Takuji Gotoda

Yuri General Hospital, Honjō, Saitama, Japan

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Publications (228)971.68 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: National guidelines recommend trastuzumab for treatment of patients with metastatic HER2-positive gastric cancer (GC). There is currently no guideline indicating the number of biopsy specimens and the location from which they should be obtained to reliably determine the human epidermal growth factor receptor 2 (HER2) status in GC. The aim of this pilot study was (a) to quantify HER2-positive tumor cells in different tumor regions to assess the spatial heterogeneity of HER2 expression and (b) to establish the required number of biopsy specimens and the location from which they should be obtained within the tumor to achieve concordance between HER2 expression status in the biopsy specimens and the resection specimen. HER2 expression was quantified in six different regions of 24 HER2-positive GC and in six virtual biopsy specimens from different luminal regions. Intratumoral regional heterogeneity and concordance between HER2 status in the biopsy specimens and the resection specimen were analyzed. HER2-positive cells were more frequent in the luminal tumor surface compared with deeper layers (p < 0.001). GCs with differentiated histological features were more commonly HER2 positive (p < 0.001). Assessment of HER2 expression status in five biopsy specimens was sufficient to achieve 100 % concordance between the biopsy specimens and the resection specimen. This is the first study to suggest preferential HER2 positivity at the luminal surface in GC and to establish a minimum number of biopsy specimens needed to obtain a biopsy HER2 result which is identical to that from the whole tumor. Our study suggests that HER2 testing in five tumor-containing endoscopic biopsy specimens from the proximal (oral) part of the tumor is advisable. The results from this pilot study require validation in a prospective study.
    Gastric Cancer 05/2015; DOI:10.1007/s10120-015-0502-3 · 4.83 Impact Factor
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    ABSTRACT: Endoscopic resection of superficial neoplasms in inflammatory bowel disease (IBD) is appropriate if a complete resection can be achieved. However, EMR is ineffective for large, nonpolypoid neoplasms in IBD due to submucosal fibrosis, and no data are available on the efficacy of endoscopic submucosal dissection (ESD). To assess ESD feasibility and efficacy for large, nonpolypoid neoplasms in patients with IBD. Prospective case series. Multicenter: Italian and Japanese centers. Consecutive patients with long-standing ulcerative colitis and a superficial nonpolypoid neoplasm, >20 mm within the colitic mucosa. Neoplasm characterization and delineation by chromoscopy and narrow-band imaging. ESD performed according to the standard technique. Feasibility, safety, curative resection rates. Nine patients with 10 neoplasms were included (7 and 3 in the Italian and Japanese centers, respectively). Neoplasms were laterally spreading tumors-non-granular in 5 cases, in the left side of the colon in 7, had median size of 33 mm, and were associated with scar in 5 cases. Margin delineation was difficult in 5 cases. Submucosal fibrosis was present in 9 cases. ESD was en bloc with negative margins (R0) in 8 cases, and curative in 7. No endoscopic invisible dysplasia or cancer was found during the follow-up (median 24 months, range 6-72 months) at the resection site and elsewhere within the colitic mucosa. Small series. ESD achieves curative resections in patients with IBD, but the procedure is difficult because of the high prevalence of submucosal fibrosis. Patients need to be accurately evaluated before resection and adhere to strict long-term follow-ups. Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
    Gastrointestinal endoscopy 05/2015; 2. DOI:10.1016/j.gie.2015.02.052 · 4.90 Impact Factor
  • Gastrointestinal Endoscopy 05/2015; 81(5):AB164. DOI:10.1016/j.gie.2015.03.116 · 4.90 Impact Factor
  • Gastrointestinal Endoscopy 05/2015; 81(5):AB133. DOI:10.1016/j.gie.2015.03.050 · 4.90 Impact Factor
  • Gastrointestinal Endoscopy 05/2015; 81(5):AB257. DOI:10.1016/j.gie.2015.03.325 · 4.90 Impact Factor
  • Gastrointestinal Endoscopy 05/2015; 81(5):AB229. DOI:10.1016/j.gie.2015.03.1310 · 4.90 Impact Factor
  • Gastrointestinal Endoscopy 05/2015; 81(5):AB289. DOI:10.1016/j.gie.2015.03.403 · 4.90 Impact Factor
