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Ryonho Koh,
Kingo Hirasawa,
Sei Yahara,
Hiroyuki Oka,
Kazuya Sugimori,
Manabu Morimoto,
Kazushi Numata,
Atsushi Kokawa,
Takeshi Sasaki,
Akinori Nozawa,
Masataka Taguri,
Satoshi Morita, Shin Maeda,
Katsuaki Tanaka
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ABSTRACT: BACKGROUND: The discontinuation of antithrombotic drugs is recommended during endoscopic submucosal dissection (ESD) for gastric neoplasms; however, controversy remains as to whether antithrombotic drugs are risk factors for postoperative bleeding. OBJECTIVE: To determine the risk factors for post-ESD bleeding. DESIGN: Single-institution, retrospective review. SETTING: University hospital. PATIENTS: From June 2000 to December 2010, we treated 1192 gastric neoplasms in 1032 consecutive patients. INTERVENTION: The ESD procedures were performed by using the standard techniques. Antithrombotic drug therapy was principally interrupted preoperatively and was restarted when hemostasis was confirmed by second-look endoscopy. MAIN OUTCOME MEASUREMENTS: Risk factors for postoperative bleeding after ESD (early, delayed, and overall [combined] occurrence of bleeding during the first 5 postoperative days or thereafter) were analyzed by using logistic regression analysis. RESULTS: Among 1166 ESD-induced ulcer lesions, overall postoperative bleeding was evident in 62 lesions (5.3%); early and delayed bleeding occurred in 30 and 32 lesions (2.6% and 2.7%), respectively. Based on a multivariate analysis, a specimen size of >40 mm was the sole independent risk factor for overall bleeding. Moreover, oral antithrombotic drug therapy was selected as independent risk factor for delayed but not early bleeding, according to the multivariate analysis. The delayed bleeding rate in patients who had a specimen size of >40 mm and who used antithrombotic drugs was 11.6%. LIMITATIONS: Retrospective design and single-site data collection. CONCLUSION: Interruption of antithrombotic drug therapy may be adequate for preventing early post-ESD bleeding; however, reinitiating antithrombotic drug therapy is a significant independent risk factor for delayed post-ESD bleeding.
Gastrointestinal endoscopy 04/2013; · 6.71 Impact Factor
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ABSTRACT: Aim: This study aimed to evaluate the fucosylated fraction of alpha-fetoprotein (AFP-L3) as a marker of early hepatocellular carcinoma (HCC). PATIENTS AND METHODS: We diagnosed early HCC in 15 patients (15 tumors) by gadolinium-ethoxybenzyl-diethylenetriamine-pentaacetic acid-enhanced magnetic resonance imaging and confirmed the diagnoses using new criteria of the International Consensus Group for Hepatocellular Neoplasia. We measured the AFP-L3%, simultaneously, using a liquid-phase binding assay-electrokinetic analyte transport assay. We compared the AFP-L3% levels between patients with early HCC and a control cohort with benign liver disease. RESULTS: The AFP-L3% levels were higher in patients with early HCC than in the controls (4.1%±4.0% vs. 2.0%±3.5%, p=0.024). The sensitivity and specificity with AFP-L3% were 33.3% and 78.7% at a cut-off value of 5%, and 20.0% and 88.0% at a cut-off value of 7%, respectively. CONCLUSION: AFP-L3% is a suitable serological marker for evaluating early HCC.
Anticancer research 03/2013; 33(3):997-1001. · 1.73 Impact Factor
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Takashi Nonaka,
Takaomi Kessoku,
Yuji Ogawa,
Shogo Yanagisawa,
Tadahiko Shiba,
Takashi Sakaguchi,
Kazuhiro Atsukawa,
Hisao Takahashi,
Yusuke Sekino,
Hiroshi Iida,
Hiroki Endo,
Yasunari Sakamoto,
Tomoko Koide,
Hirokazu Takahashi,
Masato Yoneda, Shin Maeda,
Atsushi Nakajima,
Eiji Gotoh,
Masahiko Inamori
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ABSTRACT: The aim of this study was to examine the convenience of the quality of life and utility evaluation survey technology (QUEST) questionnaire and the frequency scale for the symptoms of gastroesophageal reflux disease (FSSG) questionnaire as self-assessment diagnostic instrument.
