Hideyuki Kashiwagi

The Jikei University School of Medicine, Edo, Tōkyō, Japan

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Publications (176)405.23 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: The use of multichannel intraluminal impedance pH (MII-pH) and high-resolution manometry (HRM), which are new devices used to examine the esophageal function, has recently become common in Europe and the USA, thus garnering much attention. There have not been enough studies as of yet, however, on the esophageal motor function and the benefits of treatment after these devices have been used in laparoscopic fundoplication. Objective: To use MII-pH and HRM to study the treatment effectiveness of laparoscopic fundoplication and consider a backflow prevention mechanism for laparoscopic Toupet fundoplication. Materials and methods: The study looked at 27 of a total of 60 patients undergoing laparoscopic fundoplication due to reasons of either gastroesophageal reflux disease or esophageal hiatal hernia between October 2012 and February 2014, who underwent a postsurgical HRM examination. Of these, 25 patients whose symptoms disappeared following surgery and who were not orally administered gastric secretion inhibitor (of whom nine were male, average age 55.9 ± 14.9 years, and of whom 76 % underwent MII-pH) were taken as the subjects of the study. The postsurgical evaluation was conducted 3 months after the operation. Results: Using HRM, although no change was noted in the lower esophageal sphincter pressure (LESP) (p = 0.943), an increase in lower esophageal sphincter pressure integral (p = 0.024) and extensions in both overall length and abdominal length were noted (both p < 0.001), while a significant improvement was noted in the lower esophageal sphincter (LES). Furthermore, the cases subjected to MII-pH demonstrated a reduced gastroesophageal reflux time, total number of liquid reflux episodes, and total number of reflux episodes (p < 0.001, p = 0.008, p = 0.009). Conclusions: Backflow prevention mechanism of laparoscopic Toupet fundoplication is thus considered to improve the overall LES function without elevating LESP.
    Surgical Endoscopy 10/2015; DOI:10.1007/s00464-015-4532-z · 3.26 Impact Factor
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    ABSTRACT: Background Non-erosive gastroesophageal reflux disease (NERD) is the most common form of gastroesophageal reflux disease (GERD). The aim of this study is to evaluate efficacy of laparoscopic Toupet fundoplication for NERD by combined multichannel intraluminal impedance–pH (MII–pH) monitoring. Methods Twenty-eight patients who underwent laparoscopic Toupet fundoplication for NERD had MII–pH monitoring before surgery. Among them, 11 patients accepted to undergo MII–pH monitoring both before and after surgery. Their clinical data were collected in a prospective fashion and retrospectively reviewed. Patients’ characteristics, the esophageal function of time pH below 4, DeMeester score, the numbers of acid and nonacid reflux episodes and symptom index (SI) were evaluated. Results Pre- and postoperative time pH below 4 were 5.8 ± 7.1 and 0.7 ± 1.3, respectively, and DeMeester score was 19.7 ± 23.3 and 2.8 ± 3.8, respectively, both of which were significantly different (p = 0.022 and 0.019). Pre- and postoperative numbers of all reflux episodes were 84.3 ± 52.5 and 36.2 ± 22.8, respectively. Pre- and postoperative acid reflux episodes were 39.5 ± 35.2 and 9.9 ± 19.2, respectively. There were significant differences in the number of both all and acid reflux episodes (p = 0.001 and 0.012). Those of nonacid reflux episodes were 44.8 ± 37.4 and 26.3 ± 13.9, respectively, which did not achieve statistical significance (p = 0.068). Six patients (54.5 %) had positive SI preoperatively, but no one had positive SI after surgery. Conclusion Laparoscopic Toupet fundoplication can control gastroesophageal reflux events in patients with NERD.
    Esophagus 07/2015; 12(3):219-224. DOI:10.1007/s10388-014-0469-x · 0.74 Impact Factor
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    ABSTRACT: Mucosal injury during myotomy is the most frequent complication seen with the Heller-Dor procedure for achalasia. The present study aimed to examine risk factors for such mucosal injury during this procedure. This was a retrospective analysis of patients who underwent the laparoscopic Heller-Dor procedure for achalasia at a single facility. Variables for evaluation included patient characteristics, preoperative pathophysiological findings, and surgeon's operative experience. Logistic regression was used to identify risk factors. We also examined surgical outcomes and the degree of patient satisfaction in relation to intraoperative mucosal injury. Four hundred thirty-five patients satisfied study criteria. Intraoperative mucosal injury occurred in 67 patients (15.4 %). In univariate analysis, mucosal injury was significantly associated with the patient age ≥60 years, disease history ≥10 years, prior history of cardiac diseases, preoperative esophageal transverse diameter ≥80 mm, and surgeon's operative experience with fewer than five cases. In multivariate analysis involving these factors, the following variables were identified as risk factors: age ≥60 years, esophageal transverse diameter ≥80 mm, and surgeon's operative experience with fewer than five cases. The mucosal injury group had significant extension of the operative time and increased blood loss. However, there were no significant differences between the two groups in the incidence of reflux esophagitis or the degree of symptom alleviation postoperatively. The fragile esophagus caused by advanced patient age and/or dilatation were risk factor for mucosal injury during laparoscopic Heller-Dor procedure. And novice surgeon was also identified as an isolated risk factor for mucosal injury.