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    ABSTRACT: To evaluate whether an endoscopy position detecting unit (UPD-3) can improve cecal intubation rates, cecal intubation times and visual analog scale (VAS) pain scores, regardless of the colonoscopist's level of experience. A total of 260 patients (170 men and 90 women) who underwent a colonoscopy were divided into the UPD-3-guided group or the conventional group (no UPD-3 guidance). Colonoscopies were performed by experts (experience of more than 1000 colonoscopies) or trainees (experience of less than 100 colonoscopies). Cecal intubation rates, cecal intubation times, insertion methods (straight insertion: shortening the colonic fold through the bending technique; roping insertion: right turn shortening technique) and patient discomfort were assessed. Patient discomfort during the endoscope insertion was scored by the VAS that was divided into 6 degrees of pain. The cecum intubation rates, cecal intubation times, number of cecal intubations that were performed in < 15 min and insertion methods were not significantly different between the conventional group and the UPD-3-guided group. The number of patients who experienced pain during the insertion was markedly less in the UPD-3-guided group than in the conventional group. Univariate and multivariate analysis showed that the following factors were associated with lower VAS pain scores during endoscope insertion: insertion method (straight insertion) and UPD-3 guidance in the trainee group. For the experts group, univariate analysis showed that only the insertion method (straight insertion) was associated with lower VAS pain scores. Although UPD-3 guidance did not shorten intubation times, it resulted in less patient pain during endoscope insertion compared with conventional endoscopy for the procedures performed by trainees.
    04/2015; 21(16):4903-10. DOI:10.3748/wjg.v21.i16.4903
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    ABSTRACT: Endoscopic ultrasonography (EUS)-guided transluminal drainage for pancreatic fluid collections (PFCs) has become the standard therapy worldwide as a minimally invasive therapy compared with surgical drainage. Recently, a novel flared-type biflanged metal stent (BFMS) designed specifically for the treatment of PFCs has been developed. The aim of this study was to retrospectively assess the feasibility and safety of EUS-guided drainage and direct endoscopic necrosectomy (DEN) for PFCs using the novel flared-type BFMS. Twenty-one patients were treated by EUS-guided drainage using a flared-type BFMS for PFCs (pancreatic pseudocyst, 2 patients; walled-off necrosis, 19 patients). The present study showed a technical success rate of 100%, a final clinical success rate of 100%, a procedure-related adverse event (AE) rate of 0%, an early AE rate of 28.6% (moderate and severe AE rate of 9.5%), a mortality rate of 0%, and a recurrence rate of 9.5%. DEN (mean, 2.3 sessions) was required in 38% of the patients. The present study clarified that the EUS-guided drainage using the flared-type BFMS is an effective and safe treatment approach for PFCs. Further studies using randomized controlled multicenter trials are warranted.
    04/2015; 4(2):120. DOI:10.4103/2303-9027.156738
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    ABSTRACT: Helicobacter pylori infection causes gastric neoplasia via development of chronic atrophic gastritis and intestinal metaplasia. The effect of H. pylori eradication on pre-existing gastric neoplasias is still controversial. The aim of this study was to use long-term observation to clarify morphologic and histologic changes in gastric adenomas following H. pylori eradication. Twenty-seven patients with gastric adenomas (revised Vienna classification category 3 or 4.1) who underwent successful H. pylori eradication between April 1996 and December 1997 were followed up at regular intervals with endoscopic and histologic examination. The association between macroscopic and histologic regressions of the lesions and the following patient and lesion characteristics was assessed with univariate analysis: follow-up period, age, sex, serum pepsinogen level, lesion size, lesion location, and histologic gastritis. The mean follow-up period was 91.9 months (range 44-181 months). Twelve lesions (44.4%) showed macroscopic regression, of which 7 (25.9% of the total) also showed histologic regression, with the mean duration from H. pylori eradication to complete macroscopic and histologic regression being 19.9 months. The other 15 lesions (55.6%) remained stable macroscopically and histologically, of which 6 (22.2% of the total) progressed to malignancy during the follow-up period. Univariate analysis revealed that female sex (p = .005), smaller lesion size (p = .025), higher baseline serum pepsinogen II level (p = .041), and absence of intestinal metaplasia in the greater curvature of the corpus (p = .026) were significantly associated with complete regression. Helicobacter pylori eradication may induce regression in some gastric adenomas. © 2015 John Wiley & Sons Ltd.
