記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

Inflammatory myofibroblastic tumor (IMT) is an intermediate malignancy with myofibroblast proliferation and inflammatory cell infiltration with malignant potential. Primary IMTs are predominantly reported in the lungs, while gastric IMTs are very rare. Therefore, no guidelines exist for the diagnosis and treatment of gastric IMTs. The present case is a 39-year-old man diagnosed with an asymptomatic gastric submucosal tumor. Considering the malignancy of the tumor, we selected non-exposed endoscopic wall-inversion surgery as the resection method and successfully performed local resection. Histopathological analysis showed myofibroblast proliferation and inflammatory cell infiltration, with a diagnosis of primary gastric IMT and negative resection margins. Immunohistochemical staining was negative for anaplastic lymphoma kinase. To the best of our knowledge, including our case, there have been 52 reported cases of primary gastric IMTs that have been treated, with several recurrent cases. In this study, we report the first case of local resection of gastric IMT using non-exposed endoscopic wall-inversion surgery, with a literature review.

DOI： 10.1002/deo2.243

PubMed

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Georg Thieme Verlag KG  

DOI： 10.1055/a-2073-3608

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Subclinical stricture after esophageal endoscopic submucosal dissection (ESD) makes the detection and re-ESD of metachronous lesions difficult. This study aimed to investigate the effectiveness of prophylactic steroid use after esophageal ESD for mucosal defects with a circumference less than 75% for the prevention of symptomatic and asymptomatic stricture. METHODS: In 80 retrospectively enrolled patients, we collected paired endoscopic images of a mucosal defects immediately after resection and a scar thereafter. After calculating circumference by image analysis software, all patients were classified into three groups in reference to mucosal defect circumference (MDC; ≤ 50%, 50-75%, ≥ 75%). Frequency of steroid use and symptomatic stricture were compared, and in < 75% MDC patients, a degree of asymptomatic stricture with or without steroid was compared by calculating a scar contraction rate (SCR). RESULTS: In the ≤ 50% (43 patients), 50-75% (27 patients) and ≥ 75% (10 patients) MDC groups, steroids were used in 12%, 59% and 100%, respectively, and symptomatic stricture occurred in 0%, 7% and 40%, respectively. In < 75% MDC patients, SCR in the steroid cohort was significantly lower than that in the nonsteroid cohort (42% vs. 65%, p = 0.002). No steroid-related adverse events occurred. CONCLUSION: Steroid use even for mucosal defects with < 75% circumference appears effective for the reduction of the risk on both symptomatic and asymptomatic stricture after esophageal ESD.

DOI： 10.1007/s00464-023-09988-7

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記述言語：英語  

A 78-year-old man was admitted to our hospital with a tarry stool. Esophagogastroduodenoscopy identified tiny oozing on the greater curvature at the antrum. Despite repeated endoscopic hemostasis by coagulation and clipping, rebleeding occurred. On the third rebleeding, we performed endoscopic hand suturing to completely close the ulcer surface. Biopsy showing massive infiltration of eosinophils at the ulcer edge indicated eosinophilic gastritis. After the endoscopic closure by endoscopic hand suturing, the patient had no symptoms of bleeding thereafter and was discharged 19 days after the procedure by taking oral prednisolone. The patient remained well and was continuously treated with a small dose of steroids in outpatient. This is the first case report of the successful application of endoscopic hand suturing to a refractory hemorrhagic ulcer. Further accumulation of clinical experiences is desired to confirm the usefulness of this technique for the prevention of refractory ulcer bleeding.

DOI： 10.1002/deo2.207

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(株)東京医学社  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(株)東京医学社  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：日本語   出版者・発行元：(株)東京医学社  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Endoscopic suturing of a mucosal defect is expected to prevent postoperative bleeding after endoscopic submucosal dissection (ESD). Endoscopic suturing causes mucosal deformity, which may interfere with endoscopic surveillance thereafter. We retrospectively investigated long-term chronological changes in mucosal suturing by endoscopic suturing. METHODS: Forty-three patients who underwent endoscopic hand suturing (EHS) after gastric ESD at three institutions were enrolled. First, our hypothesis that the suturing sites healed via inflammation, disappearance of mucosal inversion, and flattening was validated. Subsequently, the duration required to reach each healing step was evaluated. RESULTS: A total of 137 follow-up endoscopies were assessed, in which all cases showed the hypothesized chronological course on the suturing sites. The 95th percentiles of the duration when showing the disappearance of the inflammatory change and the inverted change were 63 days and 15.5 months after the procedure, respectively. DISCUSSION/CONCLUSION: The data show that the mucosal deformity induced by EHS disappeared within 16 months. Endoscopic suturing is thus considered to have a negligible effect on endoscopic surveillance following the procedure.

DOI： 10.1159/000527350

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1055/a-1884-0065

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

Abstract

Background

Endocytoscopy (ECS) aids early gastric cancer (EGC) diagnosis by visualization of cells. However, it is difficult for non-experts to accurately diagnose EGC using ECS. In this study, we developed and evaluated a convolutional neural network (CNN)-based system for ECS-aided EGC diagnosis.

Methods

We constructed a CNN based on a residual neural network with a training dataset comprising 906 images from 61 EGC cases and 717 images from 65 noncancerous gastric mucosa (NGM) cases. To evaluate diagnostic ability, we used an independent test dataset comprising 313 images from 39 EGC cases and 235 images from 33 NGM cases. The test dataset was further evaluated by three endoscopists, and their findings were compared with CNN-based results.

Results

The trained CNN required 7.0 s to analyze the test dataset. The area under the curve of the total ECS images was 0.93. The CNN produced 18 false positives from 7 NGM lesions and 74 false negatives from 28 EGC lesions. In the per-image analysis, the accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 83.2%, 76.4%, 92.3%, 93.0%, and 74.6%, respectively, with the CNN and 76.8%, 73.4%, 81.3%, 83.9%, and 69.6%, respectively, for the endoscopist-derived values. The CNN-based findings had significantly higher specificity than the findings determined by all endoscopists. In the per-lesion analysis, the accuracy, sensitivity, specificity, PPV, and NPV of the CNN-based findings were 86.1%, 82.1%, 90.9%, 91.4%, and 81.1%, respectively, and those of the results calculated by the endoscopists were 82.4%, 79.5%, 85.9%, 86.9%, and 78.0%, respectively.

Conclusions

Compared with three endoscopists, our CNN for ECS demonstrated higher specificity for EGC diagnosis. Using the CNN in ECS-based EGC diagnosis may improve the diagnostic performance of endoscopists.

DOI： 10.1186/s12876-022-02312-y

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その他リンク： https://link.springer.com/article/10.1186/s12876-022-02312-y/fulltext.html

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND AND AIMS: Surgery is recommended in early gastric cancer (EGC) after noncurative endoscopic submucosal dissection (ESD), although observation can be an alternative. We aimed to develop a tailor-made treatment strategy for noncurative EGCs by comparing the lymph node metastasis risk (LNMR) and the surgical risk. METHODS: We retrospectively identified 485 patients with differentiated-type, noncurative EGCs removed by ESD and classified them into two groups: a surgery-preferable group and an observation-preferable group, according to the clinical courses. Subsequently, LNMR and surgery-related death risk were assessed using a published scoring system and a risk calculator for gastrectomy, respectively. Finally, we investigated the optimal cutoff value of the risk difference (LNMR minus surgery-related death risk) to efficiently allocate these cases into either of two groups, surgery-preferable or observation-preferable. RESULTS: In 485 patients (surgery in 322, observation in 163), 57 and 428 patients were classified into the surgery-preferable group and the observation-preferable group, respectively. The optimal cutoff value of the risk difference (LNMR minus surgery-related death risk) to allocate the cases to the two preferable groups was 7.85 with the highest area under the curve (0.689). When cases with >7.85 LNMR over the surgery-related death risk were allocated into the surgery-preferable group and vice versa, the discriminability was 73.2%, which was sufficiently higher than that in the clinical decision (44.5%). CONCLUSION: Personalized comparison of LNMR and surgery-related death risk is helpful to provide a favorable treatment option for each patient with EGCs after noncurative ESD.

DOI： 10.1159/000523972

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: It is unclear whether prophylactic endoscopic closure after colorectal endoscopic submucosal dissection (ESD) reduces the risk of postoperative adverse events due to variability in lesion characteristics. Therefore, we conducted a retrospective study using propensity score matching to evaluate the efficacy of prophylactic clip closure in preventing postoperative adverse events after colorectal ESD. METHODS: This single-center retrospective cohort study included 219 colorectal neoplasms which were removed by ESD. The patients were allocated into the closure and non-closure groups, which were compared before and after propensity-score matching. Post-ESD adverse events including major and minor bleeding and delayed perforation were compared between the two groups. RESULTS: In this present study, 97 and 122 lesions were allocated to the closure and non-closure groups, respectively, and propensity score matching created 61 matched pairs. The rate of adverse events was significantly lower in the closure group than in the non-closure group (8% vs. 28%, P = 0.008). Delayed perforation occurred in two patients in the non-closure group, whereas no patient in the closure group developed delayed perforation. In contrast, there were no significant differences in other postoperative events including the rate of abdominal pain; fever, white blood cell count, and C-reactive protein; and appetite loss between the two groups. CONCLUSIONS: Propensity score matching analysis demonstrated that prophylactic closure was associated with a significantly reduced rate of adverse events after colorectal ESD. When technically feasible, mucosal defect closure after colorectal ESD may result in a favorable postoperative course.

DOI： 10.1186/s12876-022-02259-0

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：S. Karger AG  

&lt;b&gt;&lt;i&gt;Background and Aims:&lt;/i&gt;&lt;/b&gt; Noninvasive, imaging diagnosis of gastrointestinal mesenchymal tumors (GIMTs) is still difficult. This study aimed to develop a novel diagnostic method of GIMTs via endoscopic ultrasonography (EUS) using circularity. &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; In a derivation series, we retrospectively collected 50 GIMTs 2–5 cm in diameter of two institutions. After selecting one EUS still image showing the maximal area per lesion, two endoscopists who were blind to the histological diagnosis assessed circularity, a surrogate indicator of roundness (range, 0–1; 1 = a true circle), with an image-analyzing software. Median circularity of three types of GIMT was compared, and the cutoff value to differentiate a group from other groups was presented by drawing a receiver operating characteristic curve. Subsequently, we assessed the diagnostic ability of circularity in 91 GIMTs which were retrospectively collected from the other two institutions by using the optimal cutoff value presented in the derivation series. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; The circularity in leiomyomas indicated 0.70 and was significantly lower than that of gastrointestinal stromal tumors (0.89), schwannomas (0.90), and their combined group. When leiomyomas were diagnosed as the circularity of &amp;#x3c;0.8305, which was presented as the optimal cutoff value, the diagnostic accuracy, sensitivity, and specificity in the validation series were 73.6%, 80.0%, and 72.4%, respectively. &lt;b&gt;&lt;i&gt;Conclusion:&lt;/i&gt;&lt;/b&gt; The data demonstrated that leiomyomas significantly exhibited more distortion than other GIMTs. That implies that the difference in shape, which is objectively determined as circularity, is useful to noninvasively discriminate leiomyomas from other GIMTs.

DOI： 10.1159/000523881

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: It is unclear whether prophylactic endoscopic closure after colorectal endoscopic submucosal dissection (ESD) reduces the risk of postoperative adverse events due to variability in lesion characteristics. Therefore, we conducted a retrospective study using propensity score matching to evaluate the efficacy of prophylactic clip closure in preventing postoperative adverse events after colorectal ESD. METHODS: This single-center retrospective cohort study included 219 colorectal neoplasms which were removed by ESD. The patients were allocated into the closure and non-closure groups, which were compared before and after propensity-score matching. Post-ESD adverse events including major and minor bleeding and delayed perforation were compared between the two groups. RESULTS: In this present study, 97 and 122 lesions were allocated to the closure and non-closure groups, respectively, and propensity score matching created 61 matched pairs. The rate of adverse events was significantly lower in the closure group than in the non-closure group (8% vs. 28%, P = 0.008). Delayed perforation occurred in two patients in the non-closure group, whereas no patient in the closure group developed delayed perforation. In contrast, there were no significant differences in other postoperative events including the rate of abdominal pain; fever, white blood cell count, and C-reactive protein; and appetite loss between the two groups. CONCLUSIONS: Propensity score matching analysis demonstrated that prophylactic closure was associated with a significantly reduced rate of adverse events after colorectal ESD. When technically feasible, mucosal defect closure after colorectal ESD may result in a favorable postoperative course.

