/2012; 24(4):243-6. · 1.19 Impact Factor
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Naohisa Yoshida,
Yuji Naito,
Yutaka Inada,
Munehiro Kugai,
Kazuhiro Kamada,
Kazuhiro Katada,
Kazuhiko Uchiyama,
Takeshi Ishikawa,
Tomohisa Takagi,
Osamu Handa,
Hideyuki Konishi,
Nobuaki Yagi,
Satoshi Kokura, Naoki Wakabayashi,
Akio Yanagisawa,
Toshikazu Yoshikawa
[show abstract]
[hide abstract]
ABSTRACT: Adequate mucosal elevation by submucosal injection is important for definitive en bloc resection and prevention of perforation during endoscopic mucosal resection (EMR). The objective of this study is to determine the efficacy of 0.13% hyaluronic acid (HA) solution for high and sustained mucosal elevation during colorectal EMR.
The study was a prospective randomized controlled trial; a total of 196 patients with colon polyps of < 20 mm diameter were enrolled and randomized in a 1:1 ratio to undergo EMR using either 0.13% HA or normal saline (NS). The primary outcome of the study was histopathologically confirmed complete resection. The secondary outcomes such as maintenance of high mucosal elevation and development of complications were also evaluated. Moreover, the relationship between complete resection and the experience of the endoscopist (veteran vs less experienced) was analyzed.
Compete resection was achieved in 74 of 93 polyps (79.5%) in the 0.13% HA group and 63 of 96 polyps (65.6%) in the NS group (P < 0.05). High mucosal elevation was maintained in 83.9% of procedures in the 0.13% HA group and 54.1% in the NS group (P < 0.01). The frequency of complete resection achieved by less-experienced endoscopists was higher in the 0.13% HA group (79.3%) than in the NS group (62.1%; P < 0.05).
Endoscopic mucosal resection using 0.13% HA to colon polyps of less than 20 mm diameter is more effective than NS for complete resection and maintenance of mucosal elevation.
Journal of Gastroenterology and Hepatology 05/2012; 27(8):1377-83. · 2.87 Impact Factor
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ABSTRACT: Purpose Tissue autofluorescence study is a promising means of endoscopic detection of colonic neoplasia, but the mechanism of autofluorescence eruption has still not been verified. The purpose of this study was to precisely analyze the autofluorescence characteristics of freshly prepared normal rat colon under UVA and violet light excitation. Methods Excised rat colons were studied by using multichannel spectrophotometry, spectroscopic imaging, confocal microscopy, combined two-photon excited fluorescence and second-harmonic generation (SHG) microscopy, and fluorescence lifetime imaging microscopy. Results Spectroscopic analysis of freshly prepared colon sections revealed that the mucosa and the submucosa showed strong autofluorescence under UVA and violet light excitation. The combined images of two-photon and SHG microscopy revealed that the mucosal epithelia are the important source of autofluorescence. Nicotinamide adenine dinucleotide seems to be one of the major substances involved in the autofluorescence of the mucosal layer on 365-nm light excitation. The autofluorescence spectra of the luminal surfaces were identical to those of the mucosa on cross-sectional examinations with 365-nm excitation. The main origin of autofluorescence of the luminal surface with 365-nm excitation is the epithelial cells in the mucosa without overlay of submucosal fluorescence. Conclusion: The mucosal layer is the important source of the autofluorescence observed under excitation with UVA/violet light in multilayered colonic structures. Illumination of 365-nm wavelength light is a suitable means of analyzing the autofluorescence of mucosal epithelia.
Current pharmaceutical biotechnology 02/2012; · 3.40 Impact Factor
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[show abstract]
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ABSTRACT: The mucosal layer of the colon contains metabolism-related fluorophores, such as reduced nicotinamide adenine dinucleotide (NADH), which might have the potential to serve as biomarkers for detecting neoplasia.
To examine NADH fluorescence in human colonic adenoma while eliminating the effect of hemoglobin absorption and to develop a novel imaging technique for precise detection of adenomas.
Cross-sectional study.
A total of 66 endoscopically resected colonic polyps were investigated. After serial acquisition of autofluorescence images between 450 and 490 nm illuminated with dual-wavelength excitation at 365 nm (F(365ex)) and 405 nm (F(405ex)) on cross sections of the samples, ratio images were created by dividing F(365ex) by F(405ex). The excitation-emission wavelength combinations in F(365ex) and F(405ex) were optimized for NADH fluorescence and reference fluorescence.
