Masato Hoshino

• M.D., PhD
• Instructor at Jikei University School of Medicine

Background The number of patients with giant hiatal hernias requiring surgery is increasing. However, there have been some concerns regarding the possible high recurrence rates. Additional gastropexy has been suggested to reduce recurrence rates. This study aimed to examine whether additional gastropexy is effective in patients with giant hiatal he...

Systemic inflammatory response is significant prognostic indicator in patients with various diseases. The relationship between prognostic scoring systems based on the modified Glasgow Prognostic Score (mGPS) and achalasia in patients treated with laparoscopic Heller‑myotomy with Dor‑fundoplication (LHD) remains uninvestigated. This study aimed to e...

While laparoscopic fundoplication is a standard surgical procedure for patients with esophageal hiatal hernias, the postoperative recurrence of esophageal hiatal hernias is a problem for patients with giant hernias, elderly patients, or obese patients. Although there are some reports indicating that reinforcement with mesh is effective, there are d...

Background In recent years, the number of patients requiring surgery for intra-thoracic stomach (ITS) has been increasing due to the effects of obesity and gibbus due to aging. The aim of this study is to assess the effects of the degree of hernia on the pathological conditions and surgical outcomes in ITS patients.MethodsITS was defined as cases i...

Aim: Osteopenia, characterized by low bone mineral density, is a potential prognostic factor for patients with cancer. The aim of this study was to clarify the impact of preoperative osteopenia in patients with gastric cancer (GC) after gastrectomy. Methods: We included 224 patients with GC who underwent gastrectomy between August 2013 and May 2...

Background: While laparoscopic fundoplication is a standard surgical procedure for patients with esophageal hiatal hernias, the postoperative recurrence of esophageal hiatal hernias is a problem for patients with giant hernias, elderly patients, or obese patients. Although there are some reports indicating that reinforcement with mesh is effective,...

Derangement of thoracoabdominal pressure gradient (TAPG) associates with gastroesophageal reflux disease (GERD). High-resolution esophageal manometry (HRM) is the gold standard to assess pathophysiology of GERD. Starlet HRM is widely used in Japan; however, TAPG values on Starlet HRM system have been unstudied. The aim of this study is to propose t...

Background Undifferentiated pleomorphic sarcoma (UPS) is a malignant soft tissue tumor that has been reclassified from malignant fibrous histiocytoma with the development of the pathological diagnosis. It principally occurs in the extremities but rarely occurs in the rectum. We herein report a rare case of UPS arising in the rectum. Case presentat...

Background Despite a high degree of satisfaction with laparoscopic Heller–Dor surgery (LHD) for esophageal achalasia, some cases show no improvement in postoperative esophageal clearance. We investigated whether an objective evaluation is essential for determining the therapeutic effect of LHD.Methods We investigated the difference in symptoms, reg...

Purpose: The Eckardt score (ES) is a famous scoring system used for assessing achalasia patients. We studied the correlation between our scoring system and the ES and examined the relationship between each score and the pathophysiology of achalasia. Methods: The subjects were 143 patients with diagnosed achalasia. We assessed the frequency and d...

Background: Undifferentiated pleomorphic sarcoma (UPS) is a malignant soft tissue tumor that has been reclassified from malignant fibrous histiocytoma with the development of the pathological diagnosis. It principally occurs in the extremities, but rarely occurs in the rectum. We herein report a rare case of UPS arising in the rectum. Case presenta...

Background: The diagnosis and pathological evaluation of esophageal achalasia have been improved dramatically by the development of high-resolution manometry. It is currently known to be divided into three subtypes. However, the differences between subtypes in terms of esophageal clearance remain unclear. Aims: To compare the pathology of subtyp...

Background Laparoscopic Heller-myotomy with Dor-fundoplication (LHD) is the standard surgical treatment for achalasia; however, surgical outcomes over a period greater than 10 years have not been well-explored. The objective of this study was to evaluate the long-term outcomes of LHD for achalasia based on a single-center experience. Methods Patie...

Background It is common knowledge that esophageal achalasia patients have a high risk of developing esophageal carcinoma. The present study assessed the characteristics of esophageal carcinoma patients following laparoscopic Heller-Dor surgery (LHD) for esophageal achalasia. Method Among 622 cases which were esophageal achalasia patients and under...

Background: It is anticipated that surgical treatment for gastro-esophageal reflux disease (GERD) in the elderly will increase. This time, using propensity score matching, we examined the results of laparoscopic fundoplication (LF) for GERD-related diseases in the elderly. Methods: Of 302 cases which underwent initial LF for GERD-related disease...