    Surgical Endoscopy 06/2015; DOI:10.1007/s00464-015-4264-0 · 3.26 Impact Factor
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    ABSTRACT: Purpose To clarify the feasibility and utility of reduced port surgery (RPS) for achalasia. Methods Between September 2005 and June 2013, 359 patients with esophageal achalasia, excluding cases of reoperation, underwent laparoscopic Heller myotomy and Dor fundoplication (LHD) according to our clinical pathway. Three-hundred and twenty-seven patients underwent LHD with five incisions (conventional approach), while the other 32 patients underwent RPS, including eight via SILS. The clinical data were collected in a prospective fashion and retrospectively reviewed. We selected 24 patients matched for gender, age and morphologic type with patients in the RPS group from among the 327 patients (C group). The surgical outcomes were compared between the C and RPS groups. Results There were no significant differences between the two groups in the duration of symptoms, dysphagia score, chest pain score, shape of the distal esophagus and esophageal clearance. The operative time was significantly longer in the RPS group than in the C group (p
    Surgery Today 01/2015; 45(9). DOI:10.1007/s00595-014-1109-8 · 1.53 Impact Factor

  • Journal of the American College of Surgeons 10/2014; 219(4):e17. DOI:10.1016/j.jamcollsurg.2014.07.431 · 5.12 Impact Factor
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    ABSTRACT: Introduction Upside-down stomach, an atypical form of esophageal hiatal hernia, is a rare pathology. Due to its anomalous anatomical characteristics, the level of difficulty of laparoscopic surgery is considered to be high. However, as the number of patients is very small in Japan, surgical results have not been fully investigated. We examined the results of surgical treatment for Japanese patients with upside-down stomach. Materials and methods The subjects were 11 patients given a diagnosis of upside-down stomach based on upper gastrointestinal tract radiographic imaging and who had undergone laparoscopic surgery at least 6 months prior to this study. Surgical results, postoperative recurrence, and postoperative oral intake of gastric acid-suppressive medications were examined. Results The subjects consisted of one man and ten women (91 %). The mean age was 73.0 ± 9.2 years and the mean disease period was 38.7 months. The operation time was 175.5 ± 49.1 min (range 110–280) and the intraoperative blood loss was 122.7 ± 214.9 mL (range 0–550). None of the patients had required conversion to laparotomy. The mean postoperative hospital stay was 8.9 ± 3.4 days (range 7–18) and two patients had persistent dysphagia after surgery, which improved with endoscopic dilatation. While two patients (18 %) had a postoperative recurrence of hiatal hernia, none required reoperation. Two patients (18 %) needed oral gastric acid-suppressive medications postoperatively. Conclusions Laparoscopic surgery could be performed in all patients with upside-down stomach. Because of the significant recurrence rate of postoperative esophageal hiatal hernia, the use of a mesh may be required.
    Esophagus 09/2014; 11(4):231-237. DOI:10.1007/s10388-014-0436-6 · 0.74 Impact Factor
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    ABSTRACT: We herein report our technique for laparoscopic esophageal myotomy combined with Collis gastroplasty and Nissen fundoplication for severe esophageal stenosis. Our patient had experienced vomiting since childhood, and his dysphagia had gradually worsened. He was referred to our department for surgery because of resistance to pneumatic dilation. He was diagnosed with a short esophagus based on the findings of a preoperative upper gastrointestinal series and GI endoscopy. After exposing the abdominal esophagus, esophageal myotomy around the esophago-gastric junction (EGJ) was undertaken to introduce an esophageal bougie into the stomach. Then, stapled wedge gastroplasty was performed, and a short and loose Nissen fundoplication was performed. In addition, the bulging mucosa after myotomy was patched using the Dor method. The patient's postoperative course was uneventful. Most patients with esophageal stricture require subtotal esophagectomy. Laparoscopic surgery for patients with benign esophageal stricture refractory to repeated pneumatic dilation is challenging. However, our current procedure might abrogate the need for invasive esophagectomy for the surgical management of severe esophageal stenosis.
