Kazuhiro Kashiwagi

Publications of Kazuhiro Kashiwagi

• Clinical results of observation of the upper gastrointestinal tract by transgastrostomic endoscopy using an ultrathin endoscope.

  Authors: Hiroyuki Imaeda, Naoki Hosoe, Hiromasa Nakamizo, Kazuhiro Kashiwagi, Hidekazu Suzuki, Yoshimasa Saito, Kazuhiro Suganuma, Yosuke Ida, Juntaro Matsuzaki, Eisuke Iwasaki, Yasushi Iwao, Haruhiko Ogata, Toshifumi Hibi

  Journal of gastroenterology and hepatology. 12/2010; 25(12):1850-4.

  Esophagogastroduodenoscopy through the oral cavity of patients who have undergone percutaneous endoscopic gastrostomy (PEG) causes some distress and puts these patients at risk of aspirationEsophagogastroduodenoscopy through the oral cavity of patients who have undergone percutaneous endoscopic gastrostomy (PEG) causes some distress and puts these patients at risk of aspiration pneumonia. The aim of this study was to evaluate results for the upper gastrointestinal tract by transgastrostomic endoscopy using an ultrathin endoscope. The study subjects were 43 patients, who underwent exchange of a PEG button or tube, 20-French or more in diameter. After PEG buttons or tubes were extracted from the gastrostomy tract, an ultrathin endoscope was inserted through the gastrostomy tract. The stomach and the duodenal bulb were observed and the esophagus was observed in retrograde passage. A new PEG button or tube was then inserted. The rate of successful insertion into the esophagus and duodenal bulb, the observation of the gastrostomy site in retroversion in the stomach, and the endoscopic findings were analyzed. Ninety-nine examinations were carried out. The esophagus could be observed in 95 (96.0%), the duodenum in 92 (92.9%) and the gastrostomy site in the stomach in all. Gastric polyps were detected in four patients, gastric erosions in two, reflux esophagitis in two, polypoid lesion at the gastrostomy tract in two, gastric ulcer scar in one, duodenal ulcer scar in one, early gastric cancer in one and recurrent esophageal cancer in one. Neither discomfort nor complications occurred during transgastrostomic endoscopy. Observation of the upper gastrointestinal tract by transgastrostomic endoscopy using an ultrathin endoscope during a gastrostomy button or tube replacement may be useful and safe.

• Autofluorescence videoendoscopy system using the SAFE-3000 for assessing superficial gastric neoplasia.

  Authors: Hiroyuki Imaeda, Naoki Hosoe, Kazuhiro Kashiwagi, Yosuke Ida, Yoshimasa Saito, Hidekazu Suzuki, Koichi Aiura, Haruhiko Ogata, Koichiro Kumai, Toshifumi Hibi

  Journal of gastroenterology and hepatology. 04/2010; 25(4):706-11.

  Autofluorescence (AF) videoendoscopy has an advantage over ordinary videoendoscopy in the diagnosis of gastric neoplasias, and the aim of the present study was to evaluate the effectiveness of usingAutofluorescence (AF) videoendoscopy has an advantage over ordinary videoendoscopy in the diagnosis of gastric neoplasias, and the aim of the present study was to evaluate the effectiveness of using the SAFE-3000 videoendoscopy system to diagnose superficial gastric neoplasias. Ordinary videoendoscopy, AF videoendoscopy, and chromoendoscopy (CE) were used to diagnose the tumor existence and extent in 14 patients with gastric adenoma, 40 patients with intestinal-type early gastric cancer (EGC) (10 protruded, and 30 depressed), and nine patients with diffuse-type EGC. The diagnostic accuracies of the three kinds of images were evaluated by comparison with the results of histopathological assessment of resected specimens. For gastric adenomas the diagnostic accuracy between the AF images and white light (WL) images did not differ significantly, and for protruded intestinal-type EGCs and diffuse-type EGCs the diagnostic accuracy did not differ significantly between any of the types of images. For depressed intestinal-type EGCs, the diagnostic accuracy of AF images tended to be higher than that of the WL images (P < 0.05) and it was not significantly different from that of the CE images. The detection rate of pink or orange color in AF images was significantly higher for protruded intestinal-type EGCs than gastric adenomas (P = 0.005), depressed intestinal-type EGCs (P < 0.001), and diffuse-type EGCs (P = 0.027). Autofluorescence videoendoscopy using the SAFE-3000 system for gastric neoplasias might be useful for diagnosing depressed intestinal-type early gastric cancers. The detection of orange or pink color in AF images may be efficacious in discriminating protruded intestinal-type early gastric cancers from gastric adenomas.

• Clinical results of endoscopic hemostasis using a short transparent hood and short hemoclips for non-variceal upper gastrointestinal bleeding.