This was a two-way crossover study conducted over 6 weeks from September 2010 to November 2010. The subjects were 60 consecutive patients admitted to the Hiratsuka city hospital with a gastrointestinal condition, regardless of the coexistence of heartburn. They were assigned to fill in both the QUEST and FSSG questionnaires in random order. We analyzed the time taken to complete the questionnaires, whether subjects asked any questions as they filled in the questionnaire, and the questionnaire scores.
Comparison of the QUEST and the FSSG revealed significant differences in the completion time (196.5 vs. 97.5 seconds, respectively; P < 0.0001) and in whether subjects asked any questions (37 vs. 15 subjects, respectively; P < 0.0001). Completion time in QUEST scores of ≥ 4 was lower than < 4 (170.5 vs. 214.0 seconds, respectively; P = 0.022), and the QUEST score was significantly higher without questions than with question (3 vs. 1 points, respectively; P = 0.025).
This study revealed that the FSSG questionnaire may be easier for Japanese subjects to complete than the QUEST questionnaire.
Journal of neurogastroenterology and motility 01/2013; 19(1):54-60.
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Eiji Sakai,
Hiroki Endo,
Leo Taniguchi,
Yasuo Hata,
Akiko Ezuka,
Hajime Nagase,
Eiji Yamada,
Hidenori Ohkubo,
Takuma Higurashi,
Yusuke Sekino,
Tomoko Koide,
Hiroshi Iida,
Kunihiro Hosono,
Takashi Nonaka,
Hirokazu Takahashi,
Masahiko Inamori, Shin Maeda,
Atsushi Nakajima
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ABSTRACT: AIM: To identify the predictive factors for the presence of small bowel lesions in patients with obscure gastrointestinal bleeding (OGIB). METHODS: A total of 242 patients with OGIB (overt 149: occult 93) were retrospectively included in the present study. Capsule endoscopy (CE) was carried out to investigate the small bowel, and detected lesions were classified according to the P0-P2 system. Only P2 lesions were defined as significant lesions. Univariate and multivariate logistic regression analyses were carried out to define the predictive factors for the presence of small bowel lesions. RESULTS: In patients with overt OGIB, chronic kidney disease (CKD) ≥stage 4 (odds ratio [OR] 4.03; 95% confidence interval [CI] 1.45-11.1, P = 0.007) was identified as an independent predictor of the presence of vascular lesions, and a history of non-steroidalanti-inflammatory drug (NSAID) use as that of erosive/ulcerated lesions (OR 4.73; 95% CI 1.47-15.2, P = 0.009). However, in patients with occult OGIB, no significant predictors of the presence of vascular lesions were identified, whereas a history of low-dose aspirin (LDA) (OR 3.57; 95% CI 1.21-10.5, P = 0.02) and proton pump inhibitor (PPI) use (OR 3.18; 95% CI 1.02-9.92, P = 0.05) were identified as independent predictors of the presence of erosive/ulcerated lesions. CONCLUSIONS: Our results indicated that bleeding pattern and clinical characteristics could contribute to predicting the origin of OGIB.
Digestive Endoscopy 12/2012; · 1.19 Impact Factor
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ABSTRACT: AIM: There have been some reports on the use of paired biopsies for monitoring disease progression in non-alcoholic fatty liver disease (NAFLD) patients. Recently, transient elastography has been developed as a non-invasive method for predicting the severity of liver fibrosis. We investigated 4-year disease progression in NAFLD patients by evaluating liver stiffness measurements (LSM) obtained using transient elastography. METHODS: Of 97 biopsy-proven NAFLD patients whose LSM were obtained 4 years prior, we revaluated 36 who were available for follow up and compared their current stage of fibrosis with that at initial assessment. Fibrosis stage was diagnosed according to the cut-off values previously reported by our institution. We also investigated correlations between changes in LSM and changes in non-invasive fibrosis markers obtained by performing biochemical tests and clinical data. RESULTS: A total of nine (25%) patients had fibrosis progression, 17 (47.2%) had static disease and 10 (27.8%) had fibrosis remission. Among patients with stage 0 fibrosis as per initial LSM (n = 16), 11 had static disease and five had fibrosis progression according to LSM obtained 4 years later. Changes in LSM correlated with changes in the FIB4 index (R = 0.519, P = 0.0011) and aspartate aminotransferase-to-platelet ratio index (R = 0.346, P = 0.0412), but not with changes in other non-invasive markers. CONCLUSION: Transient elastography is non-invasive and easy to use; therefore, it can be a useful tool for monitoring the severity of hepatic fibrosis in NAFLD patients.
