Fabian Emura

Universidad de La Sabana, Chía, Cundinamarca, Colombia

Are you Fabian Emura?

Claim your profile

Publications (50)173.38 Total impact

  • Source
    FABIÁN EMURA · JORGE IVÁN LIZARAZO
    [Show abstract] [Hide abstract]
    ABSTRACT: El cáncer gástrico es la causa más frecuente de cáncer en países de Asia Oriental, Europa Oriental y algunas regiones de Latino América. El pronóstico del cáncer gástrico avanzado es pobre, sin embargo, el pronóstico del cáncer gástrico temprano (CGT) es muy favorable con datos de sobrevida libre de enfermedad a cinco años, que alcanzan el 100%. El diagnóstico temprano se logra realizando una endoscopia de tamizaje completa, detallada y de alta calidad. Recientemente, se ha propuesto la endoscopia sistemática alfanumérica codificada (SACE), la cual ha probado su eficacia en Colombia al diagnosticar CGT a una tasa de 0,3% en individuos sanos de riesgo medio. Una vez diagnosticado el CGT, la endoscopia terapéutica desempeña un papel fundamental en el tratamiento curativo de la enfermedad. Entre las diferentes técnicas de resección, la disección endoscópica de la submucosa (ESD) ha demostrado excelentes tasas de curabilidad y resultados de sobrevida a cinco años similares a la gastrectomía, pero con menos morbilidad, constituyéndose actualmente en el tratamiento de elección en estos casos. Fundamentos espaciales y visuales, además de entrenamiento bajo la dirección de expertos calificados en centros de formación acreditados, son necesarios para adquirir competencia en ESD. Estas bases educacionales, tanto para el diagnóstico, como para el tratamiento del CGT, son fundamentales para aumentar la frecuencia y la tasa de curabilidad del cáncer gástrico en Latino América y el mundo.
    Preview · Article · Sep 2015
  • [Show abstract] [Hide abstract]
    ABSTRACT: Large multicenter gastric cancer endoscopic submucosal dissection (ESD) studies conducted at major Japanese institutions have reported en bloc resection, en bloc tumor-free margin resection, and curative resection rates of 92.7% to 96.1%, 82.6% to 94.5%, and 73.6% to 85.4%, respectively, with delayed bleeding and perforation rates of 0.6% to 6.0% and 3.6% to 4.7%, respectively. Although ESD is currently an alternative treatment in some countries, particularly in Asia, it remains uncertain whether ESD therapeutic outcomes in Western endoscopy settings can be comparable to those achieved in Japan. To evaluate the ESD therapeutic outcomes for differentiated early gastric cancer (EGC) in a Western endoscopy setting. Consecutive case series performed by an expertly trained Western endoscopist. Fifty-three patients with 54 lesions. ESD for early gastric cancers (T1) satisfying expanded inclusion criteria. En bloc resection, en bloc tumor-free margin resection, and curative resection rates were 98%, 93%, and 83%, respectively. The delayed bleeding rate was 7%, and the perforation rate was 4%. The mean patient age was 67 years, and the mean tumor size was 19.8 mm, with 54% of the lesions located in the lesser curvature. The median procedure time was 61 minutes, with ESD procedures 60 minutes or longer associated with submucosal fibrosis (P < .001) and tumor size 25 mm or larger (P = .03). In every ESD procedure, both circumferential incision and submucosal dissection were performed by using a single knife. Two of the 4 delayed bleeding cases required surgery, and all perforations were successfully managed by using endoscopic clips. Long-term outcome data are currently unavailable. ESD for differentiated EGC resulted in favorable therapeutic outcomes in a Western endoscopy setting comparable to those achieved at major Japanese institutions. Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
    No preview · Article · May 2015 · Gastrointestinal endoscopy

  • No preview · Article · May 2014 · Gastrointestinal Endoscopy

  • No preview · Article · May 2014 · Gastrointestinal Endoscopy
  • Fabian Emura · Todd H Baron · Ian M Gralnek

