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ABSTRACT: The demarcation line between the cancerous lesion and the surrounding area could be easily recognized with flexible spectral imaging color enhancement (FICE) system compared with conventional white light images. The characteristic finding of depressed-type early gastric cancer (EGC) in most cases was revealed as reddish lesions distinct from the surrounding yellowish non-cancerous area without magnification. Conventional endoscopic images provide little information regarding depressed lesions located in the tangential line, but FICE produces higher color contrast of such cancers. Histological findings in depressed area with reddish color changes show a high density of glandular structure and an apparently irregular microvessel in intervening parts between crypts, resulting in the higher color contrast of FICE image between cancer and surrounding area. Some depressed cancers are shown as whitish lesion by conventional endoscopy. FICE also can produce higher color contrast between whitish cancerous lesions and surrounding atrophic mucosa. For nearly flat cancer, FICE can produce an irregular structural pattern of cancer distinct from that of the surrounding mucosa, leading to a clear demarcation. Most elevated-type EGCs are detected easily as yellowish lesions with clearly contrasting demarcation. In some cases, a partially reddish change is accompanied on the tumor surface similar to depressed type cancer. In addition, the FICE system is quite useful for the detection of minute gastric cancer, even without magnification. These new contrasting images with the FICE system may have the potential to increase the rate of detection of gastric cancers and screen for them more effectively as well as to determine the extent of EGC.
World journal of gastrointestinal endoscopy. 08/2012; 4(8):356-61.
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ABSTRACT: Small-caliber endoscopy has lower resolution than normal-caliber endoscopy, limiting its use in routine outpatient practice. Flexible spectral imaging color enhancement (FICE) strengthens the color contrast of depressed-type early gastric cancer without magnification. The aim of the present study was to evaluate the detection of depressed-type early gastric cancer using small-caliber endoscopy with the FICE system.
Eighty-two patients diagnosed with depressed-type early gastric cancer by standard endoscopy and biopsy were evaluated by small-caliber endoscopy. FICE images and conventional images were compared. Color differences in all 82 lesions were measured between malignant lesions and the surrounding mucosa using the Commission Internationale de L'Eclairage (CIE) 1976 color space.
Most cancers were readily detected as reddish lesions on FICE images. Lines of demarcation between the malignant lesion and the surrounding mucosa were easily identified with FICE images, as such cancers could be clearly distinguished from the surrounding atrophic mucosa. Greater median color differences between malignant lesions and the surrounding mucosa were present in FICE images compared with conventional images, resulting in images with better contrast (27.2 vs 18.7, P<0.0001).
Small-caliber endoscopy with the FICE system provides better color contrast of depressed-type early gastric cancers than conventional small-caliber endoscopy, and the FICE system may facilitate the diagnosis of this type of cancer as a new endoscopic modality.
Digestive Endoscopy 07/2012; 24(4):231-6. · 1.19 Impact Factor
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ABSTRACT: The endoscopic appearance of gastric antral vascular ectasia (GAVE) can be easily misinterpreted as inflammatory changes of
gastric mucosa. We report on a case of GAVE that had been missed by conventional transnasal endoscopy but was diagnosed by
flexible spectral imaging color enhancement (FICE) with a transnasal endoscope. A 45-year-old woman with severe anemia presented
with a 1-month history of increasing fatigue. She was previously diagnosed as having acute antral gastritis by conventional
transnasal endoscopy (EG 530N2) because of the presence of reddish mucosal changes on the entire antral rugal fold. However,
the FICE images produced using a combination of new processor system (VP4450) and new small-caliber endoscope (EG 530NW),
did not show reddish mucosal changes on the entire rugal fold, but gave a clear image of dilated vessels associated with GAVE
distinct from the surrounding normal mucosa on the same fold. These findings are useful to differentiate GAVE from ordinary
gastritis. The lesions of GAVE were managed with a combination of focal pulse and spray-painting techniques to obliterate
the bulk of the disease in two sessions of argon plasma coagulation therapy. Three months later, the patient recovered from
iron deficiency anemia with an oral medication of iron tablets.