  Authors: Naoki Hosoe, Hiroyuki Imaeda, Kazuhiro Kashiwagi, Makoto Naganuma, Nagamu Inoue, Hidekazu Suzuki, Kazuhiro Suganuma, Yosuke Ida, Hiromasa Nakamizo, Koichi Aiura, Haruhiko Ogata, Yasushi Iwao, Koichiro Kumai, Toshifumi Hibi

  Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society. 05/2009; 21(2):93-6.

  AIM: Endoscopic hemostasis using hemoclips is useful, but there are technical difficulties because the angle of the approach is tangential. A transparent hood facilitates the observation andAIM: Endoscopic hemostasis using hemoclips is useful, but there are technical difficulties because the angle of the approach is tangential. A transparent hood facilitates the observation and treatment of these lesions, and a shorter hood provides a wider visible field. Endoscopic hemoclipping of hard lesions with hemoclips of the conventional size does not reliably result in sustained hemostasis because the clips slip. Short clips, however, can be easily clamped on protruded visible vessels without slip. The aim of the present study was to evaluate the efficacy of endoscopic hemostasis with a short transparent hood and short clips. METHODS: Subjects were 198 patients with 214 lesions of non-variceal upper gastrointestinal bleeding at Keio University Hospital. We used a video endoscope with a short transparent hood attached to its distal tip and carried out hemostasis using short hemoclips. RESULTS: The short transparent hood provided a good visual field. If the lesions were in the tangential, the short hood made it possible to observe them in the frontal view and made clip hemostasis much easier. The short clip could be securely clamped against protruded visible vessels. Of 214 lesion, 211 (98.6%) had temporal hemostasis. Rebleeding occurred in 13 of 211 lesions (6.2%), and 205 of 214 lesions (95.8%) had permanent hemostasis. Nine cases were endoscopically difficult. CONCLUSION: Endoscopic hemostasis with a short transparent hood and short clips is useful for non-variceal upper gastrointestinal bleeding.

• Novel technique of endoscopic submucosal dissection using an external grasping forceps for superficial gastric neoplasia.

  Authors: Hiroyuki Imaeda, Naoki Hosoe, Yosuke Ida, Kazuhiro Kashiwagi, Yuichi Morohoshi, Kazuhiro Suganuma, Shuichi Nagakubo, Koichi Komatsu, Hidekazu Suzuki, Yoshimasa Saito, Koichi Aiura, Haruhiko Ogata, Yasushi Iwao, Koichiro Kumai, Yuko Kitagawa, Toshifumi Hibi

  Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society. 05/2009; 21(2):122-7.

  Endoscopic submucosal dissection (ESD) for early stage gastric cancer (EGC) has improved the success rate of en bloc resection but results in perforation more often than does endoscopic mucosalEndoscopic submucosal dissection (ESD) for early stage gastric cancer (EGC) has improved the success rate of en bloc resection but results in perforation more often than does endoscopic mucosal resection. We report a novel technique of ESD using an external grasping forceps. A total of 265 lesions with EGC or gastric adenoma were enrolled in this study. Sixteen lesions were located in the upper third portion of the stomach, 114 in the middle third portion, and 135 in the lower third portion. After submucosal injection followed by circumcision of the lesions with a flex knife, the external grasping forceps was introduced with the help of a second grasping forceps and anchored at the margin of the lesion. Oral traction applied with this forceps could elevate the lesion and make the submucosal layer wider and more visible, thereby facilitating dissection of the submucosal layer under direct vision. The mean lesion size was 15.0 mm (range: 5-50 mm). All but 11 lesions (95.8%) could be resected en bloc with free margins. Mean procedure time was 45 min (range: 20-180 min). It was difficult to carry out this procedure when the lesions were located in the cardia, lesser curvature, or posterior wall of the upper third of the gastric body. Bleeding after ESD occurred in 10 patients (3.8%) and perforation occurred in one patient (0.4%). The endoscopic submucosal dissection using an external grasping forceps for superficial gastric neoplasia is efficacious and safe.

• High copy amplification of the Aurora-A gene is associated with chromosomal instability phenotype in human colorectal cancers.

  Authors: Naoshi Nishida, Takeshi Nagasaka, Kazuhiro Kashiwagi, C Richard Boland, Ajay Goel

  Cancer biology & therapy. 05/2007; 6(4):525-33.