DOI： 10.1186/s12876-022-02202-3

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記述言語：日本語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1111/den.14210

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記述言語：日本語   出版者・発行元：日本消化器病学会-関東支部  

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記述言語：英語  

DOI： 10.1016/j.gie.2021.10.007

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：英語  

Esophageal submucosal hematoma is a rare disease mainly caused by mechanical stimulation to the esophageal wall. We reported a case of esophageal submucosal hematoma after transesophageal echocardiography (TEE) which was performed during cardiovascular surgery. The stimuli of TEE insertion under general anesthesia and the perioperative use of multiple antithrombotic agents were considered as a possible cause. This is the first report of esophageal submucosal hematoma related to TEE, and endoscopic ultrasonography should be carefully performed in patients, particularly at bleeding tendency and without consciousness.

DOI： 10.1159/000525036

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Prevention of postoperative anastomotic leakage in rectal surgery is still required. This study investigated the feasibility of endoscopic hand suturing (EHS) on rectal anastomosis ex vivo. By using isolated porcine colon, we prepared ten anastomoses 6-10 cm from the virtual anus. Then, we sutured anastomoses intraluminally by EHS, which involved a continuous suturing method in 5 cases and a nodule suturing method with extra corporeal ligation in 5 cases. Completeness of suturing, number of stitches, procedure time and presence of stenosis were investigated. Furthermore, the degree of stenosis was compared between the two suturing methods. In all cases, EHS were successfully completed. The median number of stitches and procedure time was 8 and 5.8 min, respectively. Stenosis was created in all continuous suturing cases whereas none was seen in nodule suturing cases. The shortening rate was significantly greater in the continuous suturing method than in the nodule suturing method. Intraluminal reinforcement of rectal anastomosis by EHS using nodule suturing with extra corporeal ligation is feasible without stenosis, which may be helpful as a countermeasure against possible postoperative anastomotic leakage in rectal surgery.

DOI： 10.1038/s41598-021-01396-y

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記述言語：日本語   出版者・発行元：(株)東京医学社  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Endoscopic treatments for gastric cancers have still been progressing even after the great success of endoscopic submucosal dissection (ESD). SUMMARY: In further advancements of ESD, safe and less-invasive procedures are challenged by managing postoperative bleeding, one of the major adverse events in ESD. Covering the mucosal defect after removal of lesions appears reasonable and effective for preventing delayed bleeding from the post-ESD ulcers. Shielding with biodegradable sheets is attempted on clinical trials, which show equivocal results. Although suturing of the mucosal rims is technically challenging, pilot studies demonstrate favorable outcomes for avoiding post-ESD bleeding even in cases at high risk. In cases after noncurative resection of ESD, the selection of patients who truly require additional gastrectomy with lymph node dissection is important to provide necessary surgery. Risk stratification of lymph node metastases and surgery has been developed, which offers tailor-made management to each patient considering the risks and benefits. In surgery, function-preserving gastrectomy to minimize the resection area in both lymphadenectomy and the primary site is clinically introduced. The sentinel node navigation surgery is promising to realize the minimally invasive gastrectomy, and it should strongly fit ESD as well as laparoscopic endoscopic cooperative surgery or endoscopic full-thickness resection, although nonexposure approaches are desirable. Key Message: Development for less-invasive managements on gastric cancer will be continued in step with the advancement of endoscopic treatments.

DOI： 10.1159/000518892

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A diagnosis of subepithelial tumors (SETs) is sometimes difficult due to the existence of overlying mucosa on the lesions, which hampers optical diagnosis by conventional endoscopy and tissue sampling with standard biopsy forceps. Imaging modalities, by using computed tomography and endoscopic ultrasonography (EUS) are mandatory to noninvasively collect the target's information and to opt candidates for further evaluation. Particularly, EUS is an indispensable diagnostic modality for assessing the lesions precisely and evaluating the possibility of malignancy. The diagnostic ability of EUS appears increased by the combined use of contrast-enhancement or elastography. Histology is the gold standard for obtaining the final diagnosis. Tissue sampling requires special techniques to break the mucosal barrier. Although EUS-guided fine-needle aspiration (EUS-FNA) is commonly applied, mucosal cutting biopsy and mucosal incision-assisted biopsy are comparable methods to definitively obtain tissues from the exposed surface of lesions and seem more useful than EUS-FNA for small SETs. Recent advancements in artificial intelligence (AI) have a potential to drastically change the diagnostic strategy for SETs. Development and establishment of noninvasive methods including AI-assisted diagnosis are expected to provide an alternative to invasive, histological diagnosis.

DOI： 10.5009/gnl210242

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記述言語：日本語   出版者・発行元：(株)東京医学社  

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記述言語：日本語   出版者・発行元：(株)東京医学社  

早期胃癌ESD非治癒切除症例は「内視鏡的根治度(eCura)C-2症例」と呼ばれ、原則的に追加外科手術が推奨されている。一方、高齢で複数併存疾患を有するいわゆる手術ハイリスク症例では、無治療経過観察も選択肢となる。eCuraC-2症例かつ手術ハイリスクの場合、追加治療方針の決定には病変側因子(病理結果から推測されるリンパ節転移リスク)と患者側因子(年齢や併存疾患から予測される手術リスクおよび非胃癌死を含む生命予後)の両者を考慮する必要がある。現在、病変側因子についてはリンパ節転移リスクを予測するスコアリングシステムが提案され、また患者側因子に関してもさまざまな予後予測指標の有用性や侵襲性の低い術式が模索されている。近い将来、ESD非治癒切除症例における病変側因子と患者側因子の両者を包括的にとらえた、治療方針決定のアルゴリズムの登場が期待される。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)日本メディカルセンター  

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記述言語：日本語   出版者・発行元：(株)東京医学社  

H.pylori感染率が低下するなか、自己免疫性胃炎を診断する機会が増加している。自己免疫性胃炎はさまざまな胃病変を合併するが、本邦多施設共同研究によると過形成性ポリープ21.1%、1型神経内分泌腫瘍(NET)11.4%、胃癌9.8%の発生頻度であった。1型NETは大多数が小病変であるが、転移例も少数報告されており、その予後は良好と考えられている。自己免疫性胃炎に伴う胃癌の特徴は、(1)自己免疫性胃炎が高度に進行した悪性貧血を合併することが多い、(2)肉眼型は0-IIa型または0-I型の隆起型が多い、(3)局在はM領域が約半数だがL領域にも一定程度みられる、(4)組織型は分化型腺癌が多数を占め胃型粘液形質が優勢、(5)大多数が早期胃癌で進行胃癌は稀、である。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)先端医学社  

わが国ではSSBEが多く、欧米ではLSBEが中心となり、背景は異なるものの、Barrett食道は腺がんの発生母地となるため、注目されている。esophagogastric junction(EGJ)の同定方法の違い、腸上皮化生の有無など各ガイドラインの基準の違いにより、Barrett食道の定義はわが国と欧米では異なるが、内視鏡診断の標準化を目的にプラハ分類が作成されている。欧米においてBarrett食道がんは急速に増加しており、わが国においても今後増加することが懸念されている。表在型Barrett食道腺がんはテント状SSBE類似型、噴門部びらん類似型、EGJポリープ類似型に大別できる。内視鏡診断においては画像強調内視鏡を併用した拡大内視鏡観察の内視鏡診断システムが提唱されている。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(株)東京医学社  

内視鏡診療における鎮静の使用頻度は年々上昇しており、外来内視鏡においても例外ではない。これまでの全国調査で、前処置においては鎮静・鎮痛薬に関連する偶発症が最も多いことがわかっている。そうした背景をふまえ2013年に「内視鏡診療における鎮静に関するガイドライン」が作成され、それから7年後の2020年には第2版が作成されるに至った。このガイドラインにおいて、安全に内視鏡検査・治療を遂行するための標準的な指針が示されている。鎮静下内視鏡では中等度の鎮静が至適とされるが、検査数や安全性が求められる外来内視鏡においては、鎮静深度を浅めに設定する必要がある。この微妙な調整を行うためには使用する薬剤のそれぞれの特徴を理解し、患者背景に応じた薬剤の選択など、より細かなマネジメントが求められる。鎮静の安心・安全な運用のために、個々の患者の希望、年齢、合併症、社会的状況、施設の事情によって柔軟に対応する必要がある。(著者抄録)

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Three-dimensional (3D) technology has been used in many fields, including flexible endoscopy. We evaluated the usefulness of 3D visualization for endoscopically diagnosing superficial gastric neoplasia. METHODS: Twelve participants (4 novices, 4 trainees and 4 experts) evaluated two-dimensional (2D) and 3D endoscopic still images of 28 gastric neoplasias, obtained before ESD with white-light imaging (WLI) and narrow-band imaging (NBI). Assessments of the delineation accuracy of tumor extent and tumor morphology under 2D and 3D visualization were based on the histopathological diagnosis of ESD specimens. Participants answered visual analog scale (VAS) questionnaires (0-10, worst to best) concerning the (a) ease of recognition of lesion morphology, (b) lesion extent and (c) comprehensive endoscopic cognition under 2D and 3D visualization. The endpoints were the accuracy of tumor extent and morphology type and the degree of confidence in assessing (a)-(c). RESULTS: The delineation accuracy of lesion extent [mean (95% confidence interval)] with WLI under 3D visualization [60.2% (56.1-64.3%)] was significantly higher than that under 2D visualization [52.3% (48.2-56.4%)] (P < 0.001). The accuracy with NBI under 3D visualization [70.3% (66.8-73.7%)] was also significantly higher than that under 2D visualization [64.2% (60.7-67.4%)] (P < 0.001). The accuracy of the morphology type with NBI under 3D visualization was significantly higher than that under 2D visualization (P = 0.004). The VAS for all aspects of endoscopic recognition under 3D visualization was significantly better than that under 2D visualization (P < 0.01). CONCLUSIONS: Three-dimensional visualization can enhance the diagnostic quality for superficial gastric tumors.

DOI： 10.1186/s12876-021-01829-y

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: Endoscopic hand suturing (EHS) is expected to decrease the risk of post-endoscopic submucosal dissection (ESD) bleeding by closing mucosal defects. We investigated the efficacy of EHS after gastric ESD in patients with antithrombotic agents. METHODS: In this prospective single-arm trial, patients taking antithrombotic agents for cardiovascular disease, arrhythmia, cerebrovascular disease and/or peripheral arterial disease and having <3-cm gastric neoplasms were recruited. The mucosal defects after ESD were closed by EHS in which the needle was delivered through an overtube, and the mucosal rim of the defect was continuously sutured in a linear fashion by manipulating the needle grasped with the needle holder, followed by cutting the remnant suture and retrieval of the needle. The primary endpoint was the incidence of postoperative bleeding within 4 weeks after ESD. RESULTS: Twenty-two lesions in 20 patients (continuing antiplatelet agents in 11, anticoagulant agents in eight, both in one) underwent ESD followed by EHS. All defects (median size, 30 mm; range, 12-51 mm) were completely closed by EHS and remained closed on postoperative day 3. The median number of stitches was six (range, 4-8) and median suturing time was 36 (range, 24-60) min. There were no adverse events during/after EHS or postoperative bleeding. CONCLUSIONS: Postoperative bleeding was not observed in patients taking antithrombotic agents without perioperative cessation. EHS appears to be useful for prevention of post-gastric ESD bleeding in high-risk patients. (Clinical registration number: UMIN000024184).

DOI： 10.1111/den.14045

PubMed

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記述言語：日本語   出版者・発行元：(株)東京医学社  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Jackhammer esophagus (JE) is a rare disease with unclear clinical features. The objective of this study was to retrospectively compare the clinical characteristics of patients with JE whose symptoms were controlled with conservative treatment, such as observation or medication, versus those who were required surgical treatment, such as surgical myotomy or per oral endoscopic myotomy. METHODS: Eighteen patients with JE were included in this study. The patients were divided into two groups: patients who responded to conservative treatment (C group) and patients who were refractory to conservative treatment and underwent surgery (S group). Patient age, sex, disease duration before treatment, symptoms, esophagogastroduodenoscopic (EGD) findings, esophagographic findings, esophageal wall thickness on computed tomography, number of swallows with hypercontractile peristalsis in 10 water swallows, and maximum distal contractile integral (DCI) were compared between the groups. RESULTS: Thirteen of 18 patients (72%) were in the C group and five of 18 (28%) were in the S group. There were no significant differences in age, sex, disease duration before treatment, symptoms, EGD findings, esophagographic findings, esophageal wall thickness, or number of swallows with hypercontractile peristalsis between the groups. On Starlet high-resolution manometry, the median maximum DCI value was significantly higher in the S group (32,651 mmHg-s-cm) than in the C group (17,926 mmHg-s-cm) (P = 0.0136). CONCLUSIONS: JE treatment should be carefully considered because some patients require surgery, whereas others are controlled with conservative treatment alone. A higher DCI value in patients with JE may predict resistance to conservative treatment.