KeywordsFICE–GAVE–Transnasal endoscopy
Clinical Journal of Gastroenterology 04/2012; 4(1):15-18.
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ABSTRACT: Current conventional endoscopy often misses flat early gastric cancers (0–IIb) because they are sometimes invisible. We experienced
a case of small flat early gastric cancer that had been missed by normal-caliber conventional endoscopy. By small-caliber
endoscope, conventional endoscopy showed a subtle reddish change of gastric mucosa, but the image with flexible spectral imaging
color enhancement clearly showed a flat reddish lesion with 10mm diameter, distinct from the surrounding mucosa. Flat early
gastric cancer was suspected even though the lesion was not clearly described by conventional endoscopy. Histological examination
of biopsy specimen revealed atypical glands. Endoscopic submucosal dissection of the lesion was performed. Pathological examination
of the resected specimen confirmed well-differentiated adenocarcinoma localized in the mucosal layer without any depression
or protrusion compared with the surrounding mucosa, consistent with the endoscopic finding. The small flat early gastric cancer
became clearly visible with the new endoscopic technology.
KeywordsFICE-Flat early gastric cancer-Subtle mucosal change
Clinical Journal of Gastroenterology 04/2012; 3(2):88-91.
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Masayuki Arashiro, Kiichi Satoh,
Hiroyuki Osawa,
Mitsuyo Yoshizawa,
Hidetoshi Nakano,
Hironari Ajibe,
Yoshimasa Miura,
Toru Yoshida,
Tomosuke Hirasawa,
Hironori Yamamoto,
Kentaro Sugano
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ABSTRACT: Esophageal lymphangioma is a very rare disease. We report a case of esophageal lymphangioma successfully treated with endoscopic
submucosal dissection (ESD), which yielded definitive histological diagnosis and symptom relief. ESD offers a better option
for definitive diagnosis as well as complete resection of large esophageal lymphangiomas with flat configuration.
KeywordsEsophageal lymphangioma-Endoscopic mucosal resection-Endoscopic submucosal dissection
Clinical Journal of Gastroenterology 04/2012; 3(3):140-143.
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Naoyuki Nishimura,
Kiichi Tamada,
Shinichi Wada,
Akira Ohashi,
Hisashi Hatanaka,
Katsuyuki Nakazawa,
Norikatsu Numao,
Aya Kitamura, Kiichi Satoh,
Hironori Yamamoto,
Kentaro Sugano
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ABSTRACT: A 51-year-old woman was admitted to our department because of upper abdominal pain. The serum IgG4 concentration was elevated,
and abdominal computed tomography revealed diffuse enlargement of the pancreas associated with a large cyst, measuring 8cm
in diameter. Endoscopic retrograde cholangiopancreatography revealed narrowing of the main pancreatic duct (from the body
to the tail), narrowing of the intrapancreatic bile duct, and dilatation of the bile ducts. The patient was given a diagnosis
of autoimmune pancreatitis (AIP) associated with a pancreatic pseudocyst and intrapancreatic bile duct stenosis. Oral steroid
therapy resulted in reduced pancreatic swelling, complete disappearance of the pancreatic cyst, and an improvement in biliary
stenosis. AIP is rarely associated with pancreatic cyst, and only 13 cases, including ours, have been reported to date. In
our patient, intense inflammation apparently led to cyst formation in association with AIP, which responded remarkably to
corticosteroid therapy. Correct diagnosis of AIP associated with a pancreatic pseudocyst might save patients from undergoing
unnecessary endoscopic and surgical procedures.
Clinical Journal of Gastroenterology 04/2012; 2(3):199-203.
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Nippon rinsho. Japanese journal of clinical medicine 09/2011; 69 Suppl 7:450-4.