Hepatology Research 12/2012; · 2.20 Impact Factor
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Yu Shimoyama,
Akito Nozaki,
Manabu Morimoto,
Satoshi Moriya,
Masaaki Kondo,
Hiroyuki Fukuda,
Kazushi Numata,
Eiji Miyajima,
Mari S Oba,
Masataka Taguri,
Satoshi Morita, Shin Maeda,
Katsuaki Tanaka
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ABSTRACT: AIM: Interleukin (IL)-28B gene polymorphism is closely linked with treatment response to peginterferon plus ribavirin combination therapy for hepatitis C virus genotype 1. However, few studies have reported its effects on therapy for genotype 2. We aimed to examine the effects of IL-28B gene polymorphism on treatment response in hepatitis C virus genotype 2 patients. METHODS: In a retrospective study of 101 patients infected with either genotype 2a (n = 65) or 2b (n = 36) and treated with peginterferon plus ribavirin, we investigated predictive factors for a sustained virological response (SVR), including genetic variations near the IL-28B gene (rs8099917, rs11881222 and rs8103142) and clinical variables such as age, sex, body mass index, stage of fibrosis and drug adherence. RESULTS: Ultra-rapid virological response, rapid virological response (RVR), end-of-treatment response, SVR and relapse rates were 22.2%, 61.4%, 95.0%, 87.1% and 7.9%, respectively. In univariate analysis, RVR and IL-28B single nucleotide polymorphisms (SNP) (rs8099917, rs11881222 and rs8103142) were significantly associated with SVR. In subgroup analysis, IL-28B SNP were significantly associated with SVR in genotype 2a patients but not in genotype 2b patients. In multiple logistic regression analysis, RVR and IL-28B SNP (rs8099917) were independently associated with SVR. Furthermore, IL-28B SNP was significantly associated with relapse but RVR was not. CONCLUSION: In genotype 2 patients treated with peginterferon plus ribavirin combination therapy, IL-28B gene polymorphism was a significant independent predictor of SVR as well as RVR. IL-28B major allele may favor reduced relapse rates in patients with genotype 2 chronic hepatitis C.
Hepatology Research 12/2012; · 2.20 Impact Factor
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Wataru Tomeno,
Masato Yoneda,
Kento Imajo,
Kaori Suzuki,
Yuji Ogawa,
Yoshiyasu Shinohara,
Hironori Mawatari,
Koji Fujita,
Wataru Shibata,
Hiroyuki Kirikoshi, Shin Maeda,
Atsushi Nakajima,
Satoru Saito
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ABSTRACT: AIM: A rapid and non-invasive method of detecting fibrosis in patients with chronic liver diseases is of major clinical interest. The purpose of this study was to comparatively investigate the effectiveness of the Liver Fibrosis Index (LF Index) calculated using real-time tissue elastography (RTE) in patients with non-alcoholic fatty liver disease (NAFLD) and patients with chronic hepatitis C (CHC). METHODS: Twenty-seven patients with biopsy-proven NAFLD and 93 patients with biopsy-proven CHC were included. They underwent transient elastography (TE), serum liver fibrosis marker testing and RTE to calculate the LF Index. RESULTS: The LF Index showed a stepwise increase with increasing histological severity of fibrosis in CHC patients (P = 0.0102), whereas no significant correlation of the LF Index with the histological severity of liver fibrosis in NAFLD patients (P = 0.852). There was a significant correlation between the LF Index and liver stiffness measured by TE in CHC patients (r = 0.319, P = 0.0009). On the other hand, no such correlation was observed in NAFLD patients. While in CHC patients, the LF Index was correlated with the FIB-4 index, no such correlation was observed in NAFLD patients. CONCLUSION: The LF Index calculated by RTE is effective for assessment of liver fibrosis in patients with CHC. On the other hand, it is not useful in patients with NAFLD. This is the first study to compare the clinical usefulness of RTE as non-invasive assessment of liver fibrosis between CHC and NAFLD. Further investigations are required to refine statistical assessment of RTE.