DOI： 10.1007/s10388-020-00748-3

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

With advancements in the development of flexible endoscopes and endoscopic devices and the increased demand for minimally invasive treatments, the indications of therapeutic endoscopy have been expanded. Methods of endoscopic treatment used for tissue removal, hemostasis, and dilatation are as follows. Endoscopic submucosal dissection (ESD) is considered the gold standard curative method for removal of gastrointestinal node-negative neoplasms, regardless of their size or the presence of ulcer formation. Laparoscopic endoscopic cooperative surgery (LECS), which incorporates ESD, was introduced for removal of lesions in deeper layers. Another technique is endoscopic full-thickness resection, which is challenging without the assistance of laparoscopy. In terms of hemostasis, management of iatrogenic bleeding after endoscopic treatment is an important issue. Shielding methods and suturing techniques have been introduced for large mucosal defects after ESD, and their efficacy has been investigated clinically. Peroral endoscopic myotomy (POEM) is a new alternative surgical approach for minimally invasive treatment of esophageal achalasia. Furthermore, endoscopic fundoplication after POEM was devised to prevent post-POEM gastroesophageal reflux disease. Many endoscopic treatments, including ESD, LECS, and POEM, have been introduced in Japan. With the aging of the population, more attention will be directed toward therapeutic endoscopy for elderly patients, because it is less invasive. Development of endoscopic treatments with expanded indications is expected.

DOI： 10.1272/jnms.JNMS.2021_88-109

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Gastrointestinal muscular sampling is useful in the histological assessment of functional gastrointestinal disorders. We devised a new sampling method to obtain a large volume of muscle tissues and then investigated the feasibility and safety of endoscopic muscular resection with a ligation device in an in vivo porcine model. METHODS: After establishing a submucosal tunnel, a rubber band was placed on the muscle tissue by sucking the exposed muscle layer. Thereafter, the established pseudopolyp was removed using an electrocautery snare, and the entry site of the submucosal tunnel was closed endoscopically. This procedure was performed at three sites in the esophagus and stomach of two pigs. The technical success, histology, and survival rate on postoperative day 7 were examined postoperatively. RESULTS: We successfully completed the mentioned procedure in 11 of the 12 sites (92%), without the occurrence of severe adverse events. The median diameters of obtained tissues from the esophagus and stomach, respectively, were 5 mm and 10 mm. Histologically, both the inner and outer muscle layers were included in all specimens. The postprocedural course was found uneventful in both pigs during the observatory period. CONCLUSIONS: Endoscopic muscular resection using a ligation device enabled us to obtain large and thick muscle tissue samples. This approach may facilitate more precise histological assessments of functional gastrointestinal disorders.

DOI： 10.1272/jnms.JNMS.2021_88-602

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A non-neoplastic epithelium (NE) often appears in gastric cancer (GC). We explored the histological features of NE in comparison between HP-eradicated and HP-infected GCs. We enrolled 40 HP-eradicated and 40 HP-infected GCs matched by size, macroscopic and histological type. NE was classified into full gland type and surface type; the former was a non-neoplastic gland isolated within cancer, and the latter was NE on the surface of the cancer. Surface type was additionally divided into NE at the cancer margin (marginal surface type) and NE inside cancer (internal surface type). The primary endpoints were the frequency and the length ratio (the ratio to cancer length) of NE. The secondary endpoints were the relationships between NE and clinicopathological factors, including endoscopic findings of a gastritis-like appearance (GLA), reddish depressed lesion (RDL), and white nodular mucosa (WNM). The frequency and length ratio of the internal surface type in HP-eradicated GCs were significantly higher (82.5% vs 50%, P = 0.005) and larger (11.6 ± 10.6 vs 4.2 ± 9.9, P < 0.001) than those in HP-infected GCs, and the increase was more significant according to the passage of time since HP eradication. The frequency and length ratio of marginal surface type and full gland type were not significantly different between the two groups, but the coexistence of internal surface and full gland types was statistically significant (p < 0.001). The frequencies of GLA, RDLs, and WNM in HP-eradicated GCs were significantly higher than those in HP-infected GCs. GLA-positive GCs were covered more widely by internal surface type than GLA-negative GCs (13.3% vs. 6.6%, P = 0.003). Various types of NE were noted in gastric cancer, and the internal surface type of NE was shown to be significantly linked to HP-eradicated cancer and GLA.

DOI： 10.1371/journal.pone.0248333

PubMed

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：日本消化器病学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(株)先端医学社  

胃がんはHelicobacter pyloriの感染状態・背景粘膜に応じてさまざまな形態と組織型を呈する。現感染・除菌後胃がんはH.pylori関連胃がんとして共通する組織学的特徴があり、腸上皮化生粘膜からは分化型管状腺がん(腸型形質)、腸上皮化生の乏しい胃粘膜からは未分化型腺がん(胃型形質)が生じる。しかし、両者の肉眼形態は異なり、現感染胃がんは隆起型と平坦陥凹型がほぼ半々だが、除菌後胃がんは平坦陥凹型が7割と優勢となり、平坦で色調変化も乏しいことが多くなる。除菌後胃がんでは異型の乏しい上皮ががん表層を被覆する率が高くなり、この場合、拡大内視鏡観察では粘膜微細模様の不整が目立たず胃炎様所見を呈する。さらに、除菌後に地図状発赤・斑状発赤・腺窩上皮過形成が生じ、早期胃がんの内視鏡診断が困難となるため注意を要する。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)日本メディカルセンター  

＜文献概要＞管腔内での確実な創閉鎖を目的として,軟性内視鏡用持針器と外科用縫合糸を用いて連続縫合する内視鏡的手縫い縫合法が開発された.粘膜欠損部を完全に閉鎖し,縫縮の強度も高く,閉鎖の維持も期待できるため,ESDのおもな術後偶発症である後出血や遅発性穿孔の予防策として期待されている.縫合手技の取得には一定の経験が必要と考えられるが,施行医だけでなく,介助者とのコミュニケーションが重要となる.胃ESDにおける臨床での安全性と抗血栓薬服用者における後出血の予防効果に関する報告もされており,他の消化管への応用も期待される.今後,本手技の確立とさらなる適応の拡大が待たれる.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: An appropriate traction of the target lesion is a key for a safe and secure ESD procedure. We proposed the flexible traction method (F-trac) which provided an optimal traction using an endoscopic hand-suturing (EHS) and investigated the usefulness of this technique for gastric ESD in-vivo porcine model. METHODS: In the F-trac method, a lesion was suspended by pulling proximal side of endoscope which was connected to the contralateral side with a barbed suture using the EHS technique just before starting the submucosal dissection. A single endoscopist performed conventional ESD (C-ESD) and F-trac ESD alternately for a total of ten simulating lesions of 3 cm in diameter in a live porcine stomach. The pig was rotated so that each lesion was positioned in the direction of the gravity. The procedure time, technical accuracy, adverse events, and the number of additional injection to the submucosal layer during dissection were evaluated. RESULTS: The total ESD procedure time in the F-trac group was significantly shorter than in C-ESD group (19.0 min vs. 30.6 min, p = 0.039). There were no significant differences between both groups in muscular layer damage, sample damage, perforation, and intraoperative bleeding. The number of additional injection in the F-trac group was significantly fewer than that in C-ESD group (0 times vs. 4.4 times, p = 0.027). CONCLUSIONS: In gastric ESD, F-trac might be useful for shortening the total procedure time. This method can facilitate optimal traction without disturbing the endoscopic visualization and the movement of endoscope.

DOI： 10.1007/s00464-020-07850-8

PubMed

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

目的:当院では食道運動機能障害に対して2018年10月よりPOEMを開始した。今回、その短期成績を検討した。方法:2019年12月までに施行したPOEM16症例を対象とし、対象疾患、施行時間、筋層切開長、術後入院日数、合併症、POEM前後の食道内圧検査所見及び治療効果について後方視的に解析した。結果:原疾患は食道アカラシア(EA)12例、jackhammer esophagus(JE)3例、esophagogastric junction outlet obstruction(EGJOO)1例であった。施行時間は91.0(65-196)分、筋層切開長は8.0(5-21)cmであり、術後の入院日数は3.0(2-5)日間であった。重篤な有害事象は認めなかった。Eckardt scoreは中央値5.5→1.5と有意に改善し(p値=0.005)、F scaleも中央値21.0→11.0と改善を認めた(p値=0.004)、術後2ヵ月に食道内圧検査を施行した13例中、EA9例とEGJOO1例でIRPが中央値29.6→10.1mmHgに低下(p値<0.005)、JE3例ではDCIが中央値8831.4→849.2mmHg/s/cmと低下した。結語:当院においてもPOEMを安全に導入し、良好な成績を示すことができた。今後さらなる症例の蓄積と長期成績についての検討が必要である。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J04450&link_issn=&doc_id=20201225120001&doc_link_id=130007966568&url=https%3A%2F%2Fci.nii.ac.jp%2Fnaid%2F130007966568&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

当院で入院加療された急性下部消化管出血364例のうち急性出血性直腸潰瘍(AHRU)38例の臨床的特徴について検討した。男性20例、女性18例、平均年齢77歳。Performance Status(PS)は3-4が61%。併存疾患として高血圧、糖尿病、悪性腫瘍を多く認めた。患者背景についてAHRU 38例、非AHRU 326例の2群にわけて単変量解析をしたところ、PS≧3以上の症例がAHRU群で有意に多かった。AHRU全38症例に対して大腸内視鏡検査が施行され、52.6%は内視鏡処置が施行され、44.7%は保存加療で経過観察となっていた。初回内視鏡止血処置の割合は、クリップ止血術のみが11例、凝固止血7例、クリップ+凝固止血術1例、クリップ+HSE1例であった。再出血は29%で認められ、再出血11例と非再出血27例について単変量解析を用いて比較検討したが、有意差はなかった。AHRU 38例のうち入院中に死亡した例は24%で、原疾患や併存疾患などの増悪が主な死因であった。死亡例9例と非死亡例29例について単変量解析による比較検討では有意差はなかった。AHRUを認める例では、非AHRUの例と比較してPS3以上の例が有意に多かったが、ADLの低い重症例が多いことが原因と考えられる。基礎疾患や併存疾患の増悪で死亡する例も多く、内視鏡処置だけでなく、全身状態の把握と偶発症の管理が大事と言える。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J04450&link_issn=&doc_id=20201225120004&doc_link_id=130007966569&url=https%3A%2F%2Fci.nii.ac.jp%2Fnaid%2F130007966569&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

記述言語：日本語   出版者・発行元：日本消化器病学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

症例は72歳男性で、健診PET-CTにてFDG集積した胃の精査を希望した。7年前にH.pylori除菌療法の既往有り。上部消化管内視鏡検査で胃体下部前壁小彎寄りに20×8mm大の非癌斑状発赤様の浅い陥凹を認めた。病変の大部分はNBI拡大観察で島状のmicrosurface patternでmicrovascular patternの不整はなく、腸上皮化生の所見であり、接触型光学超拡大内視鏡(ECS)でも異型を認めなかった。陥凹病変の中心部はNBI拡大で非腫瘍と判断したが、ECSで高度異型、予測組織型tub1と診断した。内視鏡的粘膜下層剥離術を施行し、術後経過問題なく自宅退院した。病理診断は早期胃癌、Type 0-IIc、3mm、tub1、pT1a(M)、根治度Aであった。ECS高度異型と診断した部位は高分化型腺癌(tub1)を認め、tub1は一部表層に露出するが大部分の表層は非腫瘍粘膜または低異型粘膜で被覆されていた。

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J04450&link_issn=&doc_id=20201225120020&doc_link_id=130007966634&url=https%3A%2F%2Fci.nii.ac.jp%2Fnaid%2F130007966634&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

症例は60歳男性で、ピロリ除菌5年後の上部消化管内視鏡(EGD)検診で胃前庭部後壁に小びらんを指摘され、3ヵ月後の人間ドックEGDで同病変を生検し、signet ring cell carcinomaと診断され精査・加療目的に紹介受診した。EGDで同部位を6mm、0-IIc、sig、cT1a、UL-と診断し、周囲4点生検でGroup1であったため、内視鏡的粘膜下層剥離術を施行した。病理診断は0-IIc、por2>sig、pT1b2、pUL0、Ly0、V0、pHM0、pVM1と根治度C2であり、幽門側胃切除術を追加した。病理診断は印環細胞癌が固有筋層まで広範囲に浸潤を認めるスキルス胃癌Stage IIであり、消化器外科外来にてS-1化学療法を内服継続中である。

