Noriaki Manabe

Kawasaki Medical University, Kurasiki, Okayama, Japan

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Publications (144)710.41 Total impact

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    ABSTRACT: PillCam patency capsule (PC) is a novel and radiofrequency identification tag-free device that remains intact in the gastrointestinal tract for 30-33 h after ingestion and then disintegrates. The aim of this study was to determine the clinical relevance of PC combined with abdominal ultrasonography as a reliable indicator of functional patency.
    European Journal of Gastroenterology & Hepatology 12/2014; 26(12):1434-8. · 2.15 Impact Factor
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    ABSTRACT: Serotonin type 3 receptor (5-HT3 R) antagonists are potentially useful therapeutic agents for diarrhea-predominant irritable bowel syndrome (IBS-D). To identify biomarkers predicting effectiveness of the 5-HT3 R antagonist (ramosetron) in IBS-D. Irritable bowel syndrome-D Japanese subjects received 2.5 or 5 μg of ramosetron once daily for 4 weeks. Colonic mucosal S100A and tryptophan hydroxylase (TPH) mRNA expression levels were measured before treatment. Genomic DNA was extracted from blood and polymorphisms of TPH1 and TPH2 were analyzed. Forty-two patients (27 men and 15 women, mean age 42 years) with IBS-D were included for analysis. Improvement of IBS symptoms was seen in 26 (61.9%). Baseline S100A10 (p = 0.02) and TPH1 (p = 0.02) expression were significantly higher in the ramosetron responders than in the non-responders. The frequencies of the TPH1 rs4537731G allele in linkage disequilibrium with the TPH1 rs7130929 T allele (11.5% vs 50%, p = 0.003; OR: 12; 95% CI: 2.1-69) along with TPH1 rs211105 C allele (3.8% vs 43.8%, p = 0.0003; OR: 19; 95% CI: 2.1-181) were significantly lower in the responders than in the non-responders. The mean scores of diarrhea at baseline were significantly higher (5.2 vs 3.7, p = 0.005) in patients with TPH1 rs211105 T/T than those with the G allele. TPH1 gene polymorphisms and S100A10 expression, which correlate with 5-HT signaling were associated with ramosetron effectiveness in IBS-D, and may possibly lead to prospective identification of the resistance to treatment. © 2014 John Wiley & Sons Ltd.
    Neurogastroenterology and Motility 11/2014; · 2.94 Impact Factor
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    ABSTRACT: Background: Dysphagia in elderly patients has a major effect on nutrition and the quality of life (QOL). Although several studies showed that aging itself was associated with changes in esophageal motility, the impact of this on the symptom of dysphagia and quality of life is unknown. The aim of this study was to determine the manometric diagnoses of elderly patients with dysphagia and to see if these differed from those in non-elderly patients. Methods: From September 2007 through March 2014, after excluding patients with organic diseases, 47 consecutive older patients > 65 years reporting dysphagia (men/women, 24/23; mean age 73.0 years) (group A) were compared with those from 42 middle-aged patients with dysphagia (men/women, 18/24; mean age 56.5 years) (group B) and 27 younger patients with dysphagia (men/women, 15/12; mean age 36.1 years) (group C) in regard to symptoms, esophageal motility and health-related QOL (HRQOL). Each patient received ten 5-mL room temperature boluses of saline solution in combined multichannel intraluminal impedance-esophageal manometry examination. They all completed a selfadministered 7-point Likert scale questionnaire about their symptoms and HRQOL based on results of the SF-8. A symptom rated by the patient with a Likert scale score of 4 points or higher was defi ned as a signifi cant symptom. Results: Although all patients had dysphagia as the signifi cant symptom, more elderly patients reported globus sensation and more younger patients reported heartburn as their primary symptom, respectively. Manometricdiagnoses were generally similar among the three groups, although ineffective esophageal motility tended to be diagnosed more in group A compared to group B (Table 1). No signifi cant differences in manometric parameters were detected (Table 2). There were no signifi cant differences in HRQOL among the three groups.