    Surgery Today 03/2014; 45(2). DOI:10.1007/s00595-014-0884-6 · 1.53 Impact Factor
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    ABSTRACT: Background/Aim: Ubiquitin-conjugating enzyme H10 (UBCH10) is required in the cell-cycle transition from metaphase to anaphase. Therefore, we investigated whether its expression level in cancerous esophageal lesions affected prognosis of patients with esophageal squamous-cell carcinoma. Paraffin-embedded tissue samples from 121 patients with esophageal squamous cell carcinoma were stained with antibody to UBCH10 for immunohistochemical analysis. UBCH10 was expressed in cancerous and dysplastic lesions, but not in normal tissue. Patients were grouped according to expression: High (N=33) or low (N=88), depending on the staining pattern. There were significant differences between the groups in terms of invasion into lymphatic vessels, number of metastatic lymph nodes, TNM classification, and stages, as well as in survival: the 50% survival rate in the high expression group was 2.3 years, whereas it was 9.9 years for the low-expression group (p<0.0001). Even with multivariate adjusting for stage 0 to stage IV using the Cox proportional hazard model, patients belonging to the high-expression group had a poor prognosis (Hazard ratio=2.5; 95% Confidence Interval=1.3-4.5; p=0.004). High protein expression of UBCH10 is a marker of poor prognosis in esophageal squamous cell carcinoma.
    Anticancer research 02/2014; 34(2):955-61. · 1.83 Impact Factor
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    ABSTRACT: A 39-year-old female patient was referred to our hospital with a suspected esophageal motility disorder following a 4-month history of hiccup and dysphagia. Her past medical and family histories were unremarkable. Prior investigation with upper gastrointestinal endoscopy and esophagography failed to demonstrate any obvious pathology. Therefore, high-resolution manometry was performed, which showed the following: an integrated relaxation pressure (IRP) of 11.5mmHg; a distal contractile integral (DCI) of 6543mmHg-s-cm; and, a highest DCI of 9289mmHg-s-cm. A diagnosis of jackhammer esophagus was, therefore, considered. We reported on the details of this case and reviewed the relevant literature.
    Nippon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology 12/2013; 110(12):2107-11.
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    ABSTRACT: The diagnosis of the rare neoplasm histiocytic sarcoma (HS) relies on morphology and the presence of immunophenotypic features of histiocytic lineage. More than 57 cases, including 16 cases involving the gastrointestinal (GI) tract, have been described since the World Health Organization issued its classification system for tumors of hematopoietic and lymphoid tissue in 2001. HS is often diagnosed in its late stages, at which point the prognosis is poor. Only a small proportion of these patients can undergo surgical resection with curative intent. The present report describes how HS can be diagnosed at a stage of favorable prognosis using balloon enteroscopy (BE), thereby enabling surgical resection before the development of metastases. This strategy is reviewed in the setting of a patient with jejunal HS, followed by a discussion of data from 16 other reported cases of GI HS.
    Pathology International 02/2013; 63(2):120-4. DOI:10.1111/pin.12032 · 1.69 Impact Factor
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    ABSTRACT: Jikei University School of Medicine has established videoscopic surgery training program in 2004. In order to obtain operating privilege for videoscopic surgery, each surgeon has to take the courses in the program. The participant of this program became the residents primarily recently. Therefore, the program is operating as educational program of the residents now. In our institution, junior residents participate in this program with training initiation. And they receive the authorization of the operator qualification by all means when they become senior resident. By the results of the questionary survey, the program got an affirmative evaluation from residents. This program is expected to improve the fundamental knowledge and technical skills of residents who conduct videoscopic surgery.