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J04450&link_issn=&doc_id=20201225120021&doc_link_id=130007966633&url=https%3A%2F%2Fci.nii.ac.jp%2Fnaid%2F130007966633&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(株)医学書院  

＜文献概要＞はじめに 早期胃癌に対する内視鏡的粘膜下層剥離術(endoscopic submucosal dissection;ESD)は,その低侵襲性により耐術能の低い高齢者に対しても適応しやすい手技として認識されている.しかし,主な偶発症として挙げられる後出血は抗血栓薬の服用が危険因子の一つとされ,抗血栓薬の服用頻度の高い高齢者においては特に留意すべきものである.一方で,抗血栓薬休薬による血栓塞栓症のリスクも看過できず,安易な休薬は極めて重篤な合併症の引き金になりかねない.したがって,抗血栓薬服用者に対する胃ESDにおいては,抗血栓薬を継続することで可能な限り血栓塞栓症のリスクを回避しつつ,後出血のリスクを極力低減することが理想となる.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Three-dimensional (3D) visualization offers better depth recognition than two-dimensional (2D) imaging, thus helping to provide more useful information. We compared 3D and 2D endoscopy with regard to endoscopic recognition and endoscopic submucosal dissection (ESD) marking for superficial gastric neoplasia. METHODS: ESD marking was performed on half of a neoplasia margin under 2D observation and the on other half under 3D observation for 28 gastric lesions (26 early gastric cancers and 2 adenomas). The accuracy of ESD marking was evaluated based on the distance between the pathological and endoscopic neoplasia margins measured on histology sections of ESD specimens. The technical ease of ESD marking and endoscopic lesion recognition (lesion morphology, lesion extent, and comprehensive endoscopic cognition) were assessed using visual analog scale (VAS) questionnaires. RESULTS: The mean distance between the pathological and endoscopic margins under 3D observation (1.03 ± 0.80 mm) was significantly (p = 0.002) shorter than that under 2D observation (1.94 ± 1.96 mm). The VAS for technical ease of ESD marking under 3D observation was significantly better (p < 0.01) than that under 2D observation. The VAS for all aspects of endoscopic recognition under 3D observation was significantly better (p < 0.01) than under 2D observation. CONCLUSIONS: 3D flexible endoscopy achieved more accurate endoscopic recognition and ESD marking for superficial gastric neoplasia than a 2D approach in a clinical setting of ESD.

DOI： 10.1007/s00464-020-08124-z

PubMed

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：(株)東京医学社  

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記述言語：日本語   出版者・発行元：(株)東京医学社  

食道胃接合部ポリープを「食道胃接合部(食道胃接合部上下2cm)に存在するポリープ」と定義し、病理所見と酸逆流所見(びらん性食道炎、1cm以上のBarrett食道)の有無によって、(1)酸逆流合併円柱上皮型、(2)酸逆流非合併円柱上皮型、(3)酸逆流合併扁平上皮型、(4)酸逆流非合併扁平上皮型、に分類した。食道胃接合部ポリープの約7割が酸逆流所見を合併し、ポリープは酸分泌抑制薬で消失してBarrett食道に置換された。酸逆流合併型は「Barrett食道粘膜由来ポリープ」ともいえる。一方、酸逆流非合併型にはHelicobacter pylori関連過形成性ポリープや乳頭腫(ヒトパピローマウイルス関連)などがあり、酸分泌抑制薬によるポリープ消失は期待できない。Barrett食道腺癌には食道胃接合部ポリープ類似型があるが、食道胃接合部ポリープの癌化例を筆者らは経験していない。食道胃接合部ポリープ類似型癌は酸分泌抑制薬で縮小する症例があり、酸逆流による炎症の関与が推定される。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

管腔内での確実な創閉鎖を目的として,手術で汎用されている外科用縫合糸を内視鏡用軟性持針器で運針し組織を縫合する内視鏡的手縫い縫合法が開発された.軟性鏡下に持針器で湾曲針を把持し,バーブ付き縫合糸を組織に通して連続縫合する本法は,より強固で信頼性のあるtissue apposition methodとして,内視鏡治療後出血予防をはじめ様々な場面で有用となる可能性を秘めている.本手技の確立,普及および適応拡大が期待される.(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本潰瘍学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND AND AIMS: Endoscopic hand-suturing (EHS) provides secure intraluminal mucosal closure and should decrease the risk of adverse events after gastric endoscopic submucosal dissection (ESD). We prospectively investigated the feasibility and safety of EHS after gastric ESD, particularly for preventing post-ESD bleeding. METHODS: Patients scheduled for gastric ESD at 3 institutions were prospectively recruited. Just after ESD, the mucosal defect was closed by EHS. The primary outcome was endoscopic assessment of adequately sustained closure of the defect on postoperative day 3. Endoscopy was performed to assess maintenance of the closure for the primary outcome. During postoperative weeks 3 to 4, patients were interviewed as outpatients about any occurrence of delayed bleeding. RESULTS: Data from 30 patients (15 each who did or did not take antithrombotic agents) were analyzed. Mucosal closure by EHS was completed in 29 of 30 cases (97%) and was well maintained on postoperative day 3 in 25 cases (84%). Emergency endoscopy was required for major postoperative bleeding in 3 cases (10%), including 1 in which suturing had been incomplete. Excluding 1 patient with a remnant stomach, the other 24 with sustained closure had no bleeding, regardless of whether they did or did not take antithrombotic agents (0/11 and 0/13, respectively). No serious adverse events occurred during EHS. CONCLUSIONS: Results show that EHS is feasible and safe with favorable outcomes. Provided that mucosal suturing is successfully completed and sustained, post-ESD bleeding can be decreased even in patients undergoing antithrombotic therapy. (Clinical trial registration number: UMIN 000033988.).

DOI： 10.1016/j.gie.2019.12.046

PubMed

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

DOI： 10.1111/den.13654

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その他リンク： https://onlinelibrary.wiley.com/doi/full-xml/10.1111/den.13654

記述言語：日本語   出版者・発行元：日本消化器病学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(株)東京医学社  

欧米で増加しているBarrett食道癌は、ライフスタイルの欧米化やHelicobacter pylori感染率の低下に伴いGERDが増えたため、本邦においても次第に増加している。表在型Barrett食道癌の初期のものは微小な変化である場合も多く見逃しやすいので、内視鏡観察時には深吸気で十分に観察し、小型Barrett食道癌を3つの類型((1)テント状SSBE類似型)、(2)噴門部びらん類似型、(3)EGJポリープ類似型)に分けて特徴を理解しておくことで、微細な変化の見落としを軽減できると考えられる。また、内視鏡観察の際にはNBI拡大観察も併用することで、病変の存在診断、癌の質的診断の質が向上するが、存在診断に迷った際には生検病理診断も積極的に活用することで、病変の見落としをさらに少なくできる。(著者抄録)

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND/AIMS: Three-dimensional (3D) flexible endoscopy, a new imaging modality that provides a stereoscopic view, can facilitate endoscopic hand suturing (EHS), a novel intraluminal suturing technique. This ex-vivo pilot study evaluated the usefulness of 3D endoscopy in EHS. METHODS: Four endoscopists (two certified, two non-certified) performed EHS in six sessions on a soft resin pad. Each session involved five stitches, under alternating 3D and two-dimensional (2D) conditions. Suturing time (sec/session), changes in suturing time, and accuracy of suturing were compared between 2D and 3D conditions. RESULTS: The mean suturing time was shorter in 3D than in 2D (9.8±3.4 min/session vs. 11.2±5.1 min/session) conditions and EHS was completed faster in 3D conditions, particularly by non-certified endoscopists. The suturing speed increased as the 3D sessions progressed. Error rates (failure to grasp the needle, failure to thread the needle, and puncture retrial) in the 3D condition were lower than those in the 2D condition, whereas there was no apparent difference in deviation distance. CONCLUSION: 3D endoscopy may contribute to increasing the speed and accuracy of EHS in a short time period. Stereoscopic viewing during 3D endoscopy may help in efficient skill acquisition for EHS, particularly among novice endoscopists.

DOI： 10.5946/ce.2019.207

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND AND AIMS: Endoscopic suturing of mucosal defects after endoscopic submucosal dissection (ESD) is expected to prevent postoperative adverse events. We aimed to endoscopically and histologically evaluate the healing process of post-ESD mucosal defects closed with endoscopic hand suturing (EHS) in in vivo porcine models. METHODS: Twelve mucosal defects (2 cm in size) were created in 2 pigs (6 defects per pig). Initially, 2 defects were created: one was closed with EHS (sutured group) and the other was kept open (control group). On postoperative days (PODs) 7 and 14, 2 additional defects were created in each session, and they were treated in the same manner as in the initial procedure. On POD 21, the entire stomach, with the 6 lesion sites, was extracted for histologic evaluation after endoscopic observation. RESULTS: Endoscopically, all sutured sites remained closed in all sessions (PODs 7, 14, and 21). Histologically, on POD 14, the epithelium and muscularis mucosae were appropriately connected. The mucosae were covered with the epithelium without inversion of the mucosal edge in the sutured group, whereas the ulcer bed was exposed in the control group. Furthermore, the degree of neovascularity and fibroblasts in the submucosa was smaller in the sutured group than that in the control group. CONCLUSIONS: Our findings suggest that endoscopic suturing promotes healing of post-ESD mucosal defects histologically in in vivo porcine models. Thus, endoscopic mucosal closure after ESD might be clinically useful for the prevention of delayed perforation/bleeding if secure suturing is performed endoscopically.

DOI： 10.1016/j.gie.2019.12.032

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The diagnosis of achalasia can occasionally be difficult because of the low prevalence of apparent endoscopic abnormal findings, such as dilation and food residue, and lack of "esophageal rosette" in some patients. We have found a new endoscopic finding "Gingko leaf sign", which consists of not being able to see the full extent of the esophageal palisade vessels and a Gingko leaf-shaped morphology of a longitudinal section of the esophagogastric junction at the end of a deep inspiration, in some achalasia patients without "esophageal rosette". The aim of the study was to investigate the prevalence of "Gingko leaf sign" in these patients. METHODS: We retrospectively compared the prevalence of "Gingko leaf sign" between 11 achalasia patients without "esophageal rosette" and 22 age-/gender-matched healthy subjects. The diagnoses of achalasia were based on the results of high-resolution manometry. We also investigated the characteristics of the patients with "Gingko leaf sign". RESULTS: All the patients had "Gingko leaf sign", in contrast to none of the healthy subjects (p < 0.001). Four of 11 patients did not require any therapy. Six of seven patients did not relapse after balloon dilatation, but one patient required per-oral endoscopic myotomy 8 months after balloon dilatation. CONCLUSION: All our achalasia patients without "esophageal rosette" had "Gingko leaf sign". It is possibly a useful endoscopic finding in achalasia patients without "esophageal rosette".

DOI： 10.1007/s10388-019-00684-x

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

日本消化器内視鏡学会は、食道癌に対するESD/EMRガイドラインを作成した。本ガイドラインは、食道癌内視鏡切除の術前診断、適応、切除法、治癒判定、切除後サーベイランスに関する18のclinical questionと、それぞれに対して科学的根拠に基づき系統的な手法により作成した推奨を提示するものである。(著者抄録)

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: In a previous study that used the Starlet high-resolution manometry system to assess integrated relaxation pressure (IRP) in healthy adults, the predicted cutoff value was about 26 mm Hg. However, some patients with achalasia have an IRP value of <26 mm Hg. This study examined the validity of the Starlet IRP cutoff value in patients with achalasia. METHODS: Among 37 patients with achalasia, the percentage of patients with a Starlet IRP value ≥26 mm Hg was calculated. Patients were then classified as IRP-high (IRP ≥26 mm Hg) and IRP-low (IRP <26 mm Hg), and the groups were compared in relation to basal lower esophageal sphincter (LES) pressure, Chicago classification achalasia subtype, and esophagography subtype. RESULTS: Twenty (54%) of the 37 patients had an IRP of ≥26 mm Hg. Basal LES pressure was significantly higher in the IRP-high group than in the IRP-low group. Chicago classification Type II achalasia was most common in the IRP-high group, whereas Type I was most common in the IRP-low group. No significant difference was noted in the distribution of esophagography subtypes between groups. CONCLUSIONS: It is difficult to determine an IRP cutoff value with Starlet. When diagnosing achalasia with Starlet, comprehensive assessment must consider findings other than IRP values. In addition, IRP was associated with Chicago classification type.