    14th World Congress of International Society for Disease of the Esophagus, Vancouver; 09/2014
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    ABSTRACT: Current Japanese gastrointestinal (GI) endoscopic guidelines permit endoscopic biopsy without cessation of antiplatelet agents and warfarin in patients with a therapeutic range of prothrombin time-international normalized ratio (PT-INR) levels, although the evidence levels are low. We evaluated the safety of endoscopic biopsy in patients currently taking antithrombotics. Consecutive patients receiving antithrombotics who underwent GI endoscopy from August 2012 to August 2013 were enrolled. Adverse events and endoscopic hemostasis after biopsy were evaluated. PT-INR level was measured in patients taking warfarin the day before endoscopy. Among 7939 patients undergoing endoscopy, 1034 patients (13.0%, 706 men and 328 women, average age 72.8 years) were receiving antithrombotics. Antithrombotics included aspirin (44.8%), warfarin (34.7%), thienopyridine (16.1%), cilostazol (10.3%), dabigatran (4.8%) etc. PT-INR levels in patients taking warfarin were >3.0 in 13 patients (4.3%), between 2.5 and 3.0 in 18 patients (6.0%), <2.5 in 269 patients (89.7%). Two hundred and six patients received endoscopic biopsy while taking aspirin (51.2%), warfarin (22.8%), and thienopyridine (13.6%). Endoscopic hemostasis was required in three patients after endoscopic biopsy (spraying thrombin in two patients, spraying thrombin and clipping in one patient). There were no major complications. The incidence of endoscopic hemostasis after biopsy in patients without antithrombotic cessation was not significantly different than in the controls not taking antithrombotics (1.5% vs 0.98%, P = 0.51). Endoscopic biopsy did not increase the bleeding risk despite not stopping antithrombotics prior to biopsy even among patients taking warfarin whose PT-INR was within the therapeutic range.
    Digestive Endoscopy 04/2014; · 1.61 Impact Factor
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    ABSTRACT: Abstract Objective. Fecal hemoglobin-haptoglobin (Hb-Hpt) complex testing is theoretically superior to immunochemical fecal occult blood test detecting human hemoglobin (Hb), as Hb-Hpt is more stable compared to Hb during passage through the gastrointestinal (GI) tract. The aim was to examine the role of fecal Hb-Hpt complex testing in predicting small bowel lesions detected by video capsule endoscopy (VCE). Materials and methods. Stools from patients undergoing small bowel VCE for obscure GI bleeding (OGIB) without ongoing overt bleeding were included. Two stool specimens were obtained on different days just before VCE to measure Hb-Hpt complex by ELISA and Hb by latex agglutination turbidimetric immunoassay. Results. Seventy-six patients (39 men and 37 women, average age 66 years) with suspected small bowel lesions entered. Median Hb-Hpt complex and Hb levels were significantly higher (p < 0.001) in those with small bowel lesions compared to those without. Using the suitable cutoff points (Hb >10 ng/ml and Hb-Hpt complex >5 ng/ml), the sensitivity and specificity of the Hb-Hpt complex test to predict small bowel lesions were 71.4% and 73.3%, and those of the Hb test were 61.2% and 89.3%. Small bowel lesions were found in 58.3% with only Hb-Hpt complex positive results (15.8% of total subjects) compared to 83.3% when both were positive (55.3% of total). Conclusions. Measuring fecal Hb-Hpt complex in addition to Hb may be useful to predict the presence of small bowel lesions in patients with OGIB.
    Scandinavian Journal of Gastroenterology 03/2014; · 2.33 Impact Factor
  • Noriaki Manabe, Ken Haruma
    01/2014; 111(10):1923-32.
  • Ken Haruma, Hiroaki Kusunoki, Noriaki Manabe
    01/2014; 111(6):1049-1057.
  • Choonpa Igaku 01/2014;
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    ABSTRACT: We report a case of diffuse esophageal spasm (DES) successfully treated by esophageal long myotomy and Dor’s fundoplication. The patient was a 52-year-old man with a history of hepatitis C and severe chronic heart failure due to hypertensive cardiomyopathy. He had also undergone hemodialysis for chronic renal failure for 10 years. He had complained of dysphagia for 10 years. Diffuse esophageal spasm was diagnosed by fluoroscopy and esophageal manometry. We performed esophageal long myotomy through the opened hiatus and Dor’s fundoplication. The upper extent of the myotomy was confirmed by intraoperative endoscopic ultrasonography used to detect muscle thickening and low compliance of the esophageal wall. The procedure and postoperative recovery were uneventful, and the patient’s symptoms were relieved. This approach appears to be a potentially useful means of treating severe symptoms of DES resistant to conservative therapy, with ultrasound endoscopy being a helpful means of confirming the extent of esophageal myotomy.