Hepatology Research 11/2012; · 2.20 Impact Factor
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ABSTRACT: Background/Aims: Transarterial chemoembolization (TACE) is a widely applied standard treatment option for treatment-naïve patients with multifocal hepatocellular carcinoma (HCC). However, the treatment strategy in patients with multi-nodular recurrences has not been well addressed. This retrospective cohort study aimed to evaluate the efficacy of TACE for recurrent HCC. Methodology: Two hundred seventeen consecutive patients who received curative ablation therapy for HCC were followed up. Forty-three of the 217 underwent TACE for recurrent HCC, and the treatment efficacy after TACE was compared with that in 99 treatment-naïve patients who underwent TACE for multifocal HCC during the same period. Results: The overall survival rates of the patients after TACE for recurrent HCC were not different (P=0.136) from those of thetreatment-naïve patients after TACE. No serious adverse events related to TACE were observed in either group. Serum albumin levels (>3.5g/dL, p=0.001), alpha-fetoprotein levels (<300ng/mL, p=0.021),protein induced by vitamin K absence or antagonist II levels (<300ng/mL, p=0.045), and the number of recurrent tumors (≤3 nodules, p=0.047) were prognostic factors after TACE in patients with recurrent HCC. Conclusions: TACE for multifocal recurrent HCC is safe and effective, with good survival results, similar to those of initial TACE for treatment-naïve patients with multifocal HCC.
Hepato-gastroenterology 10/2012; 60(123). · 0.66 Impact Factor
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ABSTRACT: OBJECTIVE: This study evaluated the safety and efficacy of using radiofrequency ablation combined with transarterial chemoembolization to treat hepatocellular carcinoma in a subcapsular location, given the increased risk of complications when using radiofrequency ablation alone. MATERIALS AND METHODS: From January 2000 to December 2011, 1213 patients with unresectable hepatocellular carcinoma (up to three nodules) were screened. Of these, 132 patients with 132 subcapsular nodules (mean size, 3.0cm; range, 1.2-5.0cm) were enrolled in the study. After transarterial chemoembolization, percutaneous radiofrequency ablation was performed under ultrasound or C-arm cone-beam computed tomography guidance, on the same day or within 3 days. Local recurrence and survival curves were obtained using the Kaplan-Meier method. RESULTS: Technical success of treatment was achieved in 130 patients (98.5%). Major complications, including pleural effusion, secondary peritonitis, and liver abscess, occurred in 3 patients (2.3%); the incidence of complications was associated with the number of needle insertions (1-2 vs. 3-4, P=0.039, Fisher's exact test). No patients developed permanent sequelae, tumor seeding, or tumor bleeding. The 3-year local recurrence rate was 9.7%. Local recurrence was associated with the pretreatment serum des-gamma-carboxy prothrombin level (≤200mAU/mL vs. >200mAU/mL, P=0.019, log-rank test). The 3-, 5-, and 7-year overall survival rates in treatment-naïve cases (n=82) were 79.3%, 60.6%, and 50.9%, respectively. CONCLUSION: Combination therapy using radiofrequency ablation and transarterial chemoembolization was a safe and useful therapeutic option for patients with subcapsular hepatocellular carcinoma.
European journal of radiology 10/2012; · 2.65 Impact Factor
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Takuma Higurashi,
Kunihiro Hosono,
Hiroki Endo,
Hirokazu Takahashi,
Hiroshi Iida,
Takashi Uchiyama,
Akiko Ezuka,
Shiori Uchiyama,
Eiji Yamada,
Hidenori Ohkubo,
Eiji Sakai, Shin Maeda,
Satoshi Morita,
Yutaka Natsumeda,
Hajime Nagase,
Atsushi Nakajima
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ABSTRACT: Background: Colorectal cancer (CRC) is one of the most commonly occurring neoplasms and a leading cause of cancer death worldwide, and new preventive strategies are needed to lower the burden of this disease. Eicosapentaenoic acid (EPA), the omega-3 polyunsaturated fatty acid that is widely used in the treatment of hyperlipidemia and prevention of cardiovascular disease, has recently been suggested to have a suppressive effect on tumorigenesis and cancer cell growth. In CRC chemoprevention trials, in general, the incidence of polyps or of the cancer itself is set as the study endpoint. Although the incidence rate of CRC would be the most reliable endpoint, use of this endpoint would be unsuitable for chemoprevention trials, because of the relatively low occurrence rate of CRC in the general population and the long-term observation period that it would necessitate. Moreover, there is an ethical problem in conducting long-term trials to determine whether a test drug might be effective or harmful. Aberrant crypt foci (ACF), defined as lesions containing crypts that are larger in diameter and stain more darkly with methylene blue than normal crypts, are considered as a reliable surrogate biomarker of CRC. Thus, we devised a prospective randomized controlled trial as a preliminary study prior to a CRC chemoprevention trial to evaluate the chemopreventive effect of EPA against colorectal ACF formation and the safety of this drug, in patients scheduled for polypectomy. METHODS: This study is a multicenter, double-blind, placebo-controlled, randomized controlled trial to be conducted in patients with both colorectal ACF and colorectal polyps scheduled for polypectomy. Eligible patients shall be recruited for the study and the number of ACF in the rectum counted at the baseline colonoscopy. Then, the participants shall be allocated randomly to either one of two groups, the EPA group and the placebo group. Patients in the EPA group shall receive oral 900-mg EPA capsules thrice daily (total daily dose, 2.7 g per day), and those in the placebo group shall receive oral placebo capsules thrice daily. After one month's treatment with EPA/placebo, colonoscopic examination and polypectomy will be performed to evaluate the formation of ACF, and the cell-proliferative activity and cell-apoptotic activity in normal colorectal mucosa and colorectal polyps. DISCUSSION: This is the first study proposed to explore the effect of EPA against colorectal ACF formation in humans. This trial has been registered in the University hospital Medical Information Network (UMIN) Clinical Trials Registry as UMIN000008172.