DOI： 10.1272/jnms.JNMS.2019_86-608

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(株)東京医学社  

多彩な背景胃粘膜に生ずる胃癌は多様性に富み、適切な内視鏡診断をするためには背景粘膜と組織型・肉眼型の関係を理解する必要がある。Helicobacter pylori未感染胃癌は7つの類型がある。すなわち、(1)胃体部〜穹窿部胃底腺粘膜に生じる4つの類型である。(a)扁平隆起様腺窩上皮型胃癌、(b)ラズベリー様腺窩上皮型胃癌、(c)胃底腺型胃癌、(d)胃カルチノイドと、(2)幽門腺境界近傍の胃底腺粘膜に生じる(e)純系印環細胞癌、さらに(3)幽門輪近傍の胃幽門腺に生じる(f)高分化型管状腺癌、(4)食道胃接合部粘膜に生じる(g)噴門部癌の7つである。Helicobacter pylori関連胃癌(現感染・既感染胃癌)は腸上皮化生粘膜に生じる分化型腺癌と胃底腺領域に生じる未分化型腺癌が基本である。既感染胃癌では隆起型が減少し、陥凹が浅く、全般に平坦化する。(1)同色調で平坦な分化型腺癌、(2)地図状発赤・斑状発赤に類似する分化型腺癌、といった周囲粘膜との相違が乏しい類型があり、除菌後の内視鏡では留意を要する。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

There is the East-West paradox in prevalence and phenotype of colonic diverticula, but colonic diverticular bleeding (CDB) is the most common cause of acute lower gastrointestinal bleeding worldwide. Death from CDB can occur in elderly patients with multiple comorbidities, thus the management of CDB is clinically pivotal amid the aging populations in the East and West. Colonoscopy is the key modality for managing the condition appropriately; however, conventional endoscopic hemostasis by thermal coagulation and clipping cannot achieve the expected results of preventing early rebleeding and conversion to intensive intervention by surgery or transcatheter arterial embolization. Ligation therapy by endoscopic band ligation or endoscopic detachable snare ligation has emerged recently to enable more effective hemostasis for CDB, with an early rebleeding rate of approximately 10% and very rare conversion to intensive intervention. Ligation therapy might in turn reduce long-term rebleeding rates by eliminating the target diverticulum itself. Adverse events have been reported with ligation therapy including diverticulitis of the ascending colon in less than 1% of cases and perforation of the sigmoid colon in a few cases, thus more data are necessary to verify the safety of ligation therapy. Endoscopic hemostasis is indicated only for diverticulum with stigmata of recent hemorrhage (SRH), but the detection rates of SRH are relatively low. Therefore, efforts to increase detection are also key for improving CDB management. Urgent colonoscopy and triage by early contrast-enhanced computed tomography may be candidates to increase detection but further data are necessary in order to make a conclusion.

DOI： 10.1111/den.13547

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

Background and aims To avoid the risk of iatrogenic dissemination during procedures, we have developed a combined laparoscopic and endoscopic surgery with a nonexposure technique for resection of gastric tumors. The study aim was to evaluate the feasibility and safety of non-exposed endoscopic wall-inversion surgery (NEWS) for gastric submucosal tumors (SMTs). Methods Between August 2013 and February 2018, NEWS was performed for 42 patients with gastric SMTs <= 3 cm in diameter at our institution. We retrospectively investigated the patients' backgrounds, operative and perioperative outcomes, tumor pathological characteristics, and follow-up data. Results All tumors were resected with negative margins by NEWS. The median operation time was 198 min, and the median estimated blood loss was 5.0 mL. Adverse events occurred in one patient with pneumonia. All patients were alive without recurrence within the median follow-up period of 29.2 months. The average body weight loss rate was 0.3 +/- 4.0%. No food residue was observed at endoscopic follow-up. Conclusions On the basis of slight body weight loss and the absence of food residue observed in the postoperative endoscopy, NEWS appeared to be safe and feasible for gastric SMTs and to preserve function of the remnant stomach.

DOI： 10.1007/s10120-019-00985-1

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Hindawi Limited  

<italic>Background and Aims.</italic> Three-dimensional (3D) rigid endoscopy has been clinically introduced in surgical fields to enable safer and more accurate procedures. To explore the feasibility of 3D flexible endoscopy, we conducted a study comparing 2-dimensional (2D) and 3D visions for the performance of esophageal endoscopic submucosal dissection (ESD). <italic>Methods.</italic> Six endoscopists (3 experts and 3 trainees) performed ESD of target lesions in isolated porcine esophagus using a prototype 3D flexible endoscope under 2D or 3D vision. Study endpoints were procedure time, speed of mucosal incision and submucosal dissection, number of technical adverse events (perforation, muscle layer damage, and sample damage), and degree of sense of security, fatigue, and eye strain. <italic>Results.</italic> Procedure time and speed of mucosal incision/submucosal dissection were equivalent for 2D and 3D visions in both experts and trainees. The number of technical adverse events using 2D vision (mean [standard deviation], 3.5 [4.09]) tended to be higher than that using 3D vision in trainees (1.33 [2.80]; <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M1"><mml:mi>P</mml:mi><mml:mo>=</mml:mo><mml:mn>.06</mml:mn></mml:math>). In experts, 2D and 3D visions were equivalent. The degree of sense of security using 3D vision (3.67 [0.82]) was significantly higher than that using 2D vision (2.67 [0.52]) in trainees (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M2"><mml:mi>P</mml:mi><mml:mo>=</mml:mo><mml:mn>.04</mml:mn></mml:math>), but was equivalent in experts. The degree of eye strain using 3D vision (3.00 [0.00]) was significantly higher than that using 2D vision (2.17 [0.41]) in trainees, but was equivalent in experts. <italic>Conclusions.</italic> 3D vision improves the sense of security during ESD and may reduce technical errors, especially in trainees, indicating the feasibility of a clinical trial of ESD under 3D vision.

DOI： 10.1155/2019/4051956

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その他リンク： http://downloads.hindawi.com/journals/grp/2019/4051956.xml

記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(株)南江堂  

＜文献概要＞胃の内腔を開放せずに胃の粘膜下腫瘍(SMT)を切除できるnon-exposed endoscopic wall-inversion surgery(NEWS)は,潰瘍を伴うSMTも適応となる.内視鏡下で腫瘍周囲にヒアルロン酸を十分に局注後に,腹腔鏡下で腫瘍周囲の漿膜筋層を切開し,腫瘍を内反させながら漿膜筋層を縫合し,endoscopic submucosal dissection(ESD)テクニックで腫瘍を切除する.NEWSは非穿孔式laparoscopic and endoscopic cooperative surgery(LECS)であり,上皮性腫瘍も適応となる.内視鏡医と腹腔鏡医の密な協力が必要となるが,胃SMTおよび上皮性腫瘍に対して有用な低侵襲性手術である.

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J00393&link_issn=&doc_id=20191003060006&doc_link_id=issn%3D0016-593X%26volume%3D81%26issue%3D11%26spage%3D1130&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0016-593X%26volume%3D81%26issue%3D11%26spage%3D1130&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER JAPAN KK  

BACKGROUND: To investigate the efficacy of long-term (52 weeks) maintenance therapy by 10-mg vonoprazan administration for proton pump inhibitor-resistant reflux esophagitis continued from the preceding study. METHODS: Sixteen patients with proton pump inhibitor-resistant reflux esophagitis (mean age 70.9 years, eight males) in whom endoscopic healing was achieved by 20-mg vonoprazan administration for 4 weeks and maintenance of remission was maintained by 10-mg vonoprazan administration for 8 weeks were enrolled. Endoscopy was performed at 52 weeks after the initiation of maintenance therapy with 10-mg vonoprazan to evaluate whether there was any recurrence of reflux esophagitis. Changes in the gastric mucosa were investigated at 52 weeks. Symptoms were assessed using the frequency scale for the symptoms of gastroesophageal reflux disease and the fast gastrin level at 8 and 52 weeks following the maintenance therapy. RESULTS: Endoscopic remission was maintained at 52 weeks in 15 (93.8%) of the 16 patients with proton pump inhibitor-resistant reflux esophagitis. One patient relapsed with grade C of reflux esophagitis. There were no significant differences in the symptom score at 8 and 52 weeks, nor the gastrin level at 8 and 52 weeks. There was no change in the stomach on endoscopy at 52 weeks. CONCLUSION: Long-term maintenance therapy by 10-mg vonoprazan administration is very effective for proton pump inhibitor-resistant reflux esophagitis patients in whom endoscopic healing was maintained by 8 weeks maintenance therapy with 10-mg vonoprazan administration.

DOI： 10.1007/s10388-019-00676-x

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：英語   出版者・発行元：MOSBY-ELSEVIER  

DOI： 10.1016/j.gie.2019.03.1085

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記述言語：英語   出版者・発行元：MOSBY-ELSEVIER  

DOI： 10.1016/j.gie.2019.03.1109

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background and study aims  Endoscopic full-thickness resection (EFTR) involves several technical issues that need to be addressed. We devised a novel technique termed third-space EFTR and investigated its feasibility and safety in animal models. Methods  Third-space EFTR was performed in three isolated porcine stomachs (ex vivo) and four live pigs (in vivo, 1-week survival). The technique involved a circumferential mucosal incision, submucosal tunnelling on the proximal side, endoscopic suturing of the surrounding mucosa, a circumferential seromuscular incision in the submucosal tunnel, transoral retrieval and entry site closure of the tunnel. The technical outcomes were investigated. Results  In the ex vivo study, the procedure was successfully completed with R0 resection. In the in vivo study, the procedure was completed in all pigs; however, R0 resection failed in one pig owing to snaring resection. All pigs survived without severe adverse events. Conclusions  Our findings indicate that third-space EFTR is feasible and safe. This technique may be useful as a minimally invasive endoscopic option for reliable treatment of small gastric submucosal tumours.

DOI： 10.1055/a-0858-2210

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1055/a-0747-5408

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1055/a-0749-0075

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DOI： 10.1159/000494407

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

症例は65歳男性で、前医の上部消化管内視鏡検査で胃前庭部小彎の0-IIa早期胃癌と診断され、精査加療目的に当院を紹介受診した。生化学検査、血算に明らかな異常はなく、ヘリコバクターピロリ抗体は陽性であった。前庭部小彎前壁寄りに発赤調病変の0-IIaの分化型M癌が認められた。ESDを施行し一括切除した。肉眼所見は大きさが20×15mmの0-IIaの病変で、病理組織学的所見では高分化型腺癌で粘膜層にとどまる病変であった。HE染色を施行し、脈管侵襲やリンパ管侵襲はみられず治癒切除となった。細胞異型が強く、細胞質が淡明な腫瘍細胞が目立ったことから、追加でα-fetoprotein(AFP)およびglypican-3染色を施行した。結果、一部分陽性であり、AFP産生胃癌と診断した。6ヵ月後に内視鏡およびCTにて経過観察を行い、現時点では再発や肝転移はない。

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J04450&link_issn=&doc_id=20181220070016&doc_link_id=130007536290&url=https%3A%2F%2Fci.nii.ac.jp%2Fnaid%2F130007536290&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

DOI： 10.1016/j.gie.2018.05.002

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s10120-018-0865-3

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.2169/internalmedicine.0069-17

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Tokyo  

Background: Laparoscopic wedge resection (LWR) is widely performed for managing gastric submucosal tumors (SMTs). Despite the development of novel procedures such as laparoscopy–endoscopy cooperative surgery (LECS) and nonexposed endoscopic wall-inversion surgery (NEWS), the most appropriate surgical intervention for gastric SMTs remains unclear. Methods: We retrospectively reviewed patient characteristics, surgical outcomes, postoperative courses, results of histopathological examinations, and surgical costs of 71 consecutive patients who underwent LWR, LECS, or NEWS for gastric SMTs from January 2010 to June 2016 in our institute. Results: LWR, LECS, and NEWS were performed in 31, 14, and 26 cases, respectively. Patient backgrounds were comparable between groups. LWR was not performed for esophagogastric (E–G) junction tumors to avoid postoperative stricture, and LECS was not performed for ulcerated tumors to prevent tumor dissemination. NEWS was considered for tumors smaller than 3 cm for transoral extraction. Resected specimen area of the LWR group was significantly larger than that of the other groups. Further, the LWR group had a significantly higher complication rate. Compared to the LECS group, postoperative serum C-reactive protein level was significantly lower and postoperative hospitalization was significantly shorter in the NEWS group. Also, operation costs were significantly lower in the NEWS group. Conclusions: The surgical procedure for gastric SMTs must be carefully chosen according to tumor size, location, and presence or absence of ulceration. For selected patients, NEWS is suggested to be an appropriate option for the treatment of gastric SMTs.