The F(365ex)/F(405ex) ratio in the tumorous (T) and normal (N) mucosa.
F(365ex)/F(405ex) ratio images showed a 1.81- and 1.12-fold higher signal intensity in the adenomas and hyperplastic polyps, respectively, than in the adjacent normal mucosa. The ratio between signal intensities in tumorous mucosa and normal mucosa in F(365ex)/F(405ex) ratio images for tubular adenomas was significantly higher than that for hyperplastic polyps. The signal intensity in F(365ex)/F(405ex) ratio images was not correlated with the hemoglobin concentration index evaluated by reflection images at 550 nm and 610 nm. Diminutive adenomas (<5 mm) and large adenomas were well discriminated in F(365ex)/F(405ex) ratio images.
Ex vivo experiment.
These results suggest that the precise measurement of NADH fluorescence intensity together with eliminating the influence of blood hemoglobin concentration serves as a method for visualizing colonic adenomas and that the dual-wavelength excitation method is a promising technique applicable to endoscopic detection of early colonic adenomas.
Gastrointestinal endoscopy 01/2012; 75(1):110-7. · 6.71 Impact Factor
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Ken Inoue, Naoki Wakabayashi,
Kohei Fukumoto,
Shinya Yamada,
Nobukatsu Bito,
Naohisa Yoshida,
Kazuhiro Katada,
Kazuhiko Uchiyama,
Takeshi Ishikawa,
Osamu Handa,
Tomohisa Takagi,
Hideyuki Konishi,
Nobuaki Yagi,
Satoshi Kokura,
Mitsuo Kishimoto,
Akio Yanagisawa,
Yuji Naito
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ABSTRACT: Most cases of cytomegalovirus (CMV) colitis in patients with inflammatory bowel disease (IBD) occur in those treated with immunosuppressants and/or corticosteroids. We herein present the case of a 57-year-old man with toxic megacolon associated with CMV colitis in corticosteroid-naïve ulcerative colitis (UC). To date, there have been only eight previous case reports of CMV colitis in steroid-naïve UC. We discuss the need to consider CMV colitis when making a differential diagnosis of patients with refractory UC who are not receiving corticosteroid treatment.
Internal Medicine 01/2012; 51(19):2739-43. · 0.94 Impact Factor
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Naohisa Yoshida,
Yuji Naito,
Yutaka Inada,
Munehiro Kugai,
Ken Inoue,
Kazuhiko Uchiyama,
Osamu Handa,
Tomohisa Takagi,
Hideyuki Konishi,
Nobuaki Yagi,
Yasutaka Morimoto, Naoki Wakabayashi,
Akio Yanagisawa,
Toshikazu Yoshikawa
[show abstract]
[hide abstract]
ABSTRACT: Flexible spectral imaging color enhancement (FICE), or image-enhanced endoscopy, can enhance visualization of surface and vascular patterns of colorectal polyps. Resolution of FICE has recently been improved. We evaluated diagnostic accuracy for neoplastic and non-neoplastic colorectal polyp differentiation with detection of surface patterns by FICE without magnification.
Retrospective analysis of 151 colorectal polyps evaluated by FICE without magnification was performed. Neoplastic surface patterns were defined as tubular and oval pit. We aimed to determine sensitivity, specificity, positive and negative predictive values (PPV and NPV), and accuracy in correlating diagnosis by FICE without magnification with histology. Moreover, findings were compared to those of white-light endoscopy (WL) and chromoendoscopy (CHR).
Of the 151 colorectal polyps, 95 were identified as neoplastic and 56 were identified as non-neoplastic. FICE without magnification had a sensitivity of 89.4%, specificity of 89.2%, PPV of 93.4%, NPV of 83.3%, and accuracy of 89.4%. The accuracy of FICE value was higher than that of WL (sensitivity of 74.7%, specificity of 73.2%, PPV of 82.5%, NPV of 63.0%, and accuracy of 74.1%) and was worse than that of CHR (sensitivity of 96.8%, specificity of 89.2%, PPV of 93.9%, NPV of 96.1%, and accuracy of 94.7%). Imaging evaluation was validated by inter-/intra-observer measurements, demonstrating consistent results.
The detection of surface patterns by FICE without magnification is useful for differential diagnosis of colorectal polyps. We believe that FICE without magnification is more convenient and easier method than CHR.