    Helicobacter 02/2015; DOI:10.1111/hel.12218 · 2.99 Impact Factor
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    ABSTRACT: Recently, the need for sedation in gastrointestinal endoscopy has been increasing. However, National Health Insurance Drug Price list in Japan does not include any drug specifically used for the sedation. While benzodiazepines are the main medication, their use in cases of gastrointestinal endoscopy has not been approved. This situation has led the Japan Gastrointestinal Endoscopy Society to develop the first set of guidelines for sedation in gastrointestinal endoscopy on the basis of evidence-based medicine in collaboration with the Japanese Society for Anesthesiologists. The present guidelines comprise 14 statements, five of which were judged to be valid on the highest evidence level and three on the second highest level. The guidelines are not intended to strongly recommend the use of sedation for gastrointestinal endoscopy, but rather to indicate the policy as to the choice of appropriate procedures when such sedation is deemed necessary. In clinical practice, the final decision as to the use of sedation should be made by physicians considering the patients' willingness and physical conditions. This article is protected by copyright. All rights reserved.
    Digestive Endoscopy 02/2015; 27(4). DOI:10.1111/den.12464 · 1.99 Impact Factor
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    ABSTRACT: Background and aim Identification of the esophageal gastric junction (EGJ) is of crucial importance for the consistent detection of Barrett’s esophagus (BE). In Japan, the distal end of the lower esophageal palisade vessels is used to define the EGJ. However, in Western countries, the EGJ is defined as the proximal margin of the gastric folds. In this prospective study, we compared the variation in endoscopic diagnosis of BE using the Japanese criteria (J-criteria) and the Prague C & M criteria (P-criteria) as a landmark of the EGJ. Methods A total of 82 patients were enrolled in this study. The patients were referred to the Veterans Affair Palo Alto Health Care System from May 2008 to July 2008. We assessed the recognition rates of the EGJ and the detection rates of endoscopic BE, first using the J-criteria and later using the P-criteria by the American endoscopists. Results Identification rate of EGJ was 87.8 % (72/82) using the J-criteria and 97.5 % (80/82) using the P-criteria (P = 0.008). 28.0 % (23/82) of the cases were endoscopically diagnosed as BE using the J-criteria, whereas 17.0 % (14/82) of the cases were diagnosed as BE using the P-criteria (P = 0.049). There was a significant difference in the detection rates between the J-criteria and P-criteria. Conclusions We showed the different ratios in the endoscopic detection of BE using the J-criteria and P-criteria. The difference in the prevalence rate of BE in Japan and Western countries can be partly attributed to differences in the endoscopic diagnose of BE.
    Esophagus 02/2015; DOI:10.1007/s10388-015-0483-7 · 0.74 Impact Factor
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    ABSTRACT: We herein report a case of severe acute cholangitis complicated by bacterial meningitis. A 56-year-old Japanese man was admitted to our hospital due to a consciousness disorder that had developed while he was being treated for acute cholangitis. The levels of both hepatobiliary enzymes and inflammatory markers were high, and computed tomography revealed common bile duct stones and cholangiectasis. A diagnosis of acute cholangitis was made, and meningitis was subsequently confirmed on a cerebrospinal fluid analysis. The patient recovered successfully after receiving emergency endoscopic drainage and antibiotic therapy. This case demonstrates that a disturbance of consciousness complicated by acute cholangitis may result from septic encephalopathy as well as meningitis via bloodstream infections.