DOI： 10.1007/s10120-017-0750-5

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Blackwell Publishing  

DOI： 10.1111/den.13045

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.gie.2017.09.040

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Mosby Inc.  

Background and Aim: Patients with ulcerative colitis have an increased risk of colorectal dysplasia. Endoscopic submucosal dissection (ESD) for neoplastic lesions in ulcerative colitis remains controversial. The aim of this study was to clarify the role of ESD in the treatment strategy for ulcerative colitis. Methods: We retrospectively investigated 25 patients with ulcerative colitis in clinical remission who underwent colorectal ESD at 2 referral centers. We analyzed short-term and long-term outcomes. Preoperative diagnoses based on biopsy or endoscopy were also compared with the histologic diagnoses of resected specimens. Results: The mean size of the resected specimens was 34.9 ± 17.1 mm. The mean procedure time for ESD was 71.3 minutes. En bloc resection and R0 resection rates were achieved in 100% (25/25) and 76% (19/25), respectively. Postoperative bleeding and perforation during the procedure occurred in 0% and 4%, respectively. Five patients with noncurative resection underwent additional surgery. During a median 21 months (range, 8-80 months) follow-up, local recurrence did not occur. Metachronous high-grade dysplasia occurred in 1 case (4%). The biopsy predicted a final histologic diagnosis of carcinoma with a sensitivity of 72.2% (95% confidence interval [CI], 46.5-90.3), accuracy of 78.2% (95% CI, 56.3-92.5). The endoscopic findings predicted a final histologic diagnosis of carcinoma with a sensitivity of 72.2% (95% CI, 46.5-90.3), accuracy of 76% (95% CI, 54.9-90.6). Conclusion: ESD for neoplasms in ulcerative colitis is feasible by expert endoscopists and may avoid unnecessary surgery. Because the biopsy and endoscopic findings had relatively low accuracy for the final histology, ESD could have a curative as well as a diagnostic purpose.

DOI： 10.1016/j.gie.2017.10.035

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.gie.2017.11.007

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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DOI： 10.1016/j.gie.2017.08.036

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記述言語：英語   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1200/JCO.2018.36.4_suppl.168

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DOI： 10.11405/nisshoshi.115.168

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DOI： 10.1007/s11938-017-0152-0

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SAGE PUBLICATIONS INC  

Background and aim: The efficacy of clipping for preventing delayed bleeding after colorectal endoscopic resection is still controversial. To assess the efficacy of prophylactic clipping, we conducted a meta-analysis of randomized controlled trials.
Methods: We searched PubMed, the Cochrane library, and the Igaku-chuo-zasshi database for randomized trials eligible for inclusion in our meta-analysis. We identified seven eligible randomized trials from the database search, and compared the effect of clipping versus non-clipping with respect to delayed bleeding and perforation. Data from eligible studies were combined to calculate pooled odds ratios (ORs).
Results: Postoperative bleeding was observed in 41 of 1526 cases (2.7%) without clipping and in 32 of 1533 cases (2.1%) with clipping (OR 0.76, 95% CI: 0.39-1.47, p=0.414). There was no significant heterogeneity among the trial results (I-Square=26.7%, p=0.22). In the subgroup analysis based on small tumor size (&lt;20mm) and large tumor size (20mm), there were no significant differences. Compared with non-clipping, the pooled OR of developing perforation with clipping was 1.00 (95% CI: 0.14-7.25), indicating no significant difference between the two groups.
Conclusions: Prophylactic clipping did not decrease the occurrence of delayed bleeding after colorectal endoscopic resection. Clipping could be of interest in patients with a high risk of bleeding (anticoagulation) or large lesions, but with the available trials data to prove this are scarce.

DOI： 10.1177/2050640616687837

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記述言語：日本語   出版者・発行元：(株)医学書院  

症例は70歳代の女性で、近医にて行ったスクリーニングの上部消化管内視鏡検査で胃に隆起性病変を認め、精査加療目的で紹介となった。画像所見より、病変の口側の一部に粘膜内癌を伴う胃型腺腫と診断し、内視鏡的粘膜下層剥離術を行った。切除標本肉眼所見では、相対的に中央部がやや陥凹した45×40mm大の絨毛状隆起性病変を認めた。病理組織学的には、腫瘍の中・深部において淡明な胞体を有する大小腺管の密な増生がみられ、表層部ではやや丈の高い上皮が被覆している像が認められた。免疫染色では、表層を除く中・深部の腫瘍腺管は幽門腺・頸部粘液細胞型粘液であるMUC6陽性、表層部の上皮は腺窩上皮型粘液であるMUC5AC陽性を示し、胃型腺腫に一致する染色像であった。以上の所見から、最終診断はU、Gre.45×40mm、0-IIa+IIc.well-differentiated tubular adenocarcinoma in tubular adenoma、gastric type、pT1a、tub1、INFa、int、ly0、v0、pHM0、pVM0とした。

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MOSBY-ELSEVIER  

Background and Aims: Endoscopic biopsy sampling for the diagnosis of duodenal adenocarcinoma is not perfect. We investigated the accuracy of biopsy specimen diagnoses of superficial nonampullary duodenal epithelial tumors (NADETs).
Methods: Clinicopathologic data were retrospectively reviewed for 95 superficial NADETs from 95 patients who underwent endoscopic resection. Preoperative diagnoses based on biopsy specimens were compared with histologic diagnoses of resected specimens.
Results: Among the 21 lesions with biopsy specimen diagnoses of carcinoma, 12 (57.1%) were histologically diagnosed as adenomas after resection. Among the 74 lesions with biopsy specimen diagnoses of adenoma, 15 (20.3%) were histologically diagnosed as carcinomas after resection. The duodenal biopsy specimen predicted final histologic diagnoses of carcinoma with a sensitivity of 37.5% (95% CI, 18.8-59.4), specificity of 83.1% (95% CI, 72.3-91.0), accuracy of 71.6% (95% CI, 61.4-80.4), positive predictive value of 42.9% (95% CI, 21.8-66.0), and negative predictive value of 79.7% (95% CI, 68.8-88.2). Among 61 cases considered suitable for EMR, treatment modality was converted from EMR to endoscopic submucosal dissection because of the nonlifting sign in 15 cases (24.6%).
Conclusions: The accuracy of duodenal biopsy sampling was relatively low. Duodenal biopsy sampling may induce unexpected fibrosis. New endoscopic modalities that can improve preoperative diagnosis yield of NADETs are eagerly awaited.

DOI： 10.1016/j.gie.2016.12.007

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：GEORG THIEME VERLAG KG  

Background and study aims Mucosal suturing enables reliable and optimal defect closure after endoscopic treatments. We developed and investigated the feasibility of endoscopic hand-suturing (EHS) after gastric endoscopic submucosal dissection (ESD) in porcine in vivo models and in human clinical cases.
Patients and methods EHS involving continuous suturing of the mucosal layers using a through-the-scope needle-holder and absorbable barbed suture, was performed after gastric ESD in six live pigs and in eight consecutive patients. Success rates, adverse events, and suture maintenance were subsequently investigated.
Results EHS was successfully completed in all six pigs and eight patients (100%) without severe adverse events. However, at 1 week postoperatively the suture closures had not been maintained in all six porcine cases and in the first four clinical cases. In the later four clinical cases, wider and tight suturing of the mucosal edges ensured that the defects remained closed until postoperative week 4.
Conclusion EHS is a feasible procedure that may facilitate secure and refined endoscopic surgeries. Mucosal closure in such cases can be maintained using firm suturing.

DOI： 10.1055/s-0043-110668

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記述言語：英語   出版者・発行元：WILEY  

Endoscopic submucosal dissection is established as a curative endoscopic method for gastrointestinal epithelial neoplasms with a high possibility of complete en bloc resection; however, postoperative adverse events of bleeding and delayed perforation remain. To prevent or minimize them, several techniques for endoscopic mucosal closure have been introduced, such as using endoscopic clips, combined use of hemoclips and supplement devices, and specially designed endoscopic suturing devices. Furthermore, endoscopic full-thickness suturing technique for gastrointestinal wall defect has been developed based on the concept in natural orifice transluminal endoscopic surgery and endoscopic full-thickness resection. Several closure techniques, including over-the-scope clip, threaded bars inserted in a hollow needle, stitches or staplers, and a curved needle and thread are reported. Secure closure of the iatrogenic defect may further expand the range of therapeutic endoscopy. Accumulation of evidence for the efficacy of endoscopic closure and establishment of these techniques are desired.

DOI： 10.1111/den.12839

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY  

Background and Aim: Western studies have suggested two distinct etiologies of esophagogastric junction (EGJ) cancer: Helicobacter pylori-associated atrophic gastritis and non-atrophic gastric mucosa resembling esophageal adenocarcinoma. The present study investigated whether endoscopic gastric mucosal atrophy can distinguish between these two types of EGJ adenocarcinoma.
Methods: Data were collected from patients with Siewert type II, T1 EGJ adenocarcinoma who underwent endoscopic or surgical resection at eight Japanese institutions in 2010-2015. Clinicopathological characteristics of EGJ cancers with and without endoscopic gastric mucosal atrophy were compared. EGJ was defined as the lower end of the palisade vein and/or the top of the gastric folds.
Results: Of the 229 patients identified, 161 had endoscopic gastric mucosal atrophy and 68 did not. The latter group was younger (64 vs 70 years, P = 0.000); had a higher proportion of patients negative for H. pylori (90% vs 47%, P &lt; 0.0001); and had higher rates of gastroesophageal reflux disease symptoms (43% vs 12%, P = 0.017), mucosal breaks (25% vs 15%, P = 0.009), Barrett's esophagus (BE, 78% vs 42%, P &lt; 0.0001), and tumors above the EGJ (81% vs 19%, P &lt; 0.0001) and on the upper-right side (74% vs 38%, P &lt; 0.0001) than the former group. Multivariate analysis showed that H. pylori positivity (odds ratio [OR] = 13.0, P &lt; 0.001), long-segment BE (OR = 0.025, P = 0.033), and longitudinal (OR = 8.6, P = 0.001) and circumferential (OR = 4.7, P = 0.006) tumor locations were independently associated with gastric mucosal atrophy.
Conclusion: Two distinct types of EGJ cancer were identified, with and without endoscopic gastric mucosal atrophy. These types were associated with different tumor locations.

DOI： 10.1111/den.12849

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DOI： 10.1200/JCO.2017.35.4_suppl.26

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MOSBY-ELSEVIER  

Background and Aims: We developed a suturing method with a slip-knot string and clips for a single-channel endoscope. The feasibility of the slip-knot clip suturing method was evaluated in this clinical pilot study.
Methods: Ten patients underwent endoscopic submucosal dissection for colorectal and duodenal tumors 5 cm or less. A slip-knot loop can be tightened when tension is applied to the free end of the string. A clip and string can be passed through an instrument channel (3.2 mm) of a single-channel endoscope. The slip-knot loop is anchored onto the mucosal defect's proximal margin with the clip. Additional clips anchoring the slip-knot loop are placed at the opposite side of the margin. The slip-knot loop is tightened by pulling the string. Additional clips are placed to achieve complete closure.
Results: The mean size of resected specimen was 34.4 +/- 10.0 mm. The success rate of the slip-knot clip suturing method was 90% (9/10). In the first patient, the string was cut because of friction, and the patient dropped out of the study. After the failure of the first patient, we used wet string to reduce friction, and slip-knot string worked effectively. The mean procedure time was 18.2 +/- 3.3 minutes.
Conclusion: The slip-knot clip suturing method could close large mucosal defects completely using a singlechannel endoscope.

DOI： 10.1016/j.gie.2016.07.047

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DOI： 10.1055/s-0042-119392

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記述言語：日本語   出版者・発行元：Japanese Society of Gastroenterology  

DOI： 10.11405/nisshoshi.114.209

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記述言語：英語   出版者・発行元：MOSBY-ELSEVIER  

DOI： 10.1016/j.gie.2016.05.054

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：GEORG THIEME VERLAG KG  

Background and study aims: To avoid bacterial contamination and tumor seeding during gastrectomy surgery, we developed a nonexposure technique for endoscopic full-thickness resection with laparoscopic assistance. The feasibility and safety of nonexposed endoscopic wall-inversion surgery (NEWS) for gastric subepithelial tumors (SETs) were investigated.
Patients and methods: For protruding gastric SETs &lt;= 3cm in diameter, NEWS was performed in the following sequence: laparoscopic seromuscular incision after endoscopic submucosal injection, laparoscopic seromuscular suturing with the lesion inverted, endoscopic mucosal and submucosal incision, and transoral retrieval. Technical outcomes and postoperative courses were investigated.
Results: In all 20 consecutive cases, including six SETs with ulceration, NEWS was completed (mean procedural time, 213.5 minutes) without severe intraoperative or postoperative adverse events. R0 resection and perforation rates were 100% and 5.0 %, respectively. During the mean observational period of 10.1 months, all patients survived without recurrence or apparent discomfort during food intake.
Conclusion: NEWS for gastric SETs was feasible and safe and represents a useful option for minimally invasive local resection even in cases of SETs with ulceration or cancers.