PurposeTo compare the surgical outcomes of redo laparoscopic Heller-Dor procedure and rescue peroral endoscopic myotomy for patients with failed Heller myotomy.Methods We identified patients who had undergone redo laparoscopic Heller-Dor procedure or rescue peroral endoscopic myotomy from August 1996 to September 2019 and assessed the patients’ cha...

Peptic esophagitis can occur as a complication of laparoscopic Heller-Dor surgery (LHD) among patients with esophageal achalasia. The goal of this study was to identify the characteristics of patients who have developed peptic esophagitis following LHD surgery along with the risk factors associated with the occurrence of peptic esophagitis. Among t...

Purpose One diagnostic criterion of esophageal achalasia is that the integrated relaxation pressure (IRP) measured by high-resolution manometry (HRM) is at least 15 mmHg. Moreover, while the standard surgical treatment for esophageal achalasia is laparoscopic Heller-Dor surgery (LHD), there have been insufficient investigations concerning the surgi...

Background and objectives: The Lyon Consensus was conducted in 2017, leading to a revision of the diagnostic criteria of GERD. Conclusive GERD was defined as cases in which the distal esophageal acid exposure time (AET) is greater than 6% and there exists either peptic esophagitis, constriction, or long-segment Barrett's mucosa with a Los Angeles...

PurposeTo identify the factors that affect laparoscopic fundoplication (LF) treatment efficacy in patients with erosive gastroesophageal reflux disease (e-GERD) esophagitis, based on the findings of multichannel intraluminal impedance pH (MII-pH) and high-resolution manometry (HRM).Methods The subjects were 102 patients with e-GERD diagnosed by end...

Introduction According to the anatomy‐function‐pathology classification, the recurrence rates of A2 and A3 hiatal hernia (HH) after laparoscopic fundoplication are higher than the rate of A1 HH. Therefore, we introduced mesh reinforcement for A2 and A3 cases. In addition, gastropexy was added to A3 cases. We present the strategy for HH repair. Met...

Background Achalasia and esophagogastric junction outflow obstruction (EGJOO) are idiopathic esophageal motility disorders characterized by impaired deglutitive relaxation of the lower esophageal sphincter (LES). High-resolution manometry (HRM) provides integrated relaxation pressure (IRP) which represents adequacy of LES relaxation. The Starlet HR...

PurposeTo examine whether or not we could propose a more appropriate dilation-degree classification suitable for the pathological condition of patients with esophageal achalasia.Methods In accordance with the current dilation-degree classification, the maximum dilated diameter was measured based on the esophageal barium swallow. The relationship be...

Background: Recently, in pursuit of minimal invasion, needlescopic surgery (NS) using forceps thinner than the previous standard has garnered attention as a surgical approach to various diseases. Objective: We compared the outcomes of NS for gastroesophageal reflux disease (GERD)-related diseases with the conventional method using propensity score...

Peroral endoscopic myotomy(POEM)has been reported as safe and effective treatment for achalasia. This procedure is proposed to be a less invasive alternative to conventional laparoscopic Heller-myotomy with Dor-fundoplicatin(LHD), previous studies have shown that POEM may result in a higher incidence of gastroesophageal reflux disease(GERD)compared...

The Starlet high-resolution manometry (HRM) system is currently used in Japan. HRM provides integrated relaxation pressure (IRP) of which value represents adequacy of lower esophageal sphincter (LES) relaxation. The upper limit of normal IRP for the Starlet was proposed as 26 mmHg using healthy subjects. However, few studies have addressed whether...

Background and aim: Achalasia is a disease characterized by inadequate relaxation of the lower esophageal sphincter (LES) and impaired peristalsis, for which esophageal motor function testing is essential in making a definitive diagnosis. However, the diffusion rate of esophageal pressure testing in Japan is low. We, therefore, examined whether ac...

Background Lemmel syndrome is a rare condition that leads to cholangitis and/or pancreatitis due to intraduodenal diverticulum. Surgery is considered for the treatment of severe or repeated symptoms in patients with this condition. Case presentation An 81-year-old woman was admitted to our hospital, complaining of general fatigue, BT 38.8 degree,...

Background Noncardiac chest pain often coexists with dysphagia in patients diagnosed with achalasia. The current standard treatment for achalasia, laparoscopic Heller myotomy with Dor fundoplication, has an insufficient effect on noncardiac chest pain. The aim of this study is to investigate the efficacy of circumferential Heller myotomy on esophag...