  Chromosomal instability (CIN) is a common but not universal feature of colorectal cancer (CRC); however, the molecular basis for CIN is controversial and poorly understood. There are many plausibleChromosomal instability (CIN) is a common but not universal feature of colorectal cancer (CRC); however, the molecular basis for CIN is controversial and poorly understood. There are many plausible mechanisms proposed for CIN, including disruption of G1/S and G2/M checkpoint regulation, and alterations in the spindle checkpoint genes. However, mutations in individual growth regulatory genes are not commonly observed in CRC. Therefore, a more comprehensive analysis of the genes involved in each cell cycle checkpoint regulatory pathway might be required to evaluate a possible role for involvement in CIN. We investigated the presence of high copy amplification of the cyclin E, Aurora-A, Skp2 genes, mutation of ubiquitin ligase CDC4, and promoter methylation of Mad2L1, as well as the expression of the gene products in a panel of 11 human CRC cell lines as well as 48 human CRC specimens. In the cell lines with CIN, we found amplification of the Aurora-A, cyclin E and Skp2 genes, and a mutation in the CDC4 gene, all of which resulted in altered expression of the cognate proteins. In the human CRC tissues, amplification of Aurora-A was frequent (29%), while alterations were rarely observed in cyclin E, Skp2 or CDC4. Aurora-A amplification was strongly associated with a high fractional allelic loss score (p = 0.0001), but not with microsatellite instability, nor with the promoter methylation phenotype in these tumors. Our data confirm involvement in the CDC4-cyclin E pathway of the development of the CIN phenotype in human CRC, and find that amplification of the Aurora-A is a common target for disruption of this pathway.

• Clinical significance of microsatellite instability in the inflamed mucosa for the prediction of colonic neoplasms in patients with ulcerative colitis.

  Authors: Toshiyuki Tahara, Nagamu Inoue, Tadakazu Hisamatsu, Kazuhiro Kashiwagi, Hiromasa Takaishi, Takanori Kanai, Mamoru Watanabe, Hiromasa Ishii, Toshifumi Hibi

  Journal of gastroenterology and hepatology. 06/2005; 20(5):710-5.

  BACKGROUND AND AIM: Although molecular mechanisms underlying ulcerative colitis (UC)-associated neoplasms have been studied for years, understanding of these mechanisms remains incomplete and no goodBACKGROUND AND AIM: Although molecular mechanisms underlying ulcerative colitis (UC)-associated neoplasms have been studied for years, understanding of these mechanisms remains incomplete and no good predictable marker for development of colonic neoplasms in patients with UC has been established. The aim of this study was to assess if microsatellite instability (MSI) contributes to the development of colonic neoplasms in patients with UC. METHODS: We have examined MSI in chronic inflamed and neoplastic colonic mucosa of UC patients. We have also obtained serial biopsied colonic tissues retrospectively 2-12 years before the final diagnosis from patients with high level MSI (MSI-H+) UC-associated neoplasms, and analyzed MSI using them at different periods. RESULTS: Eight of 12 UC-associated colon cancers (67%), four of six UC-associated high grade dysplasias (67%), and two of six UC-associated low grade dysplasias (33%) revealed MSI-H+ phenotypes. In contrast, 15 of 59 lesions (25%) in inflamed UC mucosa without colonic neoplasm revealed MSI-H +. Interestingly, all four patients with MSI-H+ phenotypes at the final diagnosis of UC-associated colon cancer or dysplasia had already had MSI-H+ at the stage of chronic colitis, 2-12 years before the final diagnosis. CONCLUSION: These results support the notion that MSI contributes to the carcinogenesis of UC-associated neoplasms, and indicate that this analysis in inflamed colonic mucosa at surveillance colonoscopy is useful for identifying UC patients who have high risk for neoplastic progression.

• A case of Behçet's disease accompanied by colitis with longitudinal ulcers and granuloma.

  Authors: Makoto Naganuma, Yasushi Iwao, Kazuhiro Kashiwagi, Shinsuke Funakoshi, Hiromasa Ishii, Toshifumi Hibi

  Journal of gastroenterology and hepatology. 02/2002; 17(1):105-8.

  A 37-year-old female presenting with oral and genital ulcers and erythema nodosum on both arms was diagnosed as having Behçet's disease. The symptoms resolved spontaneously. However, she was admittedA 37-year-old female presenting with oral and genital ulcers and erythema nodosum on both arms was diagnosed as having Behçet's disease. The symptoms resolved spontaneously. However, she was admitted to our hospital (Keio University Hospital) several months later because of fever, aphthous ulcers of the oral cavity, lower abdominal pain and frequent diarrhea. A colonoscopic examination revealed multiple ulcers including longitudinal ulcers in the ascending and transverse colon, and histological examination of biopsied specimens demonstrated non-caseating epithelioid granuloma. Treatment with prednisolone and 5-aminosalicylic acid was started, and the patient responded well clinically. One month later, a repeated colonoscopy confirmed that the lesions including longitudinal ulcers had disappeared. In this report, we describe our experience of this rare case of Behçet's disease concomitant with colonic longitudinal ulcers and epithelioid granuloma, and discuss the difficulties in making a differential diagnosis, primarily with regard to Crohn's disease.