International Journal of Colorectal Disease 12/2011; 27(5):605-11. · 2.38 Impact Factor
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09/2011; , ISBN: 978-953-307-777-2
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Takeshi Ishikawa,
Satoshi Kokura,
Naoyuki Sakamoto,
Manabu Okajima,
Tatsuzo Matsuyama,
Hiromi Sakai,
Yoko Okumura,
Satoko Adachi,
Naohisa Yoshida,
Kazuhiko Uchiyama,
Osamu Handa,
Tomohisa Takagi,
Hideyuki Konishi, Naoki Wakabayashi,
Nobuaki Yagi,
Takashi Ando,
Kazuko Uno,
Yuji Naito,
Toshikazu Yoshikawa
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[hide abstract]
ABSTRACT: To investigate the relation between functional impairments of cancer patients and circulating cytokines using a multiplex technique.
50 patients with cancer were assessed using the quality of life (QOL) questionnaire. 27 plasma cytokine levels were determined by using the Bio-Plex array system. The relation to QOL scores was assessed using Chi-square test for categorical variables and univariate linear regression analysis for cytokine levels.
Multivariate analysis showed that interleukin-6 (IL-6) level is a significant independent determinant of physical (β=-0.238, P=0.0126) and cognitive functioning (β=-0.462, P=0.0006) and that vascular endothelial growth factor (VEGF) level is a significant independent determinant of emotional functioning (β=-0.414, P=0.039).
This study, in which 27 cytokines are simultaneously tested with cutting edge technology, demonstrates that plasma IL-6 and VEGF are significant independent determinants of functional impairments in patients with cancer.
Clinical biochemistry 09/2011; 45(3):207-11. · 2.02 Impact Factor
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Kohei Fukumoto,
Yuji Naito,
Tomohisa Takagi,
Shinya Yamada,
Ryusuke Horie,
Ken Inoue,
Akihito Harusato,
Ikuhiro Hirata,
Tastushi Omatsu,
Katsura Mizushima, [......],
Kazuhiko Uchiyama,
Takeshi Ishikawa,
Osamu Handa,
Hideyuki Konishi, Naoki Wakabayashi,
Nobuaki Yagi,
Satoshi Kokura,
Hiroshi Ichikawa,
Masakazu Kita,
Toshikazu Yoshikawa
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ABSTRACT: The pathogenesis of small intestinal damage caused by non-steroidal anti-inflammatory drugs (NSAIDs) such as indomethacin is still unclear. For this reason, there is currently no therapeutic strategy for ameliorating such damage. On the other hand, molecular treatment strategies targeting tumor necrosis factor (TNF)-α exert beneficial effects on intestinal lesions in patients with inflammatory bowel disease (IBD). To clarify the participation of TNF-α in NSAID-induced small intestinal damage, we investigated the effects of indomethacin administration in mice with targeted deletion of the TNF-α gene. Indomethacin (10 mg/kg) was administered subcutaneously to male C57BL/6 (wild-type: WT) mice and TNF-α-deficient (TNF-α-/-) mice to induce small intestinal damage. The ulcer score, the tissue-associated myeloperoxidase (MPO) activity as an index of neutrophil infiltration, and the expression of keratinocyte chemoattractant (KC) mRNA in the small intestinal mucosa were measured. In addition, we performed a TUNEL assay to evaluate indomethacin-induced apoptosis of intestinal epithelial cells and measured the expression of caspase-3 protein and Bcl-2 mRNA. The ulcer score, MPO activity, and expression of KC mRNA were significantly increased after indomethacin administration. These increases were significantly inhibited in TNF-α-/- mice compared with WT mice. Apoptotic cells were observed by the TUNEL assay in the area of the ulcerative lesion, and they were significantly fewer in TNF-α-/- mice compared with WT mice. The expression of cleaved caspase-3 protein was induced by indomethacin administration, and significantly inhibited in TNF-α-/- mice compared with that of WT mice. The expression level of Bcl-2 mRNA in indomethacin-treated TNF-α-/- mice was significantly higher than that in WT mice. TNF-α plays an important role in the pathogenesis of indomethacin-induced small intestinal damage. These results suggest that TNF-α could become a new therapeutic target for NSAID-induced small intestinal damage.