    No preview · Article · Apr 2013 · Gastrointestinal endoscopy
  • Fabian Emura · Ian Gralnek · Todd H Baron
    [Show abstract] [Hide abstract]
    ABSTRACT: Despite extensive worldwide use of standard esophagogastroduodenoscopy (EGD) examinations, gastric cancer (GC) is one of the most common forms of cancer and ranks as the most common malignant tumor in East Asia, Eastern Europe and parts of Latin America. Current limitations of using non systematic examination during standard EGD could be at least partially responsible for the low incidence of early GC diagnosis in countries with a high prevalence of the disease. Originally proposed by Emura et al., systematic alphanumeric-coded endoscopy (SACE) is a novel method that facilitates complete examination of the upper GI tract based on sequential systematic overlapping photo-documentation using an endoluminal alphanumeric-coded nomenclature comprised of eight regions and 28 areas covering the entire surface upper GI surface. For precise localization or normal or abnormal areas, SACE incorporates a simple coordinate system based on the identification of certain natural axes, walls, curvatures and anatomical endoluminal landmarks. Efectiveness of SACE was recently demonstrated in a screening study that diagnosed early GC at a frequency of 0.30% (2/650) in healthy, average-risk volunteer subjects. Such a novel approach, if uniformly implemented worldwide, could significantly change the way we practice upper endoscopy in our lifetimes. Key words: Endoscopy, digestive system; Gastric cancer; Screening; Anatomic landmarks (source: MeSH NLM).
    No preview · Article · Mar 2013 · Revista de gastroenterologia del Peru : organo oficial de la Sociedad de Gastroenterologia del Peru
  • [Show abstract] [Hide abstract]
    ABSTRACT: given widespread distribution and great importance in education. Ethics is always mentioned, but is little studied or investigated. The Colombian Association of Digestive Endoscopy (ACED) devotes the second part of the "Fundamental Agreement" consensus to the ethical practice of gastrointestinal endoscopy. We approach this topic from an analysis of the resolution of real dilemmas that arise in endoscopic scenarios shaping our practice. This is the way of conceptually appropriating ethical principles and moral values that should permeate the practice of specialists who rely on endoscopy. It is important to note that the end result is not intended to standardize the conduct of doctors. To the contrary, we propose to carry out an ongoing reflection about the continuous conflicts that arise in our specialty which should not be resolved without profound ethical and moral consideration. Materials and methods: This consensus is a social research study. It uses a descriptive and cross-sectional approach which mixes qualitative and quantitative analysis and is based on the Delphi Method. The information used was obtained during the "Fundamental Agreement" event held on June 23, 2012 by the Colombian Association of Digestive Endoscopy (ACED). Qualitative data were taken from four roundtable discussions in which the 34 participants discussed the 21 proposed ethical dilemmas. Quantitative data used include the final voting, individual private electronic surveys. Consensus was defined as agreement of 75% or more of participants. Speech analysis was used for qualitative analysis. It was oriented around from five variables related to moral and ethical aspects of the practice of endoscopy. For quantitative analysis, basic descriptive statistics centered on percentages were used. Results: Some of the consensus obtained were: 80.65% agreed to consult with the group that they replace in a particular institution; 80.54% shared the opinion that the type of contract limited research, educational, institutional and even personal development; 78.12% agreed that recognition of group work prevails over recognition of individual work in intellectual production, 100% agreed every individual involved in writing and publication should receive individual credit for their work; 