Background and aim The relationship between gastroesophageal reflux disease (GERD) and sleep disturbance has recently been pointed out and is garnering substantial attention. Although there are reports that point out the effectiveness of medical treatment for sleep disturbance associated with GERD, examinations of the pathological condition, includ...

Purpose: To compare the treatment results of needlescopic surgery with those of the conventional method for achalasia, using propensity score-matching. Methods: Propensity score-matching was performed based on five factors: age, gender, body mass index, extended form, and maximum expansion diameter, to extract 28 cases each for a needlescopic gr...

A 43-year-old man was referred to our hospital from a nearby clinic with a painful swelling (sense of tumor) in the neck as a case of suspected thyroid tumor. Enhanced computed tomography (CT) at our hospital showed a thyroid mass measuring 60 mm in diameter and another mass in the superior mediastinum with calcification and a clear margin. Aspirat...

Background Chest pain reduces the quality of life of patients with achalasia. Although laparoscopic Heller-Dor surgery (LHD) is a standard surgical treatment for achalasia, its therapeutic efficacy for chest pain is not clear. The present study evaluated the therapeutic efficacy of LHD for chest pain and tried to identify factors associated with th...

Background In our institution, laparoscopic Heller-Dor procedure (LHD) has been the first-line surgical procedure for achalasia since the introduction in August 1994, and 578 patients underwent LHD until January 2018. In January 2016, per-oral endoscopic myotomy (POEM) was started, taking into patients’ needs into consideration. Since then, treatme...

Background Erosive gastro-esophageal reflux disease (e-GERD) is associated with various symptoms caused by reflux of acid and gastric contents from the stomach to the esophagus. In general, it seems that as the duration of the disease is longer, surgical outcomes are inferior because of disease progression. The aim of this study is to evaluate the...

Purpose: There is some debate about whether preoperative balloon dilation influences the outcomes of laparoscopic Heller-Dor surgery (LHD), with no consensus opinion as yet. Thus, we investigated if preoperative dilation influences the treatment outcomes of LHD for achalasia. Methods: The subjects of this study were 526 patients with achalasia w...

Background Surgical results of GERD have mainly been reported from the Western countries, with a few reports found in Japan. We examined the surgical results of laparoscopic Toupet fundoplication and clarify the characteristics of recurrent cases. Methods The subjects included 375 patients who underwent laparoscopic Toupet fundoplication from June...

Background High-resolution manometry (HRM), which is breakthrough testing equipment to evaluate esophageal motor function, was developed in Europe and United State and has garnered attention. Moreover, multichannel intraluminal impedance pH (MII-pH) testing has allowed us to grasp all liquid/gas reflux including not only acid but also non-acid refl...

Background: Clinical role of low-dose aspirin (LDA) in pathogenesis of gastroesophageal reflux disease is by far controversial. This can be attributed to the paucity of basic research detailing the mechanism of LDA-induced esophageal mucosal injury (EI) on underlying chronic acid reflux esophagitis (RE). Aim: The aim of this study was to clarify...

Background: The modalities for evaluating acid reflux in medical care for gastroesophageal reflux disease (GERD) include conventional pH (C-pH), wireless pH (Bravo(®)) and multichannel intraluminal impedance pH (MII-pH), which have been reported to vary with respect to the duration of acid reflux. In this study, we examined the difference between...

Background: Balloon dilatation is reportedly less effective for young patients with esophageal achalasia than for older patients. However, there is no consensus on the impact of prior balloon dilatation on outcomes of surgical treatment. This study investigated the significance of preoperative balloon dilatation on surgical outcomes in young patie...

PurposeIn the present study, we examined how the body mass index (BMI) affected the outcomes of laparoscopic fundoplication for GERD in patients, whose backgrounds were matched in a propensity score-matched analysis. Methods We divided the patients into two groups (BMI <25 kg/m2 and BMI ≥25 kg/m2). The following background information was matched f...

Purpose Although laparoscopic Heller myotomy and Dor fundoplication (LHD) is widely performed to address achalasia, little is known about the learning curve for this technique. We assessed the learning curve for performing LHD. Methods Of the 514 cases with LHD performed between August 1994 and March 2016, the surgical outcomes of 463 cases were e...

Background Achalasia is a rare disease with a morbidity of 1 in 100,000, for which the exact mechanism of pathogenesis has not been clarified due to the small total number of patients. We herein report on our experience with two cases of familial achalasia in which the involvement of genetic inheritance was suspected. Case presentationThese cases c...