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ABSTRACT: Upper gastrointestinal (GI) injuries induced by non-steroidal anti-inflammatory drugs (NSAID) and low-dose aspirin (LDA) have been increasing, because the number of patients who need to use NSAID, LDA, other anti-platelet drugs and anti-coagulants have been increasing. The aging is one of the most important risk factors of upper GI injuries induced by LDA, such as gastric ulcer. Since atypical symptoms often lead to a delay in diagnosis and treatment in the elderly patients, endoscopic examination should be considered especially in the elderly patients to detect upper GI lesions before using LDA.
Nippon rinsho. Japanese journal of clinical medicine 11/2010; 68(11):1983-6.
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ABSTRACT: Treatment and prevention of gastric ulcers is not different between young and elderly patients. Eradication therapy for H. pylori infection should be made for elderly patients with H. pylori-gastric ulcers, because the incidence of adverse events is not higher than in young patients. NSAIDs are often given elderly persons, and aging is a risk factor of the development of NSAID-related ulcer. If elderly patients have some risk factors (high dose NSAID therapy, past history of uncomplicated ulcers or concurrent use of aspirin, corticosteroids or anticoagulants), prophylactic therapy for NSAID-ulcers should be made.
Nippon rinsho. Japanese journal of clinical medicine 11/2010; 68(11):2040-5.
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ABSTRACT: Over the past few years, the profile of Helicobacter pylori infection has changed in Japan. In particular, the relationship between H. pylori and gastric cancer has been demonstrated more clearly. Accordingly, the committee of the Japanese Society for Helicobacter Research has revised the guidelines for diagnosis and treatment of H. pylori infection in Japan.
Four meetings of guidelines preparation committee were held from July 2007 to December 2008. In the new guidelines, recommendations for treatment have been classified into five grades according to the Minds Recommendation Grades, while the level of evidence has been classified into six grades. The Japanese national health insurance system was not taken into consideration when preparing these guidelines.
Helicobacter pylori eradication therapy achieved a Grade A recommendation, being useful for the treatment of gastric or duodenal ulcer, for the treatment and prevention of H. pylori-associated diseases such as gastric cancer, and for inhibiting the spread of H. pylori infection. Levels of evidence were determined for each disease associated with H. pylori infection. For the diagnosis of H. pylori infection, measurement of H. pylori antigen in the feces was added to the tests not requiring biopsy. One week of proton-pump inhibitor-based triple therapy (including amoxicillin and metronidazole) was recommended as second-line therapy after failure of first-line eradication therapy.
The revised Japanese guidelines for H. pylori are based on scientific evidence and avoid the administrative restraints that applied to earlier versions.
Helicobacter 02/2010; 15(1):1-20. · 3.15 Impact Factor
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Kiichi Satoh
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ABSTRACT: Meta-analyses showed that quadruple therapy, ranitidine bismuth-based triple therapy and levofloxacin-based triple therapy were the most effective for the second-line H. pylori eradication therapy. In Japan, many studies showed that triple therapy with proton pump inhibitor (PPI), amoxicillin (AMPC) and metronidazole was effective after eradication failure using triple therapy with PPI, AMPC and clarithromycin. The intention-to-treat eradication rates were 81-97%, and the incidence rates of adverse events were 8-33%.
Nippon rinsho. Japanese journal of clinical medicine 12/2009; 67(12):2297-302.
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ABSTRACT: Meta-analyses showed that Helicobacter pylori eradication therapy was effective for healing and prevention of recurrence of peptic ulcers in H. pylori-positive patients and that treatment of H. pylori infection was more effective than antisecretory non-eradicating therapy (with or without long-term maintenance antisecretory therapy) in preventing recurrent bleeding from peptic ulcer. H. pylori eradication therapy is effective for prevention of development of NSAID-ulcers in NSAID-naïve patients. For prevention of recurrence of NSAID-ulcers, therapy with proton pump inhibitor is effective.
Nippon rinsho. Japanese journal of clinical medicine 12/2009; 67(12):2322-6.
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ABSTRACT: The diagnosis of endoscopic Barrett's esophagus (BE) has been under discussion for the past decade because palisade vessels may be obscured by inflammation or the location of upper end of gastric fold may be diversely changed. The flexible spectral imaging color enhancement (FICE) system can reconstruct improved spectral images decomposed from ordinary endoscopic images with free selection of three wavelengths, and can provide non-magnified images with high light intensity.