International Journal of Molecular Medicine 03/2011; 27(3):353-9. · 1.98 Impact Factor
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Shinya Yamada,
Yuji Naito,
Tomohisa Takagi,
Katsura Mizushima,
Yasuko Hirai,
Ryusuke Horie,
Kohei Fukumoto,
Ken Inoue,
Akihito Harusato,
Naohisa Yoshida,
Kazuhiko Uchiyama,
Osamu Handa,
Takeshi Ishikawa,
Hideyuki Konishi, Naoki Wakabayashi,
Nobuaki Yagi,
Satoshi Kokura,
Masakazu Kita,
Toshikazu Yoshikawa
[show abstract]
[hide abstract]
ABSTRACT: The pathogenesis of enteropathy induced by non-steroidal anti-inflammatory drugs (NSAIDs) is still unclear, and there are no established treatments. Interleukin-17A (IL-17A) is a pro-inflammatory cytokine that has been associated with the development of chronic inflammatory diseases, including autoimmune diseases. To define the role of IL-17A in small intestinal injury and inflammation, we studied the effects of indomethacin administration in mice with targeted deletions of the IL-17A gene.
Male C57BL/6 (wild-type) and homozygous IL-17A(-/-) C57BL/6 mice were subjected to this study. Indomethacin (10 mg/kg) was subcutaneously administered to induce small-intestinal damage. Indomethacin-induced lesions in the small intestine were evaluated by measuring the injured area and by histopathology. Also assessed were myeloperoxidase (MPO) activity, as an index of neutrophil accumulation, and intestinal mRNA expression for inflammatory cytokines.
The area of macroscopic ulcerative lesions, the MPO activity and the mRNA expression of inflammatory-associated chemokines, such as keratinocyte chemoattractant (KC), monocyte chemotactic protein-1 (MCP-1), and granulocyte-colony stimulating factor (G-CSF), were significantly increased in indomethacin-treated groups compared with the sham groups. The development of intestinal lesions by indomethacin was inhibited in IL-17A(-/-) mice compared with wild-type mice, together with significant suppression of the increased levels of MPO activities and KC, MCP-1, and G-CSF levels.
These findings demonstrate that IL-17A contributes to the development of indomethacin-induced small intestinal injury through upregulation of G-CSF, KC, and MCP-1. IL-17A might be a promising new therapeutic target to treat NSAID-induced enteritis.
Journal of Gastroenterology and Hepatology 02/2011; 26(2):398-404. · 2.87 Impact Factor
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Naohisa Yoshida,
Yuji Naito,
Munehiro Kugai,
Ken Inoue,
Kazuhiko Uchiyama,
Tomohisa Takagi,
Takeshi Ishikawa,
Osamu Handa,
Hideyuki Konishi, Naoki Wakabayashi,
Nobuaki Yagi,
Satoshi Kokura,
Yasutaka Morimoto,
Kazuyuki Kanemasa,
Akio Yanagisawa,
Toshikazu Yoshikawa
[show abstract]
[hide abstract]
ABSTRACT: Endoscopic mucosal resection (EMR) is the standard procedure for colorectal tumors. High mucosal elevation by submucosal injection is important for definite en bloc resection and the prevention of perforation. Hyaluronic acid (HA) is a reportedly useful injection solution for high and long-lasting mucosal elevation, but the ideal HA concentration for optimization of mucosal elevation maintenance, injection pressure, and cost is unknown. In the present study, we assessed the appropriate concentration of HA for EMR.
A resected porcine colon and esophagus were used. The injection solutions examined were 0.9% normal saline (NS) and four concentrations of an 800-KDa HA preparation (0.4%, 0.2%, 0.13%, and 0.1%). Each solution (2 mL) was injected into the submucosa; injection pressure was calculated, and elevation was measured. The durations of mucosal elevation and EMR were additionally assessed in the living minipig colon.
In the resected porcine colon, the mucosal elevation was measured 0, 2, 4, and 6 min after the submucosal injection. All concentrations of HA solution maintained greater mucosal elevation at all times than NS (P < 0.05). An almost similar result was obtained in the resected porcine esophagus. The injection pressure correlated with the HA concentration. In the living minipig colon, mucosal elevation diminished 2 min after the submucosal injection with NS, but was maintained 2 min after injection with 0.4%, 0.2%, and 0.13% HA. The average duration of EMR was 139 s.
Mucosal elevation by HA was greater than that by NS in resected and living animal models. We recommend 0.13% HA for maintaining mucosal elevation, injection pressure, and cost.