80.64% agreed that the relationship of the patient to the health system determined the kind of attention that is given, and 90.82% agreed that the quality of care was affected by the number of patients who require care. Conclusions: The Colombian consensus agrees that resolution of ethical dilemmas that arise in real-world scenarios in the practice of endoscopy should consider ethical and moral values specifically related to the particular situation faced by the specialist. Thus, conflicts related to contractual or employment issues have to consider the dignity of, and respect for, colleagues. Similarly, equality and justice as values and principles that prevail within these scenarios must be considered. Intellectual property rights require responsibility and honesty as guiding principles when situations of group or individual recognition are confronted. Endoscopists' professional relationships with patients should be framed within values and ethics including prudence, humanity, truthfulness, and choosing the lesser evil. In turn, the specialist's relations with her or his team should respect collegiality, autonomy, the right to an individual's good name, dignity and equality. A culture that promotes ethics, responsibility, humanity and charity must prevail for ethical training. © 2013 Asociaciones Colombianas de Gastroenterología, Endoscopia digestiva, Coloproctología y Hepatología.
    No preview · Article · Jan 2013 · Revista Colombiana de Gastroenterologia
  • Source
    Fabian Emura · Ian Gralnek · Yasushi Sano · Todd H. Baron
    [Show abstract] [Hide abstract]
    ABSTRACT: Despite extensive worldwide use of standard esophagogastroduodenoscopy (EGD) examinations, gastric cancer (GC) is one of the most common forms of cancer and ranks as the most common malignant tumor in East Asia, Eastern Europe and parts of Latin America. Current limitations of using non systematic examination during standard EGD could be at least partially responsible for the low incidence of early GC diagnosis in countries with a high prevalence of the disease. Originally proposed by Emura et al., systematic alphanumeric-coded endoscopy (SACE) is a novel method that facilitates complete examination of the upper GI tract based on sequential systematic overlapping photo-documentation using an endoluminal alphanumeric-coded nomenclature comprised of eight regions and 28 areas covering the entire surface upper GI surface. For precise localization or normal or abnormal areas, SACE incorporates a simple coordinate system based on the identification of certain natural axes, walls, curvatures and anatomical endoluminal landmarks. Efectiveness of SACE was recently demonstrated in a screening study that diagnosed early GC at a frequency of 0.30% (2/650) in healthy, average-risk volunteer subjects. Such a novel approach, if uniformly implemented worldwide, could significantly change the way we practice upper endoscopy in our lifetimes.
    Full-text · Article · Jan 2013 · Revista de gastroenterologia del Peru: organo oficial de la Sociedad de Gastroenterologia del Peru
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose of the work. The practice of endoscopy in Colombia was modified when Resolution 1043 of 2006 authorized specialists in general surgery, internal medicine and pediatrics to perform endoscopy after completing one year of training in endoscopy at an institution of higher education. This, together with the development of relationships with different specialties within endoscopy, generated a disordered scenario which many considered to be unjust and unequal. Training requirements became differentiated. A world of tensions and interests among specialists, scientists, health care providers and service providers led to this consensus. Starting with fundamental agreements, it makes recommendations for unification of educational features that will allow endoscopic practices which aim for quality and whose central axis is the best interest of our patients.
    Full-text · Article · Sep 2012 · Revista Colombiana de Gastroenterologia