DOI： 10.1055/s-0042-111000

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DOI： 10.1055/s-0042-112126

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記述言語：日本語   出版者・発行元：(一社)日本癌治療学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER JAPAN KK  

In Japan, palisade vessels (PV) are used to distinguish the esophagogastric junction (EGJ). Elsewhere, the EGJ is defined by the upper end of the gastric folds (GF) and PV are considered difficult to detect. This study evaluated the detection rate of PV in Western patients with Barrett's esophagus (BE) using white light imaging (WLI) and narrow band imaging (NBI), and quantified any discordance between Western and Japanese criteria for the EGJ.In 25 BE patients, the presence and location of PV and GF were determined and biopsies were obtained. High-quality images of the EGJ were collected under different conditions (insufflations-desufflation, WLI-NBI, forward-retroflex approach), resulting in eight different images per patient. The presence of PV on each still image was assessed by a panel of six Western and Japanese endoscopists with expertise in BE.PV were observed in a parts per thousand yen 1 images by a majority of the panel (a parts per thousand yen 4 raters) in 100 % of patients during insufflation versus 60 % during desufflation (p < 0.001). WLI and NBI detected PV in 100 and 92 %, respectively (p = 0.50). Interobserver agreement of the panel was 'moderate' (kappa = 0.51). During endoscopy PV were located a median of 1 cm distal of the GF in 15 patients (63 %), with intestinal metaplasia (IM) in this discordant zone, in 27 % of patients.PV are visible in most Western BE patients and are best inspected during insufflation. The location of the GF and PV differed in a substantial group of patients, partially with IM in this discordant zone.

DOI： 10.1007/s00535-015-1136-2

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MOSBY-ELSEVIER  

Background and Aims: Endoscopic submucosal dissection (ESD) can remove early stage GI tumors of various sizes en bloc; however, success requires reducing the relatively high postprocedure bleeding rate. The aim of this study was to assess the safety and efficacy of a novel, fully synthetic, and self-assembled peptide solution that functions as an extracellular matrix scaffold material to facilitate reconstruction of normal tissues in ESD-induced ulcers.
Methods: Consecutive patients who underwent gastric ESD were prospectively enrolled. Immediately after the resection, the solution was applied to the site with a catheter. Gastric ulcers were evaluated by endoscopy and classified as active, healing, or scarring stages at weeks 1, 4, and 8 after ESD.
Results: Forty-seven patients with 53 lesions, including 14 (29.8%) previously on antithrombotic therapy and 2 (4.3%) requiring heparin bridge therapy, were analyzed; 2 patients were excluded, 1 with perforations and 1 with persistent coagulopathy. The mean size of the en bloc resected specimens was 36.5 +/- 11.3 mm. The rate of post-ESD bleeding was 2.0% (1/51; 95% CI, 0.03-10.3). Transitional rate to the healing stage of ESD-induced ulcers at week 1 was 96% (49/51). Subsequent endoscopies demonstrated the scarring stage in 19% (9/48) and 98% (41/42) at weeks 4 and 8, respectively. No adverse effects related to this solution occurred.
Conclusions: The use of this novel peptide solution may potentially aid in reducing the delayed bleeding rate by promoting mucosal regeneration and speed of ulcer healing after large endoscopic resections in the stomach. Further studies, particularly randomized controlled studies, are needed to fully evaluate its efficacy.

DOI： 10.1016/j.gie.2015.11.015

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：GEORG THIEME VERLAG KG  

Background and study aims: Training using an animal model is generally recommended before performing endoscopic submucosal dissection (ESD) in humans. This study aimed to clarify the suitability of an isolated porcine stomach as an animal training model for gastric ESD.
Materials and methods: Study 1: six experienced endoscopists performed ESDs of six simulated lesions located in six locations in an isolated porcine stomach (1, lower third [L]/greater curvature [Gre]; 2, L/anterior wall [Ant]; 3, L/posterior wall [Post]; 4, upper third [U]/Gre; 5, U/Ant; 6, U/Post). The procedure times (s/cm(2)) were compared among the different lesion locations. A questionnaire (scored 1-5) completed by the endoscopists was used to assess the difference in the difficulty compared to the human stomach of the three steps of the ESD procedure (injection, incision and dissection). Study 2: the thicknesses of the mucosal layers were histologically evaluated among the six locations in three porcine and two human stomachs.
Results: Study 1: the procedure speedwas significantly slower at L/Gre and U/Gre in the porcine stomachs (P=0.0004). The questionnaire responses revealed a tendency toward similarity between the lower regions of the human and porcine stomachs at L/Ant, L/Post, U/Ant and U/Post during the dissection step (P=0.056). In contrast, the injection and incision steps at L/Gre in the porcine stomach were shown to differ in difficultly level (both P=0.0006). Study 2: the mucosal layers in the porcine stomachs were significantly thicker than those in the human stomachs in the lower areas, especially L/Gre.
Conclusions: The difficulty of ESD and the histological features of the porcine stomachs were coincident with those of the human stomachs at L/Ant, L/Post, U/Ant and U/Post. These parts of the porcine stomach may be suitable as animal training models for gastric ESD.

DOI： 10.1055/s-0034-1393047

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記述言語：英語   出版者・発行元：AME Publishing Company  

Endoscopic submucosal dissection (ESD) is the most suitable treatment option in terms of minimally invasive treatment for potential node-negative early gastric cancers (EGCs). Furthermore, making the resection area of the primary lesion as small as possible is ideal for the patient's quality of life, even for potential node-positive EGC. An endoluminal approach is a reasonable option with which to minimize stomach resection area, because this procedure can be accurately demarcated from the inside. From this point of view, endoscopic full-thickness resection (EFTR) may be optimal, while laparoscopic assistance would be more desirable to create a more secure procedure. However, hybrid EFTR for EGCs has two limitations, which must be solved. First, concerns regarding iatrogenic tumor seeding via transluminal communication between the inside and outside of the tract exist. The second limitation relates to the determination of lymphadenectomy. Conventional lymphadenectomy, which involves the removal of the majority of feeding arteries, can lead to necrosis of the remaining gastric wall. Therefore, the resection area of lymphadenectomy should also be carefully determined. To address these two problems, a non-exposed hybrid EFTR combined with sentinel node navigation surgery (SNNS) would be the most ideal method of minimally invasive surgery for EGCs.

DOI： 10.21037/tgh.2016.03.23

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記述言語：日本語   出版者・発行元：一般社団法人 日本消化器内視鏡学会  

＜背景＞内視鏡による早期胃癌の範囲診断を行う際に，範囲を同定するのが非常に難しい症例が存在する．本研究では，内視鏡的な範囲診断の誤診に寄与する早期胃癌の臨床病理学的特性を明らかにすることを目的とした．<BR>＜対象と方法＞当院で内視鏡的粘膜下層剥離術（Endoscopic submucosal dissection：ESD）を施行した分化型早期胃癌431病変を対象とした．切除標本にて，病変周囲のマーキングと組織学的な腫瘍境界の位置関係を比較することでESD直前の内視鏡的な範囲診断の正誤を判定し，性別，年齢，腫瘍径，腫瘍の局在，周在，深達度，潰瘍瘢痕（UL）の有無，肉眼型，随伴0-IIb成分の有無，優位組織型，未分化癌の混在の有無，組織混在型か否か，NBI拡大観察併用の有無，を解析因子として，範囲診断の誤診寄与因子を解析した．また範囲診断を誤診した症例の内視鏡写真，プレパラートを見直し，誤診の要因について考察した．<BR>＜結果＞全体での範囲診断の誤診率は7.4％（32/431病変）だった．多変量解析にて範囲診断の誤診に寄与する因子を解析すると，随伴0-IIb病変，大型病変，組織学的に中分化型腺癌優位な病変が有意な因子として抽出された．プレパラートにて誤診部位を見直すと，32病変中28病変（87.5％）では腫瘍辺縁が平坦だった．32病変中14病変（43.8％）では腫瘍辺縁は中分化型腺癌から成っていた．<BR>＜結論＞ESD適応となるような早期胃癌において，随伴0-IIb病変，大型病変，中分化型腺癌は側方進展範囲を誤りやすい．

DOI： 10.11280/gee.58.201

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Medknow  

BACKGROUND AND OBJECTIVES: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is an effective method for tissue diagnosis of gastrointestinal submucosal tumors (SMTs) that are difficult to diagnose by standard endoscopic biopsy. However, the learning curve, especially for gastrointestinal SMT, has not been sufficiently established. The aim of our study was to assess the skill acquisition and diagnostic accuracy of EUS-FNA for gastrointestinal SMT in trainee endoscopists in order to elucidate the optimal starting standards of EUS-FNA. MATERIALS AND METHODS: We prospectively evaluated 51 EUS-FNA procedures for gastrointestinal SMT between May 2010 and March 2014. The procedure was performed by two trainee endoscopists and two expert endoscopists. We investigated the diagnostic yield of EUS-FNA and the factors associated with the accuracy between the trainee endoscopists and expert endoscopists. RESULTS: The rate of adequate EUS-FNA materials for histological examination was 86.3%. Although infections occurred in two cases (3.9%), which were managed conservatively, no severe complications were identified. Comparing the trainee endoscopists with expert endoscopists, there was no significant difference in the rate of gaining adequate specimen (76.5% vs. 82.3%, P = 0.4626). However, the mean number of passes of the trainees tended to be more than that of the expert endoscopists (2.1 pass vs. 1.7 pass, P = 0.0511), and lesions located in the middle third of the stomach were the predictive factors for nondiagnostic tumors by the trainee endoscopists (P = 0.0075). CONCLUSION: EUS-FNA for gastrointestinal SMT by trainee endoscopists can be safely performed under the supervision of EUS-FNA expert endoscopists.

DOI： 10.4103/2303-9027.183970

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BAISHIDENG PUBLISHING GROUP INC  

Recently, several studies have reported local full-thickness resection techniques using flexible endoscopy for gastric tumors, such as gastrointestinal stromal tumors, gastric carcinoid tumors, and early gastric cancer (EGC). These techniques have the advantage of allowing precise resection lines to be determined using intraluminal endoscopy. Thus, it is possible to minimize the resection area and subsequent deformity. Some of these methods include: (1) classical laparoscopic and endoscopic cooperative surgery (LECS); (2) inverted LECS; (3) combination of laparoscopic and endoscopic approaches to neoplasia with non-exposure technique; and (4) non-exposed endoscopic wall-inversion surgery. Furthermore, a recent prospective multicenter trial of the sentinel node navigation surgery (SNNS) for EGC has shown acceptable results in terms of sentinel node detection rate and the accuracy of nodal metastasis. Endoscopic full-thickness resection with SNNS is expected to become a treatment option that bridges the gap between endoscopic submucosal dissection and standard surgery for EGC. In the future, the indications for these procedures for gastric tumors could be expanded.

DOI： 10.4253/wjge.v7.i16.1208

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Japanese Society of Gastroenterology  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：英語   出版者・発行元：MOSBY-ELSEVIER  

DOI： 10.1016/j.gie.2015.04.012

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

Non-exposed endoscopic wall-inversion surgery (NEWS) is a novel technique of endoscopic full-thickness resection without transluminal access mainly designed to treat gastric cancer. Here, we report a successful case of NEWS with sentinel node basin dissection (SNBD) for early gastric cancer (EGC) with the risk of lymph node metastasis.
A 55-year-old female patient with a 2-cm, diffuse-type intramucosal EGC with ulceration was referred to our hospital for a less invasive gastrectomy based on sentinel node navigation surgery. After obtaining informed consent, NEWS with SNBD was applied. After placing mucosal markings, indocyanine green solution was injected endoscopically into the submucosa around the lesion to examine sentinel nodes (SNs). The SN basin (the area of the left gastric artery), including three stained SNs(#3), was dissected, and an intraoperative pathological diagnosis confirmed that no metastasis had occurred. Subsequently, NEWS was performed for the primary lesion. Serosal markings were placed laparoscopically, submucosal injection was added endoscopically, and circumferential sero-muscular incision and suturing were performed laparoscopically, with the lesion inverted toward the inside of the stomach. Finally, the circumferential mucosal incision was performed, and the lesion was retrieved perorally.
The operation was finished in 270 min without complications. The patient was uneventfully discharged 10 days after the procedure. The final pathological diagnosis was coincident with the pre- and intraoperative assessment.
We demonstrated the feasibility and safety of NEWS with SNBD with a favorable result. This surgical concept is expected to become a promising, minimally invasive, function-preserving surgery to cure cases of EGC that are possibly node-positive.