Journal of Gastroenterology and Hepatology 02/2011; 26(2):286-91. · 2.87 Impact Factor
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Ken Inoue,
Yuji Naito,
Tomohisa Takagi,
Natsuko Hayashi,
Yasuko Hirai,
Katsura Mizushima,
Ryusuke Horie,
Kohei Fukumoto,
Shinya Yamada,
Akihito Harusato, [......],
Naohisa Yoshida,
Kazuhiko Uchiyama,
Takeshi Ishikawa,
Osamu Handa,
Hideyuki Konishi, Naoki Wakabayashi,
Nobuaki Yagi,
Hiroshi Ichikawa,
Satoshi Kokura,
Toshikazu Yoshikawa
[show abstract]
[hide abstract]
ABSTRACT: Heat shock protein (HSP) 47 may play an important role in the pathogenesis of intestinal fibrosis. Daikenchuto (DKT), a traditional Japanese herbal (Kampo) medicine, has been reported to ameliorate intestinal inflammation. The aims of this study were to determine time-course profiles of several parameters of fibrosis in a rat model, to confirm the HSP47-expressing cells in the colon, and finally to evaluate DKT's effects on intestinal fibrosis. Colitis was induced in male Wistar rats weighing 200 g using an enema of trinitrobenzene sulfonic acid (TNBS). HSP47 localization was determined by immunohistochemistry. Colonic inflammation and fibrosis were assessed by macroscopic, histological, morphometric, and immunohistochemical analyses. Colonic mRNA expression of transforming growth factor β1 (TGF-β1), HSP47, and collagen type I were assessed by real time-polymerase chain reaction (PCR). DKT was administered orally once a day from 8 to 14 d after TNBS administration. The colon was removed on the 15th day. HSP47 immunoreactivity was coexpressed with α-smooth muscle actin-positive cells located in the subepithelial space. Intracolonic administration of TNBS resulted in grossly visible ulcers. Colonic inflammation persisted for 6 weeks, and fibrosis persisted for 4 weeks after cessation of TNBS treatment. The expression levels of mRNA and proteins for TGF-β1, HSP47, and collagen I were elevated in colonic mucosa treated with TNBS. These fibrosis markers indicated that DKT treatment significantly inhibited TNBS-induced fibrosis. These findings suggest that DKT reduces intestinal fibrosis associated with decreasing expression of HSP47 and collagen content in the intestine.
Biological & Pharmaceutical Bulletin 01/2011; 34(11):1659-65. · 1.66 Impact Factor
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Koichi Soga,
Junichi Sakagami,
Osamu Handa,
Hideyuki Konishi, Naoki Wakabayashi,
Nobuaki Yagi,
Minoru Yamada,
Satoshi Kokura,
Yuji Naito,
Toshikazu Yoshikawa,
Naoki Arizono
[show abstract]
[hide abstract]
ABSTRACT: We present the case of a patient who was referred to our hospital after she reported having passed a long, whitish object per rectum. Accordingly, capsule endoscopy was performed using the PillCam(®) SB video capsule. A tapeworm of the species Diphyllobothrium nihonkaiense was detected; it appeared to be freely floating and unfolded in the jejunum and sometimes tangled or irregularly folded in the ileum. The stretching of the strobila by strong peristalsis in the ileum may have resulted in the separation of the caudal portion of the strobila, which descended into the colon and was eventually passed per rectum.
Internal Medicine 01/2011; 50(4):325-7. · 0.94 Impact Factor
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Naohisa Yoshida,
Yuji Naito,
Munehiro Kugai,
Ken Inoue,
Kazuhiko Uchiyama,
Tomohisa Takagi,
Takeshi Ishikawa,
Osamu Handa,
Hideyuki Konishi, Naoki Wakabayashi,
Satoshi Kokura,
Nobuaki Yagi,
Yasutaka Morimoto,
Akio Yanagisawa,
Toshikazu Yoshikawa
[show abstract]
[hide abstract]
ABSTRACT: Magnifying endoscopy with flexible spectral imaging color enhancement (FICE) is an image-enhanced endoscopy that captures the surface and vascular patterns of colorectal tumors. We evaluated and compared FICE magnification to narrow-band imaging (NBI) magnification.