To evaluate whether the transnasal FICE system enables easier diagnosis of endoscopic BE, 72 patients with endoscopic BE were observed prospectively with a transnasal endoscope using both conventional images and FICE images. The visualization of palisade vessels and the identification of the demarcation between endoscopic BE mucosa and gastric mucosa were compared between FICE images and conventional endoscopic images, and the CIELAB color differences were calculated among palisade vessels, background BE mucosa and gastric folds.
Palisade vessels could be more clearly visualized in BE mucosa with transnasal FICE than with conventional endoscopy. Demarcation between whitish BE mucosa and the upper end of the brownish gastric mucosa could be clearly identified using transnasal FICE images. Greater color differences existed with FICE images between palisade vessels and background BE mucosa as well as between BE mucosa and gastric folds than with conventional images, leading to better contrasting images.
The transnasal FICE system enables clear visualization of palisade vessels and provides better contrasting images of the demarcation between the BE mucosa and the gastric mucosa, and thus contributes to easier diagnosis of endoscopic BE.
Journal of Gastroenterology 09/2009; 44(11):1125-32. · 4.16 Impact Factor
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ABSTRACT: The endoscopic diagnosis of an elevated-type early gastric cancer is often difficult. The optimal band imaging (OBI) system can reconstruct the best spectral images decomposed from ordinary endoscopic images with free selection of 3 wavelengths and provide unmagnified images with high light intensity as well as magnified images.
To evaluate whether the OBI system facilitates detection of the demarcation lines between an elevated-type early gastric cancer and surrounding tissue and thus is more helpful for performing endoscopic therapy.
A prospective study.
Jichi Medical University, Japan.
Seventy-five patients, 81 lesions with an elevated-type early gastric cancer.
A comparison between OBI images and conventional endoscopic images in the identification of the demarcation lines of an elevated-type early gastric cancer without magnification and the rate of success in identifying the abnormal surface structure of cancer by using low-magnified OBI images.
Demarcation lines were easily identified in OBI images, even without magnification, because such cancers could be clearly distinguished from the surrounding whitish atrophic mucosa. Inexperienced endoscopists could determine demarcation lines with significantly greater accuracy with unmagnified OBI images than with conventional images. With 40-fold magnification, irregular microstructural or nonstructural patterns were also found within cancer lesions in all cases studied but in none of the cases in the surrounding noncancerous mucosa.
The new contrast images obtained with the OBI system enable better determination of the demarcation lines of elevated-type early gastric cancers, and this system may be useful for performing endoscopic therapy of this type of cancer as a new endoscopic modality.
Gastrointestinal endoscopy 02/2009; 69(1):19-28. · 6.71 Impact Factor
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ABSTRACT: The endoscopic resection of early gastric cancers (EGC) is a standard technique in Japan and is increasingly used throughout the world. Further experience in the treatment of EGC and a clearer delineation of the factors related to lymph-node metastasis would permit a more accurate assessment of endoscopic resection.
The study group comprised 1,389 patients with EGC who underwent gastrectomy with lymph-node dissection. We evaluated the relations of lymph-node metastasis to clinicopathological factors.
Of the 718 patients with intramucosal carcinomas, 14 (1.9%) had lymph-node metastasis. All cases of lymph-node metastasis were associated with ulceration. No lymph-node metastasis was found in patients with intramucosal carcinomas without ulceration, irrespective of tumor size and histological type. Lymph-node metastasis was present in 14 (4.7%) of the 296 patients who had cancer with a submucosal invasion depth of less than 500 microm (sm1). Significantly increased rates of lymph-node metastasis were associated with undifferentiated types, ulcerated lesions and lymphatic invasion. No lymph-node metastasis was found in patients with differentiated sm1 carcinomas 30 mm or less in diameter without ulceration. Lymph-node metastasis occurred in 29% of the patients who had cancer with a submucosal invasion depth of 500 microm or more (sm2).