    Nihon Gekakei Rengo Gakkaishi (Journal of Japanese College of Surgeons) 01/2013; 38(2):235-242. DOI:10.4030/jjcs.38.235
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    Nihon Gekakei Rengo Gakkaishi (Journal of Japanese College of Surgeons) 01/2013; 38(2):350-355. DOI:10.4030/jjcs.38.350
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    ABSTRACT: We report a 53-year-old woman who underwent successful 2nd reconstruction following ileocolonic necrosis after esophagogastrectomy. The patient had the initial operation for simultaneous esophageal and gastric cancer with subtotal esophagectomy and total gastrectomy after retrosternal ileocolic reconstruction. Proximal ileocolonic necrosis developed on the 7th postoperative day and massive bleeding from the left carotid artery occurred 2 days later. She was referred to our hospital after recovery from the last operation for restoration of discontinued esophageal substitute. Partial sternal resection was followed by implantation of a free jejunal graft between the remnant colon and the cervical esophagus. The transferred jejunum was covered by a left latissimus dorsi musculocutaneous flap. Postoperative course was uneventful and she was discharged 29 days after operation. For extended necrosis of an esophageal substitute after retrosternal reconstruction for esophageal surgery, this surgical procedure seems to result in less surgical stress with physiological and cosmetic benefit.
    Esophagus 09/2012; 9(3). DOI:10.1007/s10388-012-0319-7 · 0.74 Impact Factor
  • Nobuo Omura · Hideyuki Kashiwagi · Fumiaki Yano · Kazuto Tsuboi · Katsuhiko Yanaga ·
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    ABSTRACT: To define the factors predisposing to recurrence and evaluate the results of reoperations for achalasia. We reviewed the medical records of ten patients (4 men and 6 women; mean age, 51.5 ± 11.0 years), who underwent reoperations for achalasia between August 1994 and August 2010. The primary surgical procedures were Heller-Dor (HD) cardioplasty in nine patients and Heller myotomy in one patient. The factors contributing to failure of the primary operation included inadequate myotomy (n = 2), recurrent adhesion after myotomy (n = 2), reflux esophagitis (n = 2), difficulty in passage caused by tortuosity of the esophagus (n = 2), difficulty in passage through the thoracic esophagus (n = 1), and severe chest pain (n = 1). The reoperations included repeated HD procedures (n = 4), repair of an esophageal hiatal hernia (n = 2), thoracic esophageal myotomy (n = 2), straightening of the lower esophagus with gastropexy (n = 1), and subtotal esophagectomy (n = 1). The success rate of the reoperations for resolving symptoms was 90 % (9 patients). Selecting surgical procedures based on the causes and conditions of recurrence led to symptomatic improvement and acceptable outcomes.
    Surgery Today 07/2012; 42(11):1078-81. DOI:10.1007/s00595-012-0204-y · 1.53 Impact Factor
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    ABSTRACT: Although proximal gastrectomy has become a procedure of choice for patients' early cancer in the upper third of stomach, no clinical guide for optimal gastric resection in order to avoid postoperative jejunal ulcer is available. The aim of this study was to investigate whether determining the distribution of parietal and chief cells of the stomach using Congo red test is clinically relevant. The F-line was defined as a boundary line between fundic and intermediate area of the stomach according to the pathological findings in 29 patients who underwent total gastrectomy for early gastric cancer, whereas the f-line was regarded as a boundary line between intermediate and pyloric area. In the additional 6 patients undergoing vagus-preserving proximal gastrectomy with jejunal pouch interposition, endoscopic Congo red test was preoperatively performed to determine the F-f-line. The distances from the pyloric ring to f-line on the lesser and greater curvatures were variable. Long-term outcomes of proximal gastrectomy guided by preoperative endoscopic Congo red test were favorable. It is suggested that preoperative endoscopic Congo red test is useful to determine the appropriate cutting line in order to avoid postoperative jejunal ulcer after proximal gastrectomy.
    Hepato-gastroenterology 07/2012; 59(117):1478-9. DOI:10.5754/hge10063 · 0.93 Impact Factor
  • Hideyuki Kashiwagi ·

    Nippon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology 05/2012; 109(5):732-40.
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    ABSTRACT: No evidence currently exists to demonstrate the prognostic value of serum carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) in patients with unresectable colorectal cancer liver metastases (CRLM). Therefore, we retrospectively investigated the correlation between serum CEA and CA19-9 levels and overall survival in patients with unresectable CRLM. The study involved 40 patients who were diagnosed with unresectable CRLM between March 2000 and August 2010 at Jikei University Hospital, Japan. We retrospectively investigated the correlation between patient characteristics, including serum CEA and CA19-9 levels, and overall survival using univariate and multivariate analyses. In the univariate analysis, the absence of primary tumor resection (p=0.0161), the absence of systemic chemotherapy (p=0.0119), serum CEA ≥100 ng/ml (p=0.0148) and CA19-9 ≥100 U/ml (p<0.0001) were significant predictors of poor survival. In the multivariate analysis, the absence of systemic chemotherapy (p=0.0356), serum CEA ≥100 ng/ml (p=0.0079) and CA19-9 ≥100 U/ml (p=0.0002) were independent predictors. Serum CEA and CA19-9 levels are therefore independent prognostic predictors of survival in patients with unresectable CRLM.