BMC Cancer 09/2012; 12(1):413. · 3.01 Impact Factor
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Yusuke Sekino,
Masahiko Inamori,
Eiji Yamada,
Hidenori Ohkubo,
Eiji Sakai,
Takuma Higurashi,
Hiroshi Iida,
Kunihiro Hosono,
Hiroki Endo,
Takashi Nonaka,
Hirokazu Takahashi,
Tomoko Koide,
Yasunobu Abe,
Eiji Gotoh,
Shigeru Koyano,
Yoshiyuki Kuroiwa, Shin Maeda,
Atsushi Nakajima
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ABSTRACT: To reveal the frequency, characteristics and prog-nosis of chronic intestinal pseudo-obstruction (CIP) in mitochondrial disease patients.
Between January 2000 and December 2010, 31 patients (13 males and 18 females) were diagnosed with mitochondrial diseases at our hospital. We conducted a retrospective review of the patients' sex, subclass of mitochondrial disease, age at onset of mitochondrial disease, frequency of CIP and the age at its onset, and the duration of survival. The age at onset or at the first diagnosis of the disorder that led to the clinical suspicion of mitochondrial disease was also examined.
Twenty patients were sub-classified with mitochondrial encephalopathy with lactic acidosis and stroke-like episodes (MELAS), 8 with chronic progressive external ophthalmoplegia (CPEO), and 3 with myoclonus epilepsy associated with ragged-red fibers (MERRF). Nine patients were diagnosed with CIP, 8 of the 20 (40.0%) patients with MELAS, 0 of the 8 (0.0%) patients with CPEO, and 1 of the 3 (33.3%) patients with MERRF. The median age (range) at the diagnosis and the median age at onset of mitochondrial disease were 40 (17-69) and 25 (12-63) years in patients with CIP, and 49 (17-81) and 40 (11-71) years in patients without CIP. During the survey period, 5 patients (4 patients with MELAS and 1 with CPEO) died. The cause of death was cardiomyopathy in 2 patients with MELAS, cerebral infarction in 1 patient with MELAS, epilepsy and aspiration pneumonia in 1 patient with MELAS, and multiple metastases from gastric cancer and aspiration pneumonia in 1 patient with CPEO.
Patients with CIP tend to have disorders that are suspected to be related to mitochondrial diseases at younger ages than are patients without CIP.
World Journal of Gastroenterology 09/2012; 18(33):4557-62. · 2.47 Impact Factor
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ABSTRACT: The Prague C and M Criteria have been developed for the objective endoscopic diagnosis of Barrett's esophagus (BE). BE arises between the squamocolumnar junction and the gastroesophageal junction at the proximal margin of the gastric folds. In this study, we reported that 43.0% of the subjects examined were diagnosed with BE based on the Prague C and M Criteria. Previous criticism by John Dent proposed that our data should be considered invalid because the prevalence of BE reported in our study was extraordinarily high and discordant with previous studies. Dent predicted that the position of the gastroesophageal junction in our study was judged to be lower than the actual position due to the effacement of the proximal ends of the gastric folds because of the routine use of a high degree of air distension during typical Japanese endoscopic examinations. The endoscopic evaluation of the superior gastric folds is certainly influenced by the degree of air distension of the esophagus. However, in our study, the proximal limit of the gastric mucosal folds was prospectively imaged while the oesophagus was minimally insufflated. Then, under a high level of air distension, the distal ends of the palisade-shaped longitudinal vessels were imaged because they are more easily observed when distended. In the majority of patients, the distal ends of the palisade-shaped longitudinal vessels correspond to the proximal limit of the gastric mucosal folds. Our endoscopic evaluation was appropriately performed according to the Prague C and M Criteria. We suspect that the high prevalence of BE in our study may be due to the inclusion of ultrashort-segment BE, which defines BE with an affected mucosal length under 5 mm, in our positive results.