This large series of patients with EGC provides further evidence supporting the expansion of indications for endoscopic treatment, as well as warns against potential risks.
Journal of Digestive Diseases 12/2008; 9(4):213-8. · 1.59 Impact Factor
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Masahiro Asaka,
Toshiro Sugiyama,
Mototsugu Kato, Kiichi Satoh,
Hajime Kuwayama,
Yoshihiro Fukuda,
Toshio Fujioka,
Tadayoshi Takemoto,
Ken Kimura,
Takashi Shimoyama,
Kihachiro Shimizu,
Shinichi Kobayashi
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ABSTRACT: Background.Two triple therapies with lansoprazole (LPZ)/amoxicillin (AMPC)/clarithromycin (CAM) for eradication of Helicobacter pylori were studied in multicenter, double-blind fashion to evaluate the eradication rate of H. pylori and safety of eradiation treatment in Japanese patients with H. pylori-positive active gastric ulcers or duodenal ulcers.Methods.Patients were randomly chosen for the control treatment of LPZ 30 mg twice a day (b.i.d.; Group A-LPZ-only) or the test treatments of LPZ 30 mg plus AMPC 750 mg and CAM 200 mg b.i.d. (Group B-LAC200) and LPZ 30 mg, AMPC 750 mg and CAM 400 mg b.i.d. (Group C-LAC400). All eradication treatments lasted for a period of 7 days. Successful eradication was assessed by culture and gastric histology 1 month after completion of the ulcer treatment.Results.The eradication rates of H. pylori in the full analysis set were 0% in Group A-LPZ-only, 87.5% in Group B-LAC200 and 89.2% in Group C-LAC400 for gastric ulcer and, 4.4% in Group A-LPZ-only, 91.1% in Group B-LAC200 and 83.7% in Group C-LAC400 for duodenal ulcer. The eradication rates of Group B-LAC200 and Group C-LAC400 were 89.2% (95% CI: 84.8–93.7%) and 86.4% (95%CI: 81.5–91.3%) in total in the full analysis set, 89% (95% CI: 84.3–93.7%) and 85.3% (95%CI: 80.1–90.5%) in the per protocol set. The eradication rates in Groups B-LAC200 and group C-LAC400 were statistically significantly higher than the rate in Group A-LPZ-only for both gastric ulcer and duodenal ulcer patients (p < .0001 for both).Conclusion.A satisfactorily high H. pylori eradication rate was obtained in Japanese ulcer patients with the triple therapy regimen consisting of LPZ 30 mg, AMPC 750 mg, and CAM 200 mg b.i.d.
Helicobacter 09/2008; 6(3):254 - 262. · 3.15 Impact Factor
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ABSTRACT: Background: Magnifying narrow band imaging system is useful for the diagnosis of early gastric cancer. However, it is difficult for the operator of the scope to maintain the correct distance between the tip of the endoscope and the gastric mucosa for appropriate visualization. The newly developed optimal band imaging system can reconstruct good spectral images derived from ordinary endoscopic images and enhance the mucosal surface without magnification as well as with low magnification. This imaging technique is based on narrowing the bandwidth of the conventional image arithmetically, using spectral estimation technology.Methods: We evaluated endoscopic features of 30 lesions with elevated-type, 32 lesions with depressed-type and two lesions with flat-type early gastric cancer using this new system.Results: We found the best images in all cases of early gastric cancers by using a specific combination of the following three wavelengths available in this system: 470 nm for blue, 500 nm for green and 550 nm for red. The optimal band images showed the depressed-type early gastric cancer as reddish lesions distinct from the surrounding yellowish non-cancerous area, leading to a clear demarcation line between the cancerous and non-cancerous mucosa without magnification. Moreover, 30–40-fold magnified optimal band images showed a clearly irregular microvascular pattern or a microstructure pattern of the mucosal surface in all types of gastric cancers.Conclusion: This new system can provide useful information for diagnosing various types of early gastric cancers without and with low magnification.