DOI： 10.1007/s10120-014-0406-7

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

Non-exposed endoscopic wall-inversion surgery (NEWS) has been developed as an endoscopic full-thickness resection technique without translumenal communication to avoid intraabdominal infection or tumor seeding. We aimed to investigate the feasibility and safety of NEWS with sentinel node basin dissection (SNBD), which can minimize the area of lymphadenectomy for early gastric cancer (EGC), in 10 porcine survival models. After placing laparoscopic ports and making markings on both the mucosal and serosal sides of a simulated lesion, indocyanine green fluid was endoscopically injected into the submucosa at 4 quadrants around the lesion. An SN basin including the stained SNs was dissected, and a circumferential sero-muscular incision around the lesion and sero-muscular suturing were performed laparoscopically, with the lesion inverted toward the inside of the stomach. Finally, circumferential mucosal incision and transoral retrieval were made endoscopically. In all cases, the lesion was resected in an en bloc fashion, and all pigs survived without adverse events. After 1 week of observation, pigs were sacrificed for macroscopic investigation. The average procedural duration was 170 min (range 130-253 min). Intraoperative perforation occurred in 1 case, which could be safely treated by laparoscopic suturing. The number of dissected SN basins was 1 in 9 cases and 2 in 1 case. Necropsy revealed no signs of severe complication. This animal survival study demonstrated that NEWS with SNBD was safe and feasible. It may provide patients with possibly node-positive EGC a minimally-sized local resection and minimally-ranged lymphadenectomy without the risk of tumor dissemination.

DOI： 10.1007/s10120-014-0358-y

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: To clarify the effectiveness of second-look endoscopy (SLE) at preventing bleeding after gastric endoscopic submucosal dissection (ESD). DESIGN: A multicentre prospective randomised controlled non-inferiority trial was conducted at five referral institutions across Japan. Patients with a solitary gastric neoplasm were enrolled. Exclusion criteria were previous oesophagogastric surgery or radiation therapy; perforation and the administration of antithrombotics, steroids or non-steroidal anti-inflammatory drugs. Patients were assigned to the SLE group or the non-SLE group by a computer-generated random sequence after ESD and were treated perioperatively with a proton pump inhibitor. SLE was performed one day after ESD. The primary endpoint was post-ESD bleeding, defined as an endoscopically proven haemorrhage. The trial had the power to detect a non-inferiority criterion of 7% between the groups. RESULTS: From February 2012 to February 2013, 130 and 132 patients were assigned to the SLE and the non-SLE groups, respectively. All patients were included in the intention-to-treat analysis of the primary endpoint. Post-ESD bleeding occurred in seven patients with (5.4%) SLE and five patients with (3.8%) non-SLE (risk difference--1.6% (95% CI -6.7 to 3.5); pnon-inferiority<0.001), meeting the non-inferiority criterion. All 12 patients with post-ESD bleeding and one patient with a delayed perforation were successfully managed with conservative treatment. CONCLUSIONS: SLE after gastric ESD is not routinely recommended because it does not contribute to the prevention of post-ESD bleeding for patients with an average bleeding risk. TRIAL REGISTRATION NUMBER: UMIN-CTR000007170.

DOI： 10.1136/gutjnl-2014-307552

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記述言語：日本語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：英語   掲載種別：論文集(書籍)内論文   出版者・発行元：Springer Japan  

Esophageal superficial cancers with negligible risk for lymph node metastasis can be cured by endoscopic local resection. Endoscopic mucosal resection (EMR) is a conventional technique, which can resect relatively small lesion by using a snare. On the contrary, endoscopic submucosal dissection (ESD) can resect superficial lesion in an en bloc fashion irrespective of the size or presence of submucosal fibrosis, which has made the indication of endoscopic resection expanded. Although skillful hands in endoscopy and sufficient knowledge of possible complications are required, ESD is a promising technique as a minimally invasive treatment.

DOI： 10.1007/978-4-431-54977-2_14

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記述言語：英語   出版者・発行元：Korean Society of Gastrointestinal Endoscopy  

DOI： 10.5946/ce.2015.48.1.85

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記述言語：英語   出版者・発行元：MOSBY-ELSEVIER  

DOI： 10.1016/j.gie.2014.07.063

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記述言語：英語   出版者・発行元：MOSBY-ELSEVIER  

DOI： 10.1016/j.gie.2014.08.016

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：International Gastric Cancer Association, Japanese Gastric Cancer Association [編]  

DOI： 10.1007/s10120-014-0427-2

CiNii Books

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その他リンク： http://search.jamas.or.jp/link/ui/2016231583

記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

In gastric full-thickness resection employing both endoscopy and laparoscopy, intraabdominal contamination or even possibly tumor seeding is unavoidable as a result of iatrogenic perforation and the resultant spread of gastric juice. To minimize contamination and resected tissue volume, we developed a new technique without perforation termed non-exposed endoscopic wall-inversion surgery (NEWS), and present here the preliminary results. In a clinical observation cohort study, NEWS was attempted in six patients with gastric SMT to investigate the procedure, mortality, and morbidity. NEWS consists of several steps: marking around a tumor on the mucosal as well as the serosal surface, submucosal injection of sodium hyaluronate with indigo carmine dye, circumferential seromuscular dissection with suture closure under laparoscopy, and circumferential mucosubmucosal incision under gastric endoscopy. The resected specimen is then retrieved perorally. Perforation occurred as a result of misidentification and technical inadequacy in the first three patients. After modification of the devices, the entire procedure was successfully achieved in the latter three. There were no complications in any of our six cases. NEWS allows en bloc full-thickness resection, theoretically avoiding contamination and tumor dissemination into the peritoneal cavity.

DOI： 10.1007/s10120-013-0291-5

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記述言語：日本語   出版者・発行元：(一社)日本癌治療学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：PUBLIC LIBRARY SCIENCE  

Background: There have been very few reports assessing the relationship between various upper gastrointestinal (GI) symptoms or evaluating each individual upper GI symptom separately.
Methods: Based on the answers to Frequency Scale for the Symptoms of GERD from a large-scale population of healthy adults in Japan, a hierarchical cluster analysis was performed to categorize the typical 12 upper GI symptoms. The associations between the 12 symptoms and 13 background factors were systematically analyzed among the 18,097 digestive drug-free subjects, 364 proton-pump inhibitor (PPI) users, and 528 histamine H-2-receptor antagonist (H(2)RA) users.
Results: The derived relationship between the 12 upper GI symptoms suggests the five symptom categories: heartburn (2), dyspepsia (4), acid regurgitation (3), pharyngo-upper esophageal discomfort (2), and fullness while eating (1). Among the digestive drug-free subjects, inadequate sleep, weight gain in adulthood, NSAID use, meals immediately prior to sleep, and frequent skipping of breakfast showed significant positive association with most upper GI symptoms. Compared to the digestive drug-free subjects, significantly associated factors for PPI and H(2)RA users are respectively different in "4 of 5" and "5 of 5" symptoms in heartburn and acid regurgitation categories, "1 of 2" and "1 of 2" symptoms in pharyngo-upper esophageal discomfort category, and "0 of 5" and "3 of 5" symptoms in dyspepsia and fullness while eating categories. These differences between digestive drug-free subjects and gastric acid suppressant users seem to correlate with our experiences in clinical situations: heartburn and acid regurgitation category symptoms are effectively controlled with PPI and H(2)RA whereas other category symptoms are not.
Conclusions: The 12 upper GI symptoms can be classified into five categories, which are statistically associated with various background factors. The differences of associated factors between digestive drug-free subjects and digestive drug users may be useful in studying the drug effects upon diverse upper GI symptoms.

DOI： 10.1371/journal.pone.0088277

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s12328-014-0492-4

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記述言語：日本語   出版者・発行元：Japan Gastroenterological Endoscopy Society Kanto Chapter  

This subject was a 50-year-old male who underwent routine health check-up at another clinic. Upper gastrointestinal endoscopy performed during the check-up revealed a flat, slightly reddish lesion measuring about 5 mm in diameter, that appeared malignant. Hiatal hernia, reflux esophagitis, and several fundic gland polyps measuring less than 5 mm in diameter each were also observed, however, there was no evidence of atrophic gastritis. Biopsy of the reddish lesion revealed a moderately differentiated adenocarcinoma. The cancerous lesion was resected by endoscopic submucosal resection (ESD) . Histopathologic examination revealed gastric adenocarcinoma of the fundic gland type. <br> Gastric adenocarcinoma of the fundic gland type is a neoplastic lesion mainly composed of highly differentiated columnar cells mimicking the fundic gland cells, mainly chief cells, with nuclear atypia. The most important clinicopathologic feature is cancer invasion of the submucosal layer, however, most recurrent lesions tend to be less than 10 mm in diameter, as they were in our case. Immunohistochemical examination was useful for the diagnosis. The cancer cells were diffusely positive for MUC6 (a marker of fundic gland cells) and pepsinogen I (a marker of chief cells) .<br> We have reported the clinicopathologic findings of a case of gastric adenocarcinoma of the fundic gland type that was completely resected by ESD.

DOI： 10.11641/pde.84.1_100

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その他リンク： http://search.jamas.or.jp/link/ui/2014275826

記述言語：日本語   出版者・発行元：Japan Gastroenterological Endoscopy Society Kanto Chapter  

Case 1 : A 70-year-old man was referred for endoscopic resection, as a screening colonoscopy had revealed a flat neoplasm in the sigmoid colon measuring 40 mm in diameter without a granular pattern on the surface (laterally spreading tumor, non-granular type ［LST-NG］) . Magnifying endoscopy with narrow-band imaging (NBI) revealed capillary pattern (CP) type II, whereas magnifying chromoendoscopy revealed a Kudo type IIIs pit pattern.<br> Case 2 : A 70-year-old woman was referred for endoscopic resection of a 40-mm LST-NG located in the rectum. Magnifying endoscopy with NBI revealed CP type IIIB, and even magnifying chromoendoscopy failed to reveal the pit pattern clearly, although the endoscopic examination revealed no hardness of the tumor.<br> Thus, the neoplasms were diagnosed as intramucosal carcinoma or cancer with superficial submucosal invasion, and we decided to attempt endoscopic submucosal dissection (ESD) to remove them. In Case 1, the histopathologic assessment showed a cancer with deep submucosal invasion, which was fully covered by the cancer with low-grade atypia in the mucosal layer. In Case 2, the histopathologic assessment showed tubular adenoma with a large quantity of mucus on the surface of the tumor. Thus, the histopathologic assessment also revealed the depth of the tumor invasion and the reason for the difficulty in the preoperative diagnosis. This case report highlights the importance of ESD, which enabled a precise histopathologic diagnosis of the LSTs in which estimation of the depth of submucosal invasion was difficult even with the use of magnifying NBI and chromoendoscopy.

DOI： 10.11641/pde.84.1_146

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その他リンク： http://search.jamas.or.jp/link/ui/2014275849

記述言語：日本語   出版者・発行元：Japan Gastroenterological Endoscopy Society Kanto Chapter  

Recently, duodenal tumors have been detected more often due to technical progress and the development of endoscopic instruments. However, no standard endoscopic diagnostic criteria or therapeutic strategies for duodenal epithelial tumors have been established. Radical resection techniques such as pancreaticoduodenectomy should be avoided, if possible, for treating non-invasive duodenal cancer or adenoma, because they cause more serious postoperative dysfunction in the duodenum than in other parts of the gastrointestinal tract. Endoscopic submucosal dissection (ESD) yields higher rates of en bloc resection and curative resection than endoscopic mucosal resection, and these advantages explain the lower rates of residual and recurrent tumors seen after ESD. However, it is more difficult to perform ESD for duodenal tumors than for gastric tumors, as the muscle layer of the duodenum is thinner than that in other parts of the gastric tract, which results in relatively higher frequencies of perforation and bleeding. Here, we report our experience with duodenal ESD. Closure of post-ESD duodenal artificial ulcers is very effective for avoiding delayed bleeding and perforation. We