Purpose: Esophageal achalasia can be roughly divided into non-sigmoid and sigmoid types. Laparoscopic surgery has been reported to be less than optimally effective for sigmoid type. The aim of this study was to examine the impact of the esophageal flexion level on the clinical condition and surgical outcomes of patients with sigmoid esophageal ach...

Purpose: Laparoscopic fundoplication (LF) has become a standard operative procedure for GERD-related diseases in Japan, although meta-analyses have mainly evaluated findings from Western countries. The propensity score matching method was used to compare and investigate the treatment outcomes of two fundoplication procedures (the Nissen and Toupet...

Introduction: The standard surgical treatment for Gastroesophageal reflux disease (GERD) is laparoscopic fundoplication (LF). The lower esophageal sphincter (LES) is known to be an important factor in the pathology of GERD. In this study we examined the effects of preoperative LES pressure (LESP) on the treatment outcome of LF. Patients and methods...

Background Esophageal achalasia is a relatively rare disease that occurs usually in middle-aged patients. The laparoscopic Heller–Dor (LHD) procedure is the gold-standard surgical treatment for esophageal achalasia. There are many studies on the pathology and surgical outcome of esophageal achalasia from various perspectives, but there are no studi...

Background Combined multichannel intraluminal impedance and pH monitoring (MII–pH) is the gold standard for diagnosing gastroesophageal reflux (GER), but there are no concrete data for a Japanese population. The aim of this study is to determine the standard values of MII–pH for a Japanese population. Methods Twenty healthy Japanese volunteers with...

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 ben...

Purpose The number of operations for laparoscopic antireflux surgery in Japan is much less than that in Western countries. This study’s aim was to evaluate outcome measures for redo antireflux surgery (redo-ARS) in Japanese patients. Methods Subjects consisted of 11 patients (2.3 %) who required redo-ARS, from an original group of 474 patients who...

The aim of this study was to investigate high-resolution manometry (HRM) findings in symptomatic post-fundoplication patients with normal endoscopic configuration. A retrospective review of a prospectively maintained database was conducted to identify patients who underwent evaluation with HRM and endoscopy for symptom evaluation after previous fun...

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 laparosco...

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. Variabl...

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 pati...

A 52-year-old male patient was referred to our hospital because of a 2-year history of dysphagia with suspected diffuse esophageal spasms. Upper gastrointestinal endoscopy and chest computed tomography showed no apparent abnormalities. Conventional esophageal manometry indicated that the lower esophageal sphincter (LES) pressure and the residual pr...

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...

A middle school girl started a diet; she developed an eating disorder, and was diagnosed with anorexia nervosa. Endoscopic examination revealed no esophagitis due to gastric reflux, but slackness was seen in the cardiac region. Multichannel intraluminal impedance pH monitoring revealed marked non-acidic reflux. On the basis of positive symptom inde...

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 w...

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, hig...

Objective assessment of postfundoplication anatomy is of utmost importance especially if reoperative intervention is being planned. There is a lack of uniformity in the description of endoscopic findings in these patients. The purpose of this study was to propose a classification for standardized endoscopic reporting of postfundoplication anatomy....

Redo fundoplication (RF) is the mainstay of treatment for failed fundoplication. A subset of patients with failed fundoplication requires Roux-en-Y reconstruction (RNY) for symptom relief. The aim of this study was to compare the long-term subjective outcomes between RF and RNY in patients with failed fundoplication. After Institutional Board Revie...

Three lower esophageal sphincter (LES) characteristics associated with gastro-esophageal reflux disease (GERD) are, LES pressure = 6 mmHg, abdominal length (AL) <1 cm and overall length (OL) <2 cm. The objective of this study was to validate this relationship and evaluate the extent of impact various LES characteristics have on the degree of distal...

Achalasia (Ach), diffuse esophageal spasm (DES), nutcracker esophagus (NE), and nonspecific motility disorder (NSMD) are described primary esophageal body motility disorders; however, their clinical symptom correlation is poorly understood. The aim of this study is to examine the association between a patient's presenting symptoms and their manomet...

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/fema...

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 p...

There has been an increase in the number of patients seeking treatment after an anti-reflux surgical procedure. The objective of this study is to describe high-resolution manometry (HRM) topography as it relates to the post-fundoplication anatomy. Retrospective review of a prospectively maintained database was conducted to identify patients who und...

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...