    Internal Medicine 01/2015; 54(14):1757-60. DOI:10.2169/internalmedicine.54.3922 · 0.97 Impact Factor
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    ABSTRACT: Background and study aims: Recently, a novel fully covered and biflanged metal stent (BFMS) dedicated to the drainage of walled-off necrosis (WON) was developed. The aim of this study was to retrospectively evaluate the safety, efficacy, and cost performance of drainage of WON using the novel BFMS compared with a traditional plastic stent. Patients and methods: A total of 70 patients with symptomatic WON were treated under endoscopic ultrasound (EUS) guidance. Initial drainage was conducted using the single gateway technique with placement of one or more plastic stents or a single BFMS. If drainage was unsuccessful, direct endoscopic necrosectomy (DEN) was performed. Results: There were no statistically significant differences in rates of technical success, clinical success, and adverse events between plastics stents and BFMS, despite the size of WON in the BFMS group being significantly larger than that in the plastic stent group (105.6 vs. 77.1 mm; P=0.003). The mean procedure times for the first EUS-guided drainage and for re-intervention were significantly shorter in the BFMS group than in the plastic stent group (28.8 +/- 7.1 vs. 42.6 +/- 14.2, respectively, for drainage, P<0.001; and 34.9 +/- 8.5 vs. 41.8 +/- 7.6, respectively, for re-intervention, P<0.001). There was no statistically significant difference in the total cost between plastic stent and BFMS use in the treatment of WON ($5352 vs. $6274; P=0.25). Conclusions: Plastic stents and BFMS were safe and effective for the treatment of WON. In particular, BFMS placement appeared to be preferable for initial EUS-guided drainage and additional reintervention (e.g. DEN) as it reduced the procedure time. Prospective randomized controlled trials are warranted.
    Endoscopy 01/2015; 47(1):47-55. DOI:10.1055/s-0034-1377966 · 5.20 Impact Factor
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    ABSTRACT: Background. The safety of non-anesthesiologist-administered propofol (NAAP) sedation in emergent endoscopic retrograde cholangiopancreatography (ERCP) has not been fully clarified. Thus, the aim of this study was to assess the safety of NAAP sedation in emergent ERCP. Materials and Methods. We retrospectively analyzed 182 consecutive patients who had obstructive jaundice and who underwent ERCP under NAAP sedation. The patients were divided into Group A (with mild acute cholangitis or without acute cholangitis) and Group B (moderate or severe acute cholangitis). And technical safety and adverse events were assessed. Results. The adverse events were hypoxia (31 cases), hypotension (26 cases), and bradycardia (2 cases). There was no significant difference in the rate of each adverse event of hypoxia and bradycardia in either group. Although the rate of transient hypotension associated in Group B was higher than that in Group A, it was immediately improved with conservative treatment. Moreover, there were no patients who showed delayed awakening, or who developed other complications. Conclusions. In conclusion, NAAP sedation is feasible even in emergent ERCP. Although some transient adverse events (e.g., hypotension) were observed, no serious adverse events occurred. Thus, propofol can be used in emergent ERCP but careful monitoring is mandatory.
    Gastroenterology Research and Practice 01/2015; 2015:685476. DOI:10.1155/2015/685476 · 1.75 Impact Factor
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    ABSTRACT: The new developed ultrathin transnasal endoscope, the GIF-XP290N, makes possible a resolving power similar to the GIF-H260 at a distance of 3 mm. In this study, using the GIF-XP290N, we evaluated whether endoscopic diagnosis (discrimination between benign and malignant) of gastric lesions is possible using nonmagnified narrow-band imaging (NBI) endoscopy. The subjects were 255 consecutive patients who underwent screening of the gastrointestinal tract using new ultrathin transnasal endoscopy. Their average age was 65.2 ± 11.4 years. The male-female ratio was 2.5:1. All cases were examined using conventional white-light imaging (WLI) and nonmagnified NBI. When a depressed lesion was detected in the stomach, it was examined using WLI, then NBI close examination (at about 3 mm). We observed the mucosal structure of the lesion using close visualization with NBI. Concerning mucosal structural changes, we looked for a clear demarcation line between the lesion and the surrounding mucosa, and loss, irregularity, or nonuniformity of the lesion mucosal microsurface pattern. A total of 52 depressed lesions were examined. The histological diagnosis was cancer for 8 lesions, and noncancer for 44 lesions. WLI examination yielded a sensitivity of 50.0% (4/8), specificity of 63.6% (28/44), and accuracy 61.5% (32/52). On the other hand, NBI close examination yielded a sensitivity of 87.5% (7/8), specificity of 93.2% (41/44), and accuracy of 92.3% (48/52), significantly higher. NBI close examination using ultrathin transnasal endoscopy enables mucosal diagnosis even without magnification and was considered to be an effective technique for improving endoscopic diagnosis. © 2014 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.