    Oncology letters 04/2012; 3(4):767-771. DOI:10.3892/ol.2012.574 · 1.55 Impact Factor
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    ABSTRACT: We herein report the short-term results of the newly developed modified technique of Billroth I (modified B-I; pylorus reconstruction) that prevents duodenogastric reflux (DGR) and remnant gastritis after distal gastrectomy. Distal gastrectomy with this technique was performed in 20 patients (age, 41 to 86 years [mean, 68.5 ± 11.8 years], male/female = 12:8) with gastric cancer from June 2006 through December 2009. These patients were compared with another 20 patients who underwent conventional B-I after distal gastrectomy (age, 41 to 85 years [mean, 69.3 ± 8.69 years], male/female = 11:9). The side effects of gastric surgery evaluated in this study were the degree of remnant gastritis, the presence of dumping syndrome, and the degree of weight loss. By gastrografin contrast imaging on the fifth day after pylorus reconstruction, the remnant stomach was not dilated and gastrografin flowed physiologically to the duodenum without backward reflux into the remnant stomach. By gastroscopy at 6 months after the operation, DGR and the degree of remnant gastritis after pylorus reconstruction was lower than those of conventional B-I (P = 0.00068). The bile acid concentration of remnant gastric juice of pylorus reconstruction was lower than that of conventional B-I (55.5 ± 93.5 vs. 1,369.5 ± 2,502.1 μmol/L, P = 0.0415). Weight loss at 1 year after distal gastrectomy was less in pylorus reconstruction compared with conventional B-I (6.2 ± 5.2% vs. 9.8 ± 8.7%, P = 0.0725). Pylorus reconstruction is a simple and safe anastomotic technique that reduces the side effects of B-I reconstruction.
    Journal of Gastrointestinal Surgery 03/2012; 16(6):1102-6. DOI:10.1007/s11605-012-1850-5 · 2.80 Impact Factor
  • M Hoshino · N Omura · F Yano · K Tsuboi · H Kashiwagi · K Yanaga ·
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    ABSTRACT: The etiology of achalasia is believed to be the neuropathy associated with chronic inflammation of the nerve plexus, but the cause of plexus inflammation is unknown. The purpose of this study was to evaluate the pathophysiology of achalasia by examining the muscularis externa of the esophagus. We used the muscularis externa of the esophagus of 62 patients with achalasia (median 44 years, male&nbsp: female 32:30) who underwent surgical treatment (achalasia group) and of 10 patients (median 65.5 years, male&nbsp: female 9:1) who underwent esophagectomy for thoracic esophageal cancer (control group) to perform immunohistochemical staining with S-100, CD43, c-kit (CD117), n-NOS, vasoactive intestinal polypeptide (VIP), and ubiquitin. The cell counts that were positive for S-100, n-NOS, VIP, and ubiquitin were significantly lower in the achalasia group compared with the control group (P < 0.001, P= 0.001, P < 0.001, and P= 0.001, respectively). There were no statistically significant differences with respect to CD43 and c-kit staining (P= 0.586 and P= 0.209, respectively). In conclusion, the pathophysiology of achalasia is therefore considered to be an impaired production of NO and VIP, which both affect interstitial cell of Cajal and smooth muscles, and this impairment is therefore considered to play a role in the pathophysiology of achalasia.
    Diseases of the Esophagus 02/2012; 26(1). DOI:10.1111/j.1442-2050.2011.01318.x · 1.78 Impact Factor
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    ABSTRACT: A 31-year-old man, referred to our hospital for investigation of dysphagia, was found to have a spindle-shaped lower esophagus on a contrasted esophagram. The dysphagia was initially treated conservatively, but after 4 years of unsatisfactory control, he requested surgery. Our surgical team has been performing laparoscopic Heller-Dor fundoplication for achalasia since August, 1994, and 265 patients have undergone this procedure so far. Based on our experience, we decided to perform Heller-Dor fundoplication through a single incision for this patient. The operative time was 236 min with minimal blood loss and there were no perioperative complications. His postoperative course was uneventful and he was discharged on postoperative day 4, completing the clinical pathway used for conventional laparoscopic Heller-Dor fundoplication.
    Surgery Today 01/2012; 42(3):299-302. DOI:10.1007/s00595-011-0089-1 · 1.53 Impact Factor