Flexible spectral imaging color enhancement or NBI magnification was performed to the visualize surface and vascular patterns of colorectal tumors, classified into 4 types: Type A, Type B, Type C1/C2, and Type C3, as previously reported. A total of 235 colorectal tumors were examined. The correlations between classifications found by FICE or NBI magnification and histopathological diagnoses were examined. Image evaluation was validated by assessing inter-observer and intra-observer agreements on examinations.
Twenty-eight hyperplastic polyps (HPs), 115 tubular adenomas (TAs), 72 mucosal and slightly invaded submucosal cancers (M-sSM), and 20 massively invaded submucosal cancers (mSM) were diagnosed. By FICE magnification, HP and TA were observed in 93.3 and 6.7% of Type A (15 lesions), respectively. TA, M-sSM, and HP were observed in 82.6, 15.4, and 2.0% of Type B (52 lesions),respectively. M-sSM, TA, and mSM were observed in 50.0,46.0, and 4.0% of Type C1/2 (50 lesions), respectively.mSMs were observed in all 7 Type C3 lesions. In diagnosing mSM in Type C3, the sensitivity and specificity of FICE magnification were 77.7 and 100%, respectively, compared to those of NBI, at 63.6 and 99.0%, respectively. Imaging evaluation was validated accurately by intra- and intraobserver measurements showing consistent results.
The classification of colorectal tumors by FICE magnification correlated well with the histopathological diagnoses, similar to findings for NBI magnification. FICE magnification can be evaluated accurately with the same diagnostic classifications as those used for NBI magnification.
Journal of Gastroenterology 11/2010; 46(1):65-72. · 4.16 Impact Factor
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Koichi Soga,
Koichi Tomikashi,
Kohei Fukumoto,
Ki-Ichirou Miyawaki,
Kotaro Okuda,
Hideyuki Konishi,
Nobuaki Yagi, Naoki Wakabayashi,
Satoshi Kokura,
Yuji Naito,
Toshikazu Yoshikawa
[show abstract]
[hide abstract]
ABSTRACT: A 75-year-old man with general malaise and appetite loss was transferred to our hospital for assessment and treatment of liver failure. Laboratory findings on admission showed anemia, and gastroduodenoscopy (GDS) revealed linear esophageal varices and tensive duodenal varices (DV) in the second portion of the duodenum. Systemic examinations did not reveal any significant lesion capable of explaining his anemia, except for DV. Balloon-occluded retrograde transvenous obliteration was carried out to prevent DV bleeding. Good pooling of sclerosant was observed using two balloon catheters. However, contrast-enhanced computed tomography after the procedure revealed no thrombosis in DV, and the patient complained of tarry stools before additional therapy. Emergent GDS revealed ruptured DV with fresh blood and erosions on the surface. Emergent endoscopic obliteration using the tissue adhesive N-butyl-2-cyanoacrylate was carried out and complete hemostasis was achieved. Although no rebleeding episodes were observed after emergent obliteration, the patient died of sepsis following spontaneous bacterial peritonitis 53 days after admission. Autopsy revealed that DV dropped out, and the deep vein was replaced by granulation tissue. No signs of thrombi were detected, except varices. This autopsy case revealed the difficulty in DV management.
Digestive Endoscopy 10/2010; 22(4):329-33. · 1.19 Impact Factor
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Yasuyuki Gen,
Kohichiroh Yasui,
Yoh Zen,
Keika Zen,
Osamu Dohi,
Mio Endo,
Kazuhiro Tsuji, Naoki Wakabayashi,
Yoshito Itoh,
Yuji Naito,
Masafumi Taniwaki,
Yasuni Nakanuma,
Takeshi Okanoue,
Toshikazu Yoshikawa
[show abstract]
[hide abstract]
ABSTRACT: SOX2 is a transcription factor with a high-mobility group DNA-binding domain that functions as a master regulator during embryogenesis and organogenesis. We investigated DNA copy number aberrations in esophageal squamous cell carcinoma (ESCC) cell lines using a high-density oligonucleotide microarray and found frequent amplification at the chromosomal region 3q26. The estimated extent of the minimal overlapping region of amplification was 1.3 Mb. This chromosomal region includes a single gene, SOX2. The SOX2 protein was overexpressed in cell lines in which the gene was amplified. Knockdown experiments showed that SOX2 promotes proliferation of ESCC cells. Genes potentially modulated by SOX2 were determined by expression array analyses combined with small interfering RNA cell-transfection studies. A copy number gain of SOX2 (>2-fold) was observed in 6 of the 40 primary ESCCs (15%). Immunohistochemical study revealed that expression of the SOX2 protein was significantly elevated in 62 of the 89 ESCC tumors (70%), compared with their nontumorous counterparts, and that upregulated expression of SOX2 was associated with poor differentiation of ESCC. Our results suggest that SOX2 is likely to be a target of the 3q26 amplification and may therefore be involved in the development or progression of ESCC.