World Journal of Gastroenterology 07/2012; 18(26):3477-8. · 2.47 Impact Factor
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Yasunari Sakamoto,
Yusuke Sekino,
Eiji Yamada,
Takuma Higurashi,
Hidenori Ohkubo,
Eiji Sakai,
Hiroki Endo,
Hiroshi Iida,
Takashi Nonaka,
Koji Fujita,
Masato Yoneda,
Tomoko Koide,
Hirokazu Takahashi,
Ayumu Goto,
Yasunobu Abe,
Eiji Gotoh, Shin Maeda,
Atsushi Nakajima,
Masahiko Inamori
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ABSTRACT: To determine the effect of oral sumatriptan on gastric emptying using a continuous ¹³C breath test (BreathID system).
Ten healthy male volunteers participated in this randomized, 2-way crossover study. The subjects fasted overnight and were randomly assigned to receive a test meal (200 kcal/200 mL) 30 min after pre-medication with sumatriptan 50 mg (sumatriptan condition), or the test meal alone (control condition). Gastric emptying was monitored for 4 h after administration of the test meal by the ¹³C-acetic acid breath test performed continually using the BreathID system. Then, using Oridion Research Software (β version), the time taken for emptying of 50% of the labeled meal (T(1/2)) similar to the scintigraphy lag time for 10% emptying of the labeled meal (T(lag)), the gastric emptying coefficient (GEC), and the regression-estimated constants (β and κ) were calculated. The statistical significance of any differences in the parameters were analyzed using Wilcoxon's signed-rank test.
In the sumatriptan condition, significant differences compared with the control condition were found in T(1/2) [median 131.84 min (range, 103.13-168.70) vs 120.27 min (89.61-138.25); P = 0.0016], T(lag) [median 80.085 min (59.23-125.89) vs 61.11 min (39.86-87.05); P = 0.0125], and β [median 2.3374 (1.6407-3.8209) vs 2.0847 (1.4755-2.9269); P = 0.0284]. There were no significant differences in the GEC or κ between the 2 conditions.
This study showed that oral sumatriptan significantly delayed gastric emptying of a liquid meal.
World Journal of Gastroenterology 07/2012; 18(26):3415-9. · 2.47 Impact Factor
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Y Sekino,
H Endo,
E Yamada,
E Sakai,
H Ohkubo,
T Higurashi,
H Iida,
K Hosono,
H Takahashi,
T Koide,
T Nonaka,
Y Abe,
E Gotoh, S Maeda,
A Nakajima,
M Inamori
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ABSTRACT: Aim A case-controlled study was performed to investigate the association of colonic angiectasia with other conditions and to identify risk factors for bleeding. Method Information was collected from all patients who underwent colonoscopy at our hospital between January 2008 and December 2010. Data on 90 individuals with angiectasia [58 men; median age 69 (26-92) years] were compared with those of 180 individuals without angiectasia, matched for gender and age. Results Multivariate analysis showed that occult gastrointestinal bleeding [odds ratio (OR) 2.523; 95% confidence interval (CI) 1.238-5.142], liver cirrhosis (OR 13.195; 95% CI 3.502-49.711), chronic renal failure (OR 6.796; 95% CI 1.598-28.904) and valvular heart disease (OR 6.425; 95% CI 1.028-40.165) were identified as significant predictors of the presence of colonic angiectasia. Eight patients were diagnosed with bleeding from angiectasia. Cardiovascular disease (OR 22.047; 95% CI 1.063-457.345) and multiple angiectasias (P-value 0.0019) were identified as significant risk factors for active bleeding. Medication and a large size were not associated with an increased risk of bleeding. Conclusion The presence of colonic angiectasia was associated with valvular heart disease, liver cirrhosis and chronic renal failure. Valvular heart disease and multiple lesions increased the risk of bleeding.