Study objective was to compare high-resolution impedance manometry (HRIM) findings between patients with and without dysphagia. After Institutional Review Board approval, a prospectively maintained database was reviewed to identify patients who underwent HRIM. Patients without upper endoscopy within 7 days of manometry, patients with achalasia, his...

Recurrent hiatus hernia is frequently found in patients undergoing reoperative antireflux surgery. The objective of this study is to report perioperative complications and subjective and objective outcomes for patients who underwent reoperative intervention for symptomatic large recurrent hiatus hernia. Retrospective review of a prospectively maint...

The objective of this study was to investigate the role of lower esophageal sphincter (LES) length and pressure on acid exposure with high-resolution manometry (HRM). After Institutional Review Board approval, a retrospective review of a prospectively maintained database identified patients who had undergone HRM and 24-hour pH studies. Abdominal LE...

The objective of this study was to evaluate the association between high-resolution manometry (HRM) and impedance findings and symptoms in patients with nutcracker esophagus (NE). After institutional review board approval retrospective review of a prospectively maintained database identified patients who were diagnosed with NE as per the Chicago cl...

Background: Reports on quality of life (QOL) after minimally invasive esophagectomy (MIE) have been limited. This report compares perioperative outcomes, survival, and QOL after MIEs with open transthoracic esophagectomy (TTE) and open transhiatal esophagectomy (THE). Methods: After institutional review board approval, retrospective review of a...

The objective of this study is to explore the prognostic implications of lymphadenectomy in esophageal cancer patients after neo-adjuvant therapy. Retrospective review of a prospectively maintained database identified esophageal cancer patients with locoregional disease who received neo-adjuvant therapy and surgery. Patients were grouped based on t...

Preoperative endoscopic assessment of the failed fundoplication is instrumental in diagnosis and surgical management. Endoscopy is a routine and essential part of the workup for a failed fundoplication, but no clear guidelines exist for reporting endoscopic findings. This study aimed to compare endoscopic findings reported by community physicians (...

The effect of myotomy for achalasia on chest pain has not been clarified. The current study aimed to investigate the therapeutic effect of laparoscopic myotomy on chest pain associated with achalasia and to identify prognostic factors for outcomes. Between March 2005 and September 2008, 95 patients were available for detailed interviews and for ass...

The mechanisms responsible for development of gastric carcinoid tumors (type I carcinoids) in type A atrophic gastritis are hyperplasia of enterochromaffin-like cells that are associated with hypergastrinemia, and tumorigenesis. Endoscopic resection and gastrectomy are applied as treatment modalities for gastric carcinoids associated with gastrin h...

A 41-year-old woman was admitted due to dysphagia and weight loss of 6 kg. An upper gastrointestinal radiographic contrast study demonstrated an S-shaped lower esophagus with a peak transverse diameter of 65 mm. Moreover, an epiphrenic diverticulum was also detected in the lower part of the esophagus (50 x 40 mm). The measurement of intraesophageal...

Laparoscopic fundoplication is the current standard operation for gastroesophageal reflux disease and achalasia. An esophageal bougie is often placed for constructing a wrap or performing myotomy easily during the operation. The surgical complications reportedly include hemorrhage, esophageal perforation, gastric perforation, and vagus nerve damage...

A 30-year-old man was referred to our hospital in October 2006 for asymptomatic free air in the peritoneal cavity found on a plain chest X-ray on a routine health examination. Esophagogastroduodenoscopy (EGD) revealed an ulcer scar and deformity of the duodenal bulb, a healing-phase ulcer in the anterior wall of the upper gastric corpus, gradeB eso...

A male patient in his thirties was referred with dysphagia lasting 8 years. He had a history of a laparotomy for a testicular tumor in his twenties. From an upper gastrointestinal contrast X-ray, he was diagnosed to have sigmoid-type achalasia (greatest transverse diameter, 80 mm). Hand-assisted laparoscopic Heller-Dor surgery was performed because...

The case was a 30-year-old woman found to have a 7-cm mass around the pancreatic head during a company health examination. No abnormal values other than anemia were observed in the physical findings, blood exam, and various tumor markers at the initial visit. An abdominal computed tomography (CT) revealed a tumor, 6.5cm in diameter, accompanying a...

A-67 year-old man reporting dysphasia was found in endoscopy to have a submucosal tumor 30mm in diameter 18cm from the incisor in the cervical esophagus. In a surgical procedure incising the skin in an arc in his left cervix, we confirmed the lesion was located in the posterior esophageal wall after the esophagus was manipulated sufficiently throug...