    Esophagus 12/2013; 10(4). · 0.74 Impact Factor
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    ABSTRACT: Abnormal proximal gastric relaxation is one of the causes of functional dyspepsia. The purpose of this study is to use a barostat in conscious dogs to determine the effects of rikkunshito, which is considered to have beneficial effects on functional dyspepsia, on the proximal stomach. Eight beagles were used. A gastrocutaneous fistula and force transducers were surgically implanted in the middle corpus and gastric antrum and duodenum, respectively. After a recovery period, a plastic bag was inserted through the gastrocutaneous fistula and the proximal stomach was distended using a barostat. First, four dogs were used to investigate the pressure-volume relation in the fasted and postprandial phases. Second, the stomachs of four different dogs were continuously distended at minimal distending pressure +2mmHg, and 5min later were infused with warmed liquid rikkunshito (2g/20mL) or water through the gastrocutaneous fistula. Finally, changes in the proximal gastric volume and gastrointestinal motility were observed. The proximal stomach was significantly more pliable in the postprandial phase than in the fasted phase. The proximal gastric volume increased immediately after liquid infusion under constant pressure in both phases and duodenal motility was accelerated. The effect of rikkunshito was significantly greater and lasted longer than that of water. No significant difference between the effects during the fasted or postprandial phase and no change in the gastric antrum motility were observed when rikkunshito was infused. These results indicate that rikkunshito accelerates duodenal motility and relaxes the proximal stomach.
    Autonomic neuroscience: basic & clinical 07/2013; · 1.82 Impact Factor
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    ABSTRACT: BACKGROUND: Both ulcerative colitis (UC) and diarrhea-predominant irritable bowel syndrome (IBS-D) are associated with alterations in enteric serotonin (5-HT) signaling. AIMS: The purpose of this study was to compare the rectal and sigmoid colonic mucosal expression of S100A proteins and functional polymorphisms of the 5-HT transporter (5HTT) and interleukin-10 genes in patients with IBS-D or UC with healthy controls. METHODS: mRNA expression of S100 proteins was measured in sigmoid and rectal biopsies and in rectal epithelium isolated by laser-captured microdissection. Leucocyte DNA was analyzed by PCR-based reaction fragment length polymorphisms and direct sequencing. Clinical symptoms were assessed by the self-rating depression scale and by the gastrointestinal symptom rating scale. RESULTS: Fifty patients with IBS-D, 56 with UC and 50 healthy controls were studied. Colonic mucosal expression of S100A8 and S100A9 in UC was significantly higher than in IBS or controls and correlated with the UC disease activity index (r = 0.65, p < 0.001). S100A10 expression in the rectal epithelium of the IBS patients was significantly higher (0.643 vs. 0.402, p = 0.01) than in controls and correlated with the SDS scores (r = 0.41, p = 0.002). The frequency of IL10-819 CC genotype was significantly higher in IBS-D (10.7 vs. 0 %, p = 0.047) and UC (16 vs. 0 %, p = 0.007) than that in controls. CONCLUSION: Overexpression of S100A10 in the rectum may play a role in IBS as it is involved in modulating 5-HT1B receptors. The IL10-819 CC is a candidate genotype for both IBS and UC in Japanese.
    Digestive Diseases and Sciences 04/2013; · 2.26 Impact Factor
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    ABSTRACT: OBJECTIVES:Chronic intestinal pseudo-obstruction (CIPO) is a rare, serious motility disorder, with life-threatening complications over time. However, lack of an established, non-invasive diagnostic method has caused delays in the diagnosis of this intractable disease. Cine-magnetic resonance imaging (MRI) is an emerging technique, with a potential to evaluate the motility of the entire bowel. We compared small bowel motility in healthy volunteers, patients with irritable bowel syndrome (IBS), and those with CIPO, using cine-MRI, and evaluated the usefulness of cine-MRI as a novel diagnostic method for CIPO.METHODS:Twelve healthy volunteers, IBS patients, and CIPO patients prospectively underwent cine-MRI at 1.5 T. Luminal diameter, contraction ratio, and contraction cycle were measured and compared between the groups.RESULTS:Cine-MRI provided sufficient dynamic images to assess the motility of the entire small bowel. Luminal diameter (mean±s.d.) in CIPO patients was significantly higher than that in healthy volunteers and IBS patients (43.4±14.1, 11.1±1.5, and 10.9±1.9 mm, respectively), and contraction ratio was significantly lower in CIPO patients than that in healthy volunteers and IBS patients (17.1±11.0%, 73.0±9.3%, and 74.6±9.4%, respectively). No significant differences were observed in the contraction cycle.CONCLUSIONS:This study is the first to assess the clinical utility of cine-MRI in CIPO patients. Cine-MRI clearly detected contractility impairments in CIPO patients. Cine-MRI is noninvasive, radiation-free, and can directly evaluate the entire small bowel peristalsis, and can detect the affected loops at a glance; therefore, it might be extremely useful for the diagnosis and follow-up of CIPO patients in clinical practice.Am J Gastroenterol advance online publication, 19 March 2013; doi:10.1038/ajg.2013.57.
    The American Journal of Gastroenterology 03/2013; · 9.21 Impact Factor
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    ABSTRACT: A 64-year-old man underwent distal gastrectomy for gastric cancer. His postoperative recovery was uneventful until he suddenly started complaining of difficulty swallowing. Fluoroscopy revealed narrowing of the abdominal esophagus into a spindle-like shape. Endoscopic esophageal balloon dilatation was performed with no improvement in his condition. We concluded that the patient could not eat because of mechanical stenosis of the gastroesophageal junction. Reoperation was performed via laparotomy. The abdominal esophagus and gastroesophageal junction were found to have become stiff with adhesions, probably as a result of surgical scarring. We incised the esophageal muscle layer and dissected adhesions around the abdominal esophagus to relieve esophageal stenosis. After reoperation, the patient was able to eat. We recommend that in cases of sudden onset dysphagia after distal gastrectomy, the possibility of secondary achalasia because of scar tissue formation should be considered.
    Esophagus 02/2013; · 0.74 Impact Factor
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    ABSTRACT: There have been few studies on the efficacy of proton pump inhibitors and the doses required to treat dyspeptic symptoms observed in clinical practice. The aim of this study was to compare the efficacy of different doses of omeprazole and different administration methods in Helicobacter pylori-negative, dyspeptic patients. Patients with chronic upper abdominal symptoms within the previous 3 months were randomly divided into three groups: a daily, omeprazole 20 mg treatment group (OPZ20, n=61); a daily, omeprazole 10 mg treatment group (OPZ10, n=72); and an on-demand omeprazole 20 mg treatment group (on-demand, n=62). After 4 weeks of administration of the drug, symptom improvement rates were evaluated based on the Overall Global Severity score. The rates of symptom improvement after 4 weeks of treatment were 65.6% (40/61) in the OPZ20 group, 47.2% (34/72) in the OPZ10 group, and 50.0% (31/62) in the on-demand group. The OPZ20 group exhibited a significantly higher improvement rate (p=0.034) than the OPZ10 group. The OPZ20 group had significant improvements in regurgitation, postprandial fullness, vomiting, and bloating compared with the OPZ10 group. Daily treatment with 20 mg of omeprazole was efficient in treating upper abdominal symptoms. Trial registration:, number UMIN000002621.
    Gut and liver 01/2013; 7(1):16-22. · 1.49 Impact Factor
  • Noriaki Manabe, Jiro Hata, Ken Haruma
    Nihon Naika Gakkai Zasshi 01/2013; 102(1):32-9.
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    ABSTRACT: Aim:  The main aim of this study was to determine whether questionnaire evaluations of clinical symptoms in gastroesophageal reflux disease were useful to assess proton pump inhibitor therapy. Methods:  A total of 185 Japanese patients (men, 88; women, 97; age: 55.7 ± 16.1 years) with gastroesophageal reflux disease were enrolled. The patients were divided based on the frequency scale for symptoms of gastroesophageal reflux disease: severe symptoms with scores ≥8 and mild symptoms with scores ≤7. Quality of life was evaluated with the Medical Outcomes Study 8-Item Short-Form Health Survey. All patients were treated with a proton pump inhibitor, rabeprazole (10 mg/day), for 8 weeks. Results:  Patients were classified into four groups: reflux esophagitis with severe symptoms (n = 92, 49.7%); reflux esophagitis with mild symptoms (n = 17, 9.2%); non-erosive reflux disease with severe symptoms (n = 66, 35.7%); and non-erosive reflux disease with mild symptoms (n = 10, 5.4%). The dysmotility score was high in non-erosive reflux disease with severe symptoms compared with reflux esophagitis with severe symptoms (9.1 ± 0.5 vs 6.8 ± 0.5, P < 0.05). The symptom score and quality of life in the severe symptoms groups for both reflux esophagitis and non-erosive reflux disease were significantly improved by rabeprazole treatment. Only the reflux score was improved by rabeprazole in the reflux esophagitis with mild symptoms group; no therapeutic effect was observed for the non-erosive reflux disease with mild symptoms group. Conclusions:  Low scores on the frequency scale for the symptoms of gastroesophageal reflux disease indicate poor responsiveness to proton pump inhibitor treatment, and high scores indicate good responsiveness.
    Digestive Endoscopy 11/2012; 24(6):407-411. · 1.61 Impact Factor
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    ABSTRACT: PURPOSE: Contrast-enhanced ultrasonography (CEUS) is a novel approach used for measuring organ perfusion changes. Studies using CEUS to assess the effects of non-steroidal anti-inflammatory drugs (NSAIDs) on renal blood flow (RBF) have not yet been conducted. We aimed to evaluate the effects of NSAIDs on the renal hemodynamics of healthy subjects with CEUS. METHODS: We performed CEUS using the bolus injection method in a total of 10 healthy subjects. Measurements were completed over two study days in a randomized, crossover manner. On each study day, CEUS was performed twice, before and after the administration of NSAIDs. Subjects received an injection of contrast medium and images were recorded. A region-of-interest (ROI) was selected within the renal cortex, signal intensity in the ROI of the kidney was measured and a time-intensity curve (TIC) was automatically generated with attached software. RESULTS: The mean (±SD) peak intensity decreased significantly after an administration of diclofenac sodium (from 26.0 × 10(-4) ± 17.4 × 10(-4) AU to 19.2 × 10(-4) ± 12.0 × 10(-4) AU; P = 0.022), but not significantly with etodolac (from 26.5 × 10(-4) ± 9.7 × 10(-4) AU to 25.9 × 10(-4) ± 20.8 × 10(-4) AU; P = 0.474). The mean (±SD) percent reduction in intensity following diclofenac sodium administration was significantly reduced compared with etodolac administration (22.2 ± 20.5 % vs. 3.4 ± 8.9 %, P = 0.037). CONCLUSIONS: These finding suggests that diclofenac sodium (P = 0.022), but not etodolac (P = 0.474), affects renal hemodynamics even in healthy subjects.
    European Journal of Clinical Pharmacology 06/2012; · 2.70 Impact Factor
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    ABSTRACT: Patients with gastroesophageal reflux disease (GERD) also have various extra-esophageal symptoms. Laryngopharyngeal reflux disease (LPRD) is a subtype of GERD associated with globus sensation, but proton pump inhibitor (PPI) therapy achieves disappointing results. This study investigated esophageal motility in GERD patients with globus sensation who were resistant to PPI therapy. The subjects were 350 patients with globus sensation. All patients underwent both laryngoscopy and upper gastrointestinal endoscopy to exclude organic disease. After 4 weeks of treatment with rabeprazole sodium (20 mg daily), the patients were divided into PPI-responsive and PPI-resistant groups. Then we investigated esophageal motility in the PPI-resistant group by a multichannel intraluminal impedance and manometry study. A total of 119 patients (55.6%) were resistant to PPI therapy, among whom 57 patients (47.9%) had abnormal esophageal motility. They included 36 patients (66.4%) with ineffective esophageal motility, 9 patients (14.4%) with achalasia, 6 patients (9.6%) with diffuse esophageal spasm, 5 patients (8%) with nutcracker esophagus, and 1 patient (1.6%) with hypertensive lower esophageal sphincter. There were significant differences of upper esophageal sphincter pressure and esophageal body peristalsis between the patients with PPI-resistant LPRD and healthy controls matched for age and sex. Among patients with PPI-resistant LPRD, 47.9% had abnormal esophageal motility.
    Scandinavian Journal of Gastroenterology 05/2012; 8-9(47):893-9. · 2.33 Impact Factor
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    ABSTRACT: Barrett's esophagus with specialized intestinal metaplasia (SIM), which is at high risk of progressing to esophageal adenocarcinoma, has been identified by obtaining biopsy specimens randomly. Magnified endoscopy with narrow band imaging (ME-NBI) is reported to be useful for detecting SIM or the intestinal phenotype. We aimed to evaluate the usefulness of endoscopic brushing followed by ME-NBI for the detection of the intestinal phenotype. Biopsy and brushing samples were taken following endoscopic observation by ME-NBI. Total RNA was extracted from the whole sample and microdissected samples, and quantitative reverse transcription-polymerase chain reaction (PCR) analysis of SHH, CDX2, and mucin mRNA expression was performed. Fifty patients (32 men, 18 women, average age 67.3 years) with metaplastic columnar epithelium of the lower esophagus were studied. MUC2 (85 vs. 65 %) and CDX2 (95 vs. 75 %) were detected more frequently in the brushing samples than in the biopsy samples. MUC2 expression levels were significantly higher in the brushing samples than those in the biopsy samples. CDX2 and MUC2 expression levels in the brushing samples were significantly higher in the mucosa with tubular/villous pattern observed by ME-NBI than the levels in mucosae with other patterns. Endoscopic brushing in mucosa of columnar epithelium with a tubular/villous pattern visualized by ME-NBI is useful to detect the intestinal phenotype.
    Journal of Gastroenterology 05/2012; 47(10):1108-14. · 4.02 Impact Factor
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    ABSTRACT: : The aim was to investigate the clinical utility of RAPID Access 6.5 Quickview software and to evaluate whether preview of the capsule endoscopy video by a trained nurse could detect significant lesions accurately compared with endoscopists. : As reading capsule endoscopy is time consuming, one possible cost-effective strategy could be the use of trained nonphysicians or newly available software to preread and identify potentially important capsule images. : The 100 capsule images of a variety of significant lesions from 87 patients were investigated. The minimum percentages for settings of sensitivity that could pick up the selected images and the detection rate for significant lesions by a well-trained nurse, two endoscopists with limited experience in reading, and one well-trained physician were examined. : The frequency of the selected lesions picked up by Quickview mode using percentages for sensitivity settings of 5%, 15%, 25%, and 35% were 61%, 74%, 93%, and 98%, respectively. The percentages for sensitivity significantly correlated (r=0.78, P<0.001) with the reading time. The detection rate by the nurse or the well-trained physician was significantly higher than that by the physician with limited capsule experience (87% and 84.1% vs. 62.7%; P<0.01). The clinical use of Quickview at 25% did not significantly improve the detection rate. : Quickview mode can reduce reading time but has an unacceptably miss rate for potentially important lesions. Use of a trained nonphysician assistant can reduce physician's time and improve diagnostic yield.
    Journal of clinical gastroenterology 04/2012; 46(10):e92-5. · 2.21 Impact Factor

Publication Stats

778 Citations
710.41 Total Impact Points


  • 2007–2013
    • Kawasaki Medical University
      • • Department of General Internal Medicine 2
      • • Department of General Medicine
      • • Department of Gastroenterology
      • • Department of Endoscopy and Ultrasound
      Kurasiki, Okayama, Japan
  • 2012
    • Okayama Kyokuto Hospital
      Okayama, Okayama, Japan
  • 2010–2012
    • Kawasaki Saiwai Hospital
      Kawasaki, Fukuoka, Japan
    • Mayo Clinic - Rochester
      • Department of Health Science Research
      Rochester, Minnesota, United States
  • 2011
    • Hiroshima International University
      • Faculty of Nursing
      Hirosima, Hiroshima, Japan
  • 2008–2011
    • Numazu City Hospital
      Sizuoka, Shizuoka, Japan
    • Shimane University
      Matsu, Shimane Prefecture, Japan
  • 2003–2008
    • Hiroshima University
      • Health Service Center
      Hirosima, Hiroshima, Japan