  • No preview · Article · Jul 2012 · Gastrointestinal endoscopy
  • Fabian Emura · Juan C. Mejia · Camilo Osorio · Hiroyuki Ono

    No preview · Article · Apr 2012 · Gastrointestinal Endoscopy

  • No preview · Article · Apr 2011 · Gastrointestinal Endoscopy

  • No preview · Article · Apr 2011 · Gastrointestinal Endoscopy
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: La cromoendoscopia de magnificación es una nueva y atractiva herramienta que permite un análisis detallado de la arquitectura morfológica de los orificios de las criptas de la mucosa. En esta revisión describimos, principalmente, la eficacia de la cromoendoscopia de magnificación y de la colonoscopia de magnificación con NBI para el diagnóstico diferencial de las lesiones colorrectales, incluyendo una distinción entre lesiones neoplásicas y no-neoplásicas y también entre cáncer temprano tratable endoscópicamente o no, basados en una revisión de la literatura. Hemos conducido un estudio prospectivo mostrando que una combinación de la colonoscopia de magnificación y la cromoendoscopia es actualmente un método más confiable que la colonoscopia convencional y la cromoendoscopia para la distinción entre lesiones neoplásicas y no-neoplásicas del colon y del recto. La colonoscopia de magnificación con NBI es tan precisa como la cromoendoscopia de magnificación. Nosotros utilizamos colonoscopia de magnificación con NBI más que la cromoendoscopia para distinguir de rutina los pólipos neoplásicos de los no-neoplásicos. Los colonoscopistas pueden predecir la profundidad de la invasión del cáncer colorrectal por medio de la cromoendoscopia de magnificación, la colonoscopia de magnificación con NBI y a través del signo de no-levantamiento. Entre estos métodos, la cromoendocopia de magnificación es el más confiable, con una exactitud, sensibilidad y especificidad de 98,8%, 85,6% y 99,4%, respectivamente. Aunque su confiabilidad depende de la habilidad del que hace la observación, la difusión de las aplicaciones de la técnica de magnificación podría influir en las indicaciones de biopsias de muestreo durante la colonoscopia y en las de mucosectomía.
    Full-text · Article · Mar 2011 · Revista Colombiana de Gastroenterologia
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The electrosurgical knives required to perform endoscopic submucosal dissection (ESD) have recently passed the 510(k) premarketing evaluation by the U.S. Food and Drug Administration and are now available for purchase in the United States. Challenges to ESD being more widely performed in the United States include the lack of intensive hands-on training programs and a low incidence of appropriate, highly dysplastic gastric lesions on which an ESD-trained endoscopist can begin performing this procedure in patients. Furthermore, there are no guidelines regarding the safety of continuing antiplatelet therapy in patients undergoing ESD. To report on the first gastric ESD performed in the United States by using recently approved electrosurgical knives on a patient who was maintained on aspirin therapy. Case report. Large academic medical center. One patient with a 2-cm high-grade dysplasia (HGD) lesion in the posterior antrum who had indwelling coronary stents and was maintained on aspirin therapy throughout the periprocedural period. High-definition white-light and narrow-band imaging endoscopy, endosonography, and ESD by using recently approved electrosurgical knives. Complete resection of the HGD gastric lesion. En bloc complete resection of the HGD gastric lesion was achieved without any immediate or delayed bleeding or perforation. No residual or recurrent dysplasia was found on 1- or 3-month follow-up endoscopies. Generalizations cannot be made from this single case. After receiving intensive hands-on training in both ex vivo and in vivo animal models, gastric ESD was successfully performed by 2 U.S. endoscopists by using recently approved electrosurgical knives in a patient maintained on aspirin therapy without any complications.
    Full-text · Article · Nov 2010 · Gastrointestinal endoscopy
  • [Show abstract] [Hide abstract]
    ABSTRACT: The presence of meshed capillary (MC) vessels is highly sensitive (96%) and specific (92%) for diagnosing colorectal neoplasia on colonoscopy by using narrow-band imaging (NBI) with optical magnification, which is not available in North America. However, the efficacy of NBI to identify an MC pattern without optical magnification has not been determined. To determine the diagnostic capabilities of NBI colonoscopy without optical magnification in differentiating neoplastic from non-neoplastic colorectal polyps by using the MC pattern. Retrospective comparison of prospectively collected colorectal polyp data. Large, academic medical center. This study involved 126 consecutive colorectal polyps (median size 3 mm) that were found in 52 patients (33 men) with a median age of 59.5 years. All lesions identified by white-light colonoscopy were prospectively diagnosed in real-time by using the MC pattern as determined on high-definition NBI, with 1.5x zoom but without true optical magnification, and then endoscopically excised. Surgical pathology was used as the criterion standard. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of identifying neoplastic polyps were calculated. NBI without optical magnification was found to have a sensitivity of 93%, specificity of 88%, positive predictive value of 90%, negative predictive value of 91%, and diagnostic accuracy of 91% when all polyp sizes were considered. For lesions < or =5 mm, sensitivity was 87%, specificity was 93%, positive predictive value was 89%, negative predictive value was 91%, and diagnostic accuracy was 90%. Single-center, single-endoscopist experience. Use of the MC pattern on NBI colonoscopy without optical magnification effectively distinguishes neoplastic from non-neoplastic colorectal polyps. NBI colonoscopy without optical magnification for neoplastic polyp diagnosis appears to be comparable with NBI with optical magnification when the MC pattern is used. A large, prospective trial is needed for further validation.
    No preview · Article · Apr 2010 · Gastrointestinal endoscopy