Colorectal Disease 06/2012; 14(10):e740-6. · 2.93 Impact Factor
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Noritoshi Kobayashi,
Ryu Kobayashi,
Shingo Kato,
Seitaro Watanabe,
Takashi Uchiyama,
Takeshi Shimamura,
Kensuke Kubota, Shin Maeda,
Atsushi Nakajima,
Yasushi Ichikawa,
Hisashi Oshiro,
Itaru Endo
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ABSTRACT: In July 2003, a 63-year-old man received a low anterior resection for rectal cancer. In February 2006, he underwent a right
hepatectomy for a solitary metastatic liver tumor; the liver tumor had not invaded the bile duct, and a curative resection
was performed. In August 2008, an enhanced computed tomography examination revealed a massive focal lesion at the point of
the common bile duct. Endoscopic ultrasonography clearly revealed a hyperechoic polypoid lesion that had spread laterally
on the surface of the slightly dilated bile duct and had a smooth outer hyperechoic layer. No lymph nodes were present in
this region. Endoscopic retrograde cholangiopancreatography revealed an irregular stricture, and a biopsy was performed through
the scope. Microscopic examination revealed a tumor characterized as a moderately differentiated adenocarcinoma resembling
the liver tumor. We diagnosed the intrabiliary tumor as a metachronous metastatic bile duct tumor from rectal cancer without
involvement of the liver parenchyma. This is a very rare case, with recurrence only in an extrahepatic bile duct after the
complete resection of a metastatic liver tumor. This is the first clinical, pathological, and radiological description of
this rare condition.
KeywordsColorectal cancer–Bile duct cancer–Pathology of biliary epithelia
Clinical Journal of Gastroenterology 05/2012; 4(4):278-282.
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ABSTRACT: Endoscopic submucosal dissection (ESD) was introduced worldwide as a new treatment option for early gastric cancer. Our objective was to discuss the limited ESD reports available and to determine the lesions suitable for use in training endoscopists on which lesions are appropriate for ESD. We reviewed a series of ESD reports that have been written on various risk factors related to the resectability or curability of a variety of lesions. These published studies show that certain risk factors such as tumor size and location and the presence of ulceration are closely related to both resectability and curability. Because the combination of these risk factors resulted in a much higher risk than did any single factor, we recently established a 'risk assessment chart' to determine an individual's total risk of treatment failure for early gastric cancer that has been treated using ESD. This risk chart provides a clear indication that small, non-ulcerated lesions located in the lower third of the stomach have a high rate of curative resection and are technically less challenging if ESD is used. We suggest that trainees should gain ESD experience with such lesions before they start to perform ESD on more difficult lesion types that have a lower probability of curative resection. In addition, we suggest that this risk assessment chart is suitable for the pretreatment assessment of curability and the likelihood of successful en bloc resection.
Digestive Endoscopy 05/2012; 24 Suppl 1:143-7. · 1.19 Impact Factor
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Hiroyuki Kirikoshi,
Masato Yoneda,
Hironori Mawatari,
Koji Fujita,
Kento Imajo,
Shingo Kato,
Kaori Suzuki,
Noritoshi Kobayashi,
Kensuke Kubota, Shin Maeda,
Atsushi Nakajima,
Satoru Saito
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ABSTRACT: To evaluate the effectiveness of hepatic arterial infusion chemotherapy (HAIC) for advanced hepatocellular carcinoma (HCC) resistant to transarterial chemoembolization (TACE).
This study was conducted on 42 patients who received HAIC for advanced HCC between 2001 and 2010 at our hospital. 5-fluorouracil (5-FU) was administered continuously for 24 h from day 1 to day 5 every 2-4 wk via an injection reservoir. Intra-arterial cisplatin or subcutaneous interferon was administered in combination with the 5-FU. The patients enrolled in this retrospective study were divided into two groups according to whether or not they fulfilled the criteria for resistance to TACE proposed by the Japan Society of Hepatology in 2010 (written in Japanese); one group of patients who did not fulfill the criteria for TACE resistance (group A, n = 23), and another group who fulfilled the criteria for TACE resistance (group B, n = 19). We compared the outcomes in terms of the response and survival rates between the two groups.
