Takeshi Yamashina

Publications (5)19.25 Total impact

• Source

  Available from: Noriya Uedo

  Article: Delayed perforation: A hazardous complication of endoscopic resection for non-ampullary duodenal neoplasm.

  Takuya Inoue, Noriya Uedo, Takeshi Yamashina, Sachiko Yamamoto, Noboru Hanaoka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara, Hiroyasu Iishi, Masaharu Tatsuta, Hidenori Takahashi, Hidetoshi Eguchi, Hiroaki Ohigashi
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  ABSTRACT: BACKGROUND: Perforation is a major complication of endoscopic resection for gastrointestinal neoplasms. However, little is known about delayed perforation after endoscopic resection for non-ampullary duodenal neoplasm. The aim of the present study was to investigate the clinical features of delayed perforation after endoscopic resection for non-ampullary duodenal neoplasm. PATIENTS AND METHODS: This was a retrospective cohort study conducted in a referral cancer center. A total of 63 patients (41 with adenomas and 22 with carcinomas) underwent endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) from January 1993 to December 2011. Incidence, outcome, and factors associated with occurrence of delayed perforation were investigated. RESULTS: Delayed perforation occurred in four patients (6.3%). All lesions were located distal to Vater's ampulla. Three of four delayed perforations occurred within 36 h after endoscopic resection. All patients developed retroperitonitis, and two also had retroperitoneal abscesses. Although three patients were cured with conservative management, a long hospital stay was required (28-, 80-, and 81-day hospital stay, respectively). One patient required emergency surgery as a result of panperitonitis. There was, fortunately, no mortality in this series. The significant predictors of delayed perforation were location (distal to Vater's ampulla, P = 0.007) and resection method (ESD and piecemeal EMR, P = 0.003). CONCLUSION: Endoscopic resection for non-ampullary duodenal neoplasms has a possible risk of morbid complication i.e. delayed perforation, especially in patients with lesions located on the side distal from the ampulla and who are treated with piecemeal EMR or ESD.
  Digestive Endoscopy 04/2013; · 1.19 Impact Factor
• Article: Long-Term Outcome and Metastatic Risk After Endoscopic Resection of Superficial Esophageal Squamous Cell Carcinoma.

  Takeshi Yamashina, Ryu Ishihara, Kengo Nagai, Noriko Matsuura, Fumi Matsui, Takashi Ito, Mototsugu Fujii, Sachiko Yamamoto, Noboru Hanaoka, Yoji Takeuchi, Koji Higashino, Noriya Uedo, Hiroyasu Iishi
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  ABSTRACT: OBJECTIVES:Long-term outcomes after endoscopic resection (ER) provide important information for the treatment of esophageal carcinoma. This study aimed to investigate the rates of survival and metastasis after ER of esophageal carcinoma.METHODS:From 1995 to 2010, 570 patients with esophageal carcinoma were treated by ER. Of these, the 402 patients with squamous cell carcinoma (280 epithelial (EP) or lamina propria (LPM) cancer, 70 muscularis mucosa (MM) cancer, and 52 submucosal (SM) cancer) were included in our analysis. Seventeen patients had cancer invading into the submucosa up to 0.2 mm (SM1) and 35 patients had cancer invading into the submucosa more than 0.2 mm (SM2).RESULTS:The mean (range) follow-up time was 50 (4-187) months. The 5-year overall survival rates of patients with EP/LPM, MM, and SM cancer were 90.5, 71.1, and 70.8%, respectively (P=0.007). Multivariate analysis identified depth of invasion and age as independent predictors of survival, with hazard ratios of 3.6 for MM cancer and 3.2 for SM cancer compared with EP/LPM cancer, and 1.07 per year of age. The cumulative 5-year metastasis rates in patients with EP/LPM, MM, SM1, and SM2 cancer were 0.4, 8.7, 7.7, and 36.2%, respectively (P<0.001). Multivariate analysis identified depth of invasion as an independent risk factor for metastasis, with hazard ratios of 13.1 for MM, 40.2 for SM1, and 196.3 for SM2 cancer compared with EP/LPM cancer. The cumulative 5-year metastasis rates in patients with mucosal cancer with and without lymphovascular involvement were 46.7 and 0.7%, respectively (P<0.0001).CONCLUSIONS:The long-term risk of metastasis after ER was mainly associated with the depth of invasion. This risk should be taken into account when considering the indications for ER.Am J Gastroenterol advance online publication, 12 February 2013; doi:10.1038/ajg.2013.8.
  The American Journal of Gastroenterology 02/2013; · 7.28 Impact Factor
• Article: Histologic features responsible for brownish epithelium in squamous neoplasia of the esophagus by narrow-band imaging.