  • No preview · Article · Apr 2010 · Gastrointestinal Endoscopy
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Capillary patterns (CP) observed by magnifying Narrow Band Imaging (NBI) are useful for differentiating non-adenomatous from adenomatous colorectal polyps. However, there are few studies concerning the effectiveness of magnifying NBI for determining the depth of invasion in early colorectal neoplasms. We aimed to determine whether CP type IIIA/IIIB identified by magnifying NBI is effective for estimating the depth of invasion in early colorectal neoplasms. A series of 127 consecutive patients with 130 colorectal lesions were evaluated from October 2005 to October 2007 at the National Cancer Center Hospital East, Chiba, Japan. Lesions were classified as CP type IIIA or type IIIB according to the NBI CP classification. Lesions were histopathologically evaluated. Inter and intraobserver variabilities were assessed by three colonoscopists experienced in NBI. There were 15 adenomas, 66 intramucosal cancers (pM) and 49 submucosal cancers (pSM): 16 pSM superficial (pSM1) and 33 pSM deep cancers (pSM2-3). Among lesions diagnosed as CP IIIA 86 out of 91 (94.5%) were adenomas, pM-ca, or pSM1; among lesions diagnosed as CP IIIB 28 out of 39 (72%) were pSM2-3. Sensitivity, specificity and diagnostic accuracy of the CP type III for differentiating pM-ca or pSM1 (<1000 microm) from pSM2-3 (>or=1000 microm) were 84.8%, 88.7 % and 87.7%, respectively. Interobserver variability: kappa = 0.68, 0.67, 0.72. Intraobserver agreement: kappa = 0.79, 0.76, 0.75 Identification of CP type IIIA/IIIB by magnifying NBI is useful for estimating the depth of invasion of early colorectal neoplasms.
    Full-text · Article · Mar 2010 · BMC Gastroenterology
  • Source
    Fabián Emura · Ichiro Oda

    Preview · Article · Mar 2010 · Revista Colombiana de Gastroenterologia
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Gastric cancer is the most common maligancy in South America and East Asia. In addition to the high mortality, in Colombia a great disvantage is the lack of data regarding premalignant lesions and early cancer. Aim: To evaluate the usefulness of systematic chromoendoscopy in the prevalence of early cancer and gastric premalignant lesions. A total of 950 were invited to participate, 800 fulfilled the inclusion criteria and finally 650 were analyzed. Results: None of participants had normal gastric mucosa. Mild antrum gastritis was found in 21.8% (142/650), meanwhile moderate or severe antrum gastritis in 77.4% (508/650). Atrophy and metaplasia was found in 14.5% (94/650) and 15.5% (101/650) respectively. H Pilory infection was found in 7.3%, 79.3% 75.5% 57.4% y 0% of subjects with mild, moderate and severe, atrophy, metaplasia and dysplasia respectively. Gastric premalignant lesion was found in 30% (195/650). Two subjects were diagnosedas early gastric cancer and treated by endoscopic submucosal dissection (ESD) with curability as final result.Conclusions: By systematic chromoendoscopy this series has demonstrated that 1/325 healthy volunteers had early gastric cancer and that 1/33 had a premalignant lesion explaining in part the high prevalence of gastric cancer in the region. Bases on this series, gastric cancer is diagnosable and curable among healthy volunteers in Colombia. © 2010 Asociaciones Colombianas de Gastroenterología, Endoscopia digestiva, Coloproctología y Hepatología.
    Preview · Article · Mar 2010 · Revista Colombiana de Gastroenterologia

Publication Stats

2k Citations
173.38 Total Impact Points

Institutions

  • 2008-2015
    • Universidad de La Sabana
      Chía, Cundinamarca, Colombia
  • 2004-2009
    • National Cancer Center
      • Endoscopy Division
      Tokyo, Tokyo-to, Japan
  • 2006-2007
    • El Bosque University
      Μπογκοτά, Bogota D.C., Colombia
  • 2005
    • National Hospital Organization Kyushu Cancer Center
      Hukuoka, Fukuoka, Japan