Both the response rate and tumor suppression rate following HAIC were significantly superior in group A than in group B (response rate: 48% vs 16%, P = 0.028, tumor suppression rate: 87% vs 53%, P = 0.014). Furthermore, both the progression-free survival rate and survival time were significantly superior in group A than in group B (3-, 6-, 12-, and 24-mo = 83%, 70%, 29% and 20% vs 63%, 42%, 16% and 0%, respectively, P = 0.040, and 9.8 mo vs 6.2 mo, P = 0.040). A multivariate analysis (Cox proportional hazards regression model) showed that resistance to TACE was an independent predictor of poor survival (P = 0.007).
HAIC administrating 5-FU was not effective against advanced HCC resistant to TACE. Other tools for treatment, i.e., molecular-targeting agents may be considered for these cases.
World Journal of Gastroenterology 04/2012; 18(16):1933-9. · 2.47 Impact Factor
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Nippon rinsho. Japanese journal of clinical medicine 04/2012; 70 Suppl 2:50-5.
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Kaori Suzuki,
Shiori Uchiyama,
Kento Imajyo,
Wataru Tomeno,
Eiji Sakai,
Eiji Yamada,
Emiko Tanida,
Tomoyuki Akiyama,
Seitaro Watanabe,
Hiroki Endo, [......],
Masato Yoneda,
Hirokazu Takahashi,
Tomoko Koide,
Chikako Tokoro,
Yasunobu Abe,
Minoru Kawaguchi,
Eiji Gotoh, Shin Maeda,
Atsushi Nakajima,
Masahiko Inamori
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ABSTRACT: Diverticular hemorrhage is the common cause of lower gastrointestinal bleeding, and its incidence has been increasing in Japan. However, the exact cause of diverticular hemorrhage is not well understood. We investigated the risk factors for diverticular hemorrhage.
We selected 103 patients with diverticular hemorrhage as cases and patients with colonic diverticulosis without a history of bleeding were selected as control subjects, exactly matched for age and gender. We collected the data from the medical records of each of the patients, such as those related to the comorbidities, medications and findings of colonoscopy, and conducted a matched case-control study to analyze the risk factors for diverticular hemorrhage.
Both groups were composed of 75 men and 28 women. The median age of the patients in both groups was 72.0 years (47.0-87.0). The body weight (p = 0.0065), body mass index (p = 0.006), prevalence of hypertension (p = 0.0242), prevalence of ischemic heart disease (p = 0.0015), and frequency of use of low-dose aspirin (p = 0.042) were significantly different between the two groups. The percentage of patients with bilateral diverticula, that is, diverticula on both the right and left hemicolon, was significantly higher in the diverticular hemorrhage group (p = 0.0011). Multiple regression analysis identified only the diverticular location as being significantly associated with the risk of diverticular hemorrhage (p = 0.0021).
Only the diverticular location (bilateral) was found to be an independent risk factor for diverticular hemorrhage.
Digestion 03/2012; 85(4):261-5. · 2.05 Impact Factor
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Hiroshi Iida,
Masahiko Inamori,
Tetsuro Fujii,
Yusuke Sekino,
Hiroki Endo,
Kunihiro Hosono,
Takashi Nonaka,
Tomoko Koide,
Hirokazu Takahashi,
Masato Yoneda,
Ayumu Goto,
Yasunobu Abe,
Noritoshi Kobayashi,
Hiroyuki Kirikoshi,
Kensuke Kubota,
Satoru Saito,
Eiji Gotoh, Shin Maeda,
Atsushi Nakajima
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ABSTRACT: The ideal medication for acid-related diseases should have a rapid onset of action to promote hemostasis and cause efficient resolution of symptoms. The aim of our study was to comparatively investigate the inhibitory effect on gastric acid secretion of a single oral administration of omeprazole plus mosapride with that of omeprazole alone.
Ten Helicobacter pylori-negative male subjects participated in this randomized, two-way crossover study. Intragastric pH was monitored continuously for 6 hours after a single oral administration of omeprazole 20 mg or that of omeprazole 20 mg plus mosapride 5 mg (the omeprazole being administered one hour after the mosapride). Each administration was separated by a 7-days washout period.
The average pH during the 6-hour period after administration of omeprazole 20 mg plus mosapride 5 mg was higher than that after administration of omeprazole 20 mg alone (median: 3.22 versus 4.21, respectively; p = 0.0247).
In H. pylori -negative healthy male subjects, an oral dose of omeprazole 20 mg plus mosapride 5 mg increased the intragastric pH more rapidly than omeprazole 20 mg alone.
BMC Gastroenterology 03/2012; 12:25. · 2.42 Impact Factor