Cancer genetics and cytogenetics 10/2010; 202(2):82-93. · 1.54 Impact Factor
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[show abstract]
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ABSTRACT: To evaluate a new hemostatic method using hemostatic forceps to prevent perforation and perioperative hemorrhage during colonic endoscopic submucosal dissection (ESD).
We studied 250 cases, in which ESD for colorectal tumors was performed at the Kyoto Prefectural University of Medicine or Nara City Hospital between 2005 and 2010. We developed a new hemostatic method using hemostatic forceps in December 2008 for the efficient treatment of submucosal thick vessels. ESD was performed on 126 cases after adoption of the new method (the adopted group) and the new method was performed on 102 of these cases. ESD was performed on 124 cases before the adoption of the new method (the unadopted group). The details of the new method are as follows: firstly, a vessel was coagulated using the hemostatic forceps in the soft coagulation mode according to the standard procedure, and the coagulated vessel was removed using the forceps in the "endocut" mode without perioperative hemorrhage. Secondly, the partial surrounding submucosa was dissected using the forceps in the endocut mode. In the current study, we evaluated the efficacy of this method.
Coagulated vessels were successfully removed using the hemostatic forceps in all 102 cases without severe perioperative hemorrhage. Moderate perioperative hemorrhage occurred in five cases (4.9%); however, it was stopped by immediately reuse of the hemostatic forceps. The partial surrounding submucosa was dissected using the forceps in all 102 cases. In the adopted group, the median operation time was 105 min. The proportion of endoscopic en bloc resection was 92.8% (P < 0.01) compared to 80.6% in the unadopted group. The postoperative hemorrhage and perforation rates were 2.3% and 2.3%. The rate of perforation was significantly lower than that in the unadopted group (9.6%, P < 0.01). We evaluated the ease of use of this method by allowing our three trainees to performed ESD on 46 cases, which were accomplished without any severe hemorrhage.
The new method effectively treated submucosal thick vessels and shows promise for the prevention of perforation and perioperative hemorrhage in colonic ESD.
World Journal of Gastroenterology 09/2010; 16(33):4180-6. · 2.47 Impact Factor
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Ken Inoue, Naoki Wakabayashi,
Yasutaka Morimoto,
Kiichirou Miyawaki,
Atsufumi Kashiwa,
Naohisa Yoshida,
Keimei Nakano,
Hisashi Takada,
Yoshinori Harada,
Nobuaki Yagi,
Yuji Naito,
Tetsuro Takamatsu,
Toshikazu Yoshikawa
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ABSTRACT: Autofluorescence (AF) imaging, which can potentially differentiate tissue types based on differences in fluorescence emission, may be useful in the diagnosis and treatment of colorectal malignancies. This study was designed to assess the potential usefulness of AF colonoscopy for evaluating superficial colorectal neoplastic lesions.
A total of 49 colorectal lesions in 43 patients were investigated. All superficial colorectal neoplastic lesions were identified with white light (WL) colonoscopy. Each detected lesion was investigated by WL colonoscopy, AF colonoscopy, and chromoendoscopy using 0.2% indigo carmine dye. Three endoscopists, blinded to each patient's history, evaluated the still images (as obtained with these three methods) in random order and evaluated their influence on the assessment of lesion visualization. All the lesions were biopsied or resected endoscopically, with the pathological results used as the gold standard.
For visualization of the surface appearance and differences in color of the lesions compared with the surrounding mucosa, AF colonoscopy was superior to WL colonoscopy (p < 0.01) and comparable to chromoendoscopy (Mann-Whitney U test). For visualization of the circumferential margin, AF colonoscopy was superior to WL colonoscopy (p < 0.05) but inferior to chromoendoscopy (p < 0.01).
AF colonoscopy may be a valuable tool for detection and diagnosis of superficial colorectal neoplastic lesions.
International Journal of Colorectal Disease 07/2010; 25(7):811-6. · 2.38 Impact Factor