    Journal of Gastroenterology and Hepatology 12/2014; 29 Suppl S4:33-36. DOI:10.1111/jgh.12797 · 3.63 Impact Factor
  • Mizutomo Azuma, Chika Kusano, Takuji Gotoda
    Digestive Endoscopy 12/2014; 27. DOI:10.1111/den.12429 · 1.99 Impact Factor
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    ABSTRACT: Background Endoscopic biopsies (EB) are the gold standard for diagnosing gastrointestinal carcinoma yet no guidelines address EB use for prognostic and predictive molecular testing. This review summarises the reported quantity and quality of EB, their relationship with molecular test failure rates, and result concordance between EB and resection specimens.Methods Studies reporting molecular testing on gastrointestinal carcinoma EBs published between 2002 and 2012 were identified. Details regarding EB quantity, quality, tumour content, molecular test failure rates and causes, and concordance with resection specimens were reviewed.ResultsSeventy-five studies were identified. Eighteen (24%) reported the mean EB number per patient (median: 2.1, range: 1 to 6.6 biopsies). Sixty-one (81%) reported the frequency of test failure (median: 0%, range: 0 to 100%). Twenty-two (29%) investigated biopsy and resection concordance (range: 0 to 100%). EB quantity and quality affected neither concordance nor failure rate.Conclusion Few studies currently report EB quantity, EB quality, or biopsy and resection concordance. Reliable molecular testing in EBs appears achievable and can be representative of resection specimens. Concordance depends on the testing methodology and biomarker heterogeneity within the tumour. To improve patient care, EB sampling, processing and reporting requires standardisation and needs optimisation for each biomarker individually.This article is protected by copyright. All rights reserved.
    Histopathology 11/2014; DOI:10.1111/his.12626 · 3.30 Impact Factor
  • Journal of Hepato-Biliary-Pancreatic Sciences 11/2014; 22(2). DOI:10.1002/jhbp.172 · 2.31 Impact Factor
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    ABSTRACT: Based on the results of several case-control and cohort studies gastrointestinal X-ray (GI X-ray) has been recommended for use in the nationwide screening program for gastric cancer.. Although this was the only effective screening program when almost all of the Japanese population were Helicobacter pylori (H. pylori) positive, there has been concern whether an alternative effective screening system should be established for the future H. pylori-negative generation. We therefore conducted the first randomized controlled trial (RCT) comparing GI X-ray and gastrointestinal endoscopy (GIE) scheduled according to results of serological testing (ST); this was done to determine the potential for an alternative screening method.
    Gastric Cancer 08/2014; DOI:10.1007/s10120-014-0408-5 · 4.83 Impact Factor

Publication Stats

8k Citations
971.68 Total Impact Points


  • 2015
    • Yuri General Hospital
      Honjō, Saitama, Japan
  • 2010–2015
    • Tokyo Medical University
      • Department of Gastroenterology and Hepatology
      Edo, Tōkyō, Japan
    • Changi General Hospital
      • Department of Gastroenterology
      Singapore, Singapore
  • 2010–2012
    • National Center for Global Health and Medicine in Japan
      Edo, Tōkyō, Japan
  • 1999–2010
    • National Cancer Center, Japan
      • Endoscopy Division
      Edo, Tōkyō, Japan
  • 2009
    • University of Missouri
      Columbia, Missouri, United States
  • 1999–2008
    • National Hospital Organization Kyushu Cancer Center
      Hukuoka, Fukuoka, Japan
  • 2007
    • Sapienza University of Rome
      • Department of General Surgery, Surgical Specialities and Organ Transplantation "Paride Stefanini"
      Roma, Latium, Italy
    • Yamaguchi University
      Yamaguti, Yamaguchi, Japan
  • 2006
    • Wakayama Medical University
      Wakayama, Wakayama, Japan
  • 2004
    • Tonan Hospital
      Kôti, Kōchi, Japan
  • 2003
    • Mitsui Memorial Hospital
      Edo, Tōkyō, Japan
    • Stanford University
      Palo Alto, California, United States
  • 2002
    • The University of Tokyo
      • Department of Gastroenterology
      Edo, Tōkyō, Japan