  Hiromitsu Kanzaki, Ryu Ishihara, Shingo Ishiguro, Kengo Nagai, Fumi Matsui, Takeshi Yamashina, Takashi Ohta, Sachiko Yamamoto, Noboru Hanaoka, Masao Hanafusa, Yoji Takeuchi, Koji Higashino, Noriya Uedo, Hiroyasu Iishi, Yasuhiko Tomita
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  ABSTRACT: BACKGROUND AND STUDY AIM: Esophageal squamous neoplasias usually appear brown under narrow-band imaging as a result of microvascular proliferation and brownish color changes in the areas between vessels, referred to as brownish epithelium. However, the reasons for the development of this brownish epithelium and its clinical implications have not been fully investigated. METHODS: Patients with superficial esophageal neoplasias treated by endoscopic resection were included in the study. Areas of mucosa with brownish and non-brownish epithelia were evaluated histologically. RESULTS: A total of 68 superficial esophageal neoplasias in 58 patients were included in the analysis. Of the 68 lesions, 32 were classified in the brownish epithelium group, and 36 in the non-brownish epithelium group. Brownish epithelium was significantly associated with a diagnosis of high-grade intraepithelial neoplasia or invasive cancer (P < 0.0001). Thinning of the keratinous layer, thinning of the epithelium, and cellular atypia were significantly associated with brownish epithelium by univariate analysis, and thinning of the keratinous layer and thinning of the epithelium were confirmed to be independent factors by multivariate analysis. The odds ratios were 9.6 (95% confidence interval: 2.0-46.3) for thinning of the keratinous layer and 4.6 (95% confidence interval: 1.1-19.4) for thinning of the epithelium. CONCLUSIONS: Brownish epithelium is an important finding in the diagnosis of esophageal squamous neoplasia, and may be related to thinning of the keratinous layer, caused by neoplastic cell proliferation, and thinning of the epithelium.
  Journal of Gastroenterology and Hepatology 11/2012; · 2.87 Impact Factor
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  Available from: Noriya Uedo

  Article: Safety and curative ability of endoscopic submucosal dissection for superficial esophageal cancers at least 50 mm in diameter.

  Takeshi Yamashina, Ryu Ishihara, Noriya Uedo, Kengo Nagai, Fumi Matsui, Natsuko Kawada, Takashi Oota, Hiromitsu Kanzaki, Masao Hanafusa, Sachiko Yamamoto, Noboru Hanaoka, Yoji Takeuchi, Koji Higashino, Hiroyasu Iishi
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  ABSTRACT: Limited data are available regarding the use of endoscopic submucosal dissection (ESD) for superficial esophageal cancers ≥ 50 mm in diameter. The aim of the present study was to investigate the safety and success of ESD for superficial esophageal cancers ≥ 50 mm. A total of 39 patients with superficial esophageal squamous cell carcinoma ≥ 50 mm were treated with ESD at Osaka Medical Center for Cancer and Cardiovascular Diseases between January 2004 and April 2011, and were analyzed in a retrospective study. En bloc resection was achieved in all patients. One mediastinal emphysema without perforation occurred during the procedure. Stricture developed in 11 of 39 patients, requiring a median of five endoscopic balloon dilatation procedures. Thirty-three clinical epithelial or lamina propria mucosal cancers were treated by ESD with curative intent, of which invasion into the muscularis mucosa or deeper was detected in seven and lymphovascular involvement in three. The en bloc resection rate was 100% with a tumor-free margin achieved in 92% of lesions. The curative resection and complication rates during ESD were 70% and 2.5%, respectively. ESD achieved a high en bloc resection rate of 92% with a tumor-free margin. Curative resection rate of ESD in patients with clinical epithelial or lamina propria mucosal cancers was not low at 70%. However, the risk of stricture must be taken into account when considering the use of ESD in lesions ≥ 50 mm.
  Digestive Endoscopy 07/2012; 24(4):220-5. · 1.19 Impact Factor
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  Available from: Noriya Uedo

  Article: Factors predicting perforation during endoscopic submucosal dissection for gastric cancer.

  Takashi Ohta, Ryu Ishihara, Noriya Uedo, Yoji Takeuchi, Kengo Nagai, Fumi Matsui, Natsuko Kawada, Takeshi Yamashina, Hiromitsu Kanzaki, Masao Hanafusa, Sachiko Yamamoto, Noboru Hanaoka, Koji Higashino, Hiroyasu Iishi
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  ABSTRACT: Perforation is a common complication of endoscopic submucosal dissection (ESD), but little is known about the relevant risk factors. To investigate the risk factors for perforation. Retrospective study. A cancer referral center. A total of 1795 early gastric tumors in 1500 patients treated by ESD from July 2002 to December 2010 were included in the analysis. The associations between the incidence of perforation and patient and lesion characteristics were investigated. Perforation during ESD occurred in 50 lesions (2.8%). Univariate analysis identified tumor location (upper, middle, or lower stomach), tumor diameter (≤ 20 or >20 mm), and treatment period (lesions treated in the first or second period) as predictors of perforation. Multivariate analysis identified tumor location (upper stomach), tumor diameter (>20 mm), and treatment period (first half) as independent risk factors for perforation. The odds ratios were 2.4 (95% CI, 1.3-4.7; P = .006) for lesions in the upper stomach and 1.9 (95% CI, 1.0-3.5; P = .04) for lesions larger than 20 mm. Perforation risks were 5.4% for lesions in the upper stomach and 4.4% for lesions larger than 20 mm. Three patients required emergency surgery, but the rest of the patients were successfully treated with endoscopic clipping. There was no perforation-related mortality. Single-center, retrospective study design. Lesions in the upper stomach and lesions larger than 20 mm were independent risk factors for perforation during ESD. Patients should be made aware of the estimated high risks of these lesions before undergoing ESD.
  Gastrointestinal endoscopy 04/2012; 75(6):1159-65. · 6.71 Impact Factor