Digestive Endoscopy 09/2008; 20(4):194 - 197. · 1.19 Impact Factor
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ABSTRACT: A 74-year-old man with diabetic nephropathy developed epigastric pain and high fever after endoscopic submucosal dissection (ESD) for early gastric cancer. Gastroscopy, endoscopic ultrasonography and computed tomography showed ulceration with a purulent lake, thickened entire gastric mucosal layers suggesting focal abscess formation, leading to the diagnosis of phlegmonous gastritis. He underwent total gastrectomy as an emergency. Histological findings of the resected specimen showed severe inflammatory cell infiltration and multiple focal abscess formation spreading to the entire gastric wall. In patients with poorer general conditions, phlegmonous gastritis should be considered as a serious complication after ESD, indicating a requirement of antibiotic prophylaxis.
Therapeutic Advances in Gastroenterology 09/2008; 1(2):91-5.
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Kiichi Satoh,
Ken Kihira,
Hiroshi Kawata,
Kenkichi Tokumaru,
Yasuhisa Kumakura,
Yumiko Ishino,
Satoshi Kawakami,
Keiko Inoue,
Toshichika Kojima,
Yukihiro Satoh,
Hiroyuki Mutoh,
Kentaro Sugano
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ABSTRACT: Background.Accumulation of p53 has been recognized in the gastric mucosa infected with Helicobacter pylori. We investigated the prevalence of p53-positive cells in the gastric mucosa before and one month after eradication of H. pylori and the relationship between p53 positivity and inflammation and cell proliferation.Methods.The subjects included 24 H. pylori-positive patients. They achieved eradication one month after anti-H. pylori therapy. Biopsies were taken from the greater curvatures of the antrum and middle body. H. pylori status was assessed using culture and tissue section (Giemsa stain). Serial sections were used for examination of gastritis (hematoxylin and eosin stain) and for immunostaining of p53, Ki-67 and myeloperoxidase (MPO). p53 index and Ki-67 labeling index (LI) were calculated by counting p53-positive and Ki-67-positive cells in the entire gastric pits longitudinally sectioned and expressing them as a percentage of the total cells in a gastric pit. In the neck regions with and without p53-positive cells, polymorphonuclear leukocytes (PMNs) were counted in the corresponding area (/50 × 50 µm2) of the sections stained both with p53 and MPO.Results.p53-positive cells decreased significantly after eradication of H. pylori. Before eradication, the number of PMNs was significantly higher in the neck regions with p53-positive cells than in those without.Conclusions.In the gastric mucosa infected with H. pylori, p53-positive cells were found in the neck region infiltrated with PMNs. p53 expression decreased significantly one month after eradication of H. pylori.
Helicobacter 07/2008; 6(1):31 - 36. · 3.15 Impact Factor
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ABSTRACT: An international group of gastroenterologists and pathologists (Operative Link for Gastritis Assessment (OLGA)) proposed the staging system of atrophy. The aim of this study was to assess the severity of atrophic gastritis using the OLGA system.
The subjects comprised 163 H. pylori-positive patients: 18 with early gastric cancers of the intestinal type (GC), 55 with atrophic gastritis (AG), 49 with gastric ulcers or scars (GU), and 41 with duodenal ulcers or scars (DU). Biopsies were taken from the lesser and greater curvatures of the antrum and middle body. The OLGA gastritis stage (0-IV) (the severity and topography of atrophy) was obtained by combining antral with body atrophy scores. The gastritis grade (the severity and topography of inflammation) was obtained by combining antral and body inflammation scores.
Most (84%) of patients with GC showed stage III or IV. Gastritis stages were significantly higher in patients with GC than in those with AG, GU, and DU. Gastritis stage became higher with age. Gastritis grades were slightly higher in patients with AG than in others.
Our results indicate that higher stages are found in patients with GC using the OLGA staging system and that the high risk of GC can be recognized. It is simple to use and useful for the assessment of the severity of atrophic gastritis.
Helicobacter 07/2008; 13(3):225-9. · 3.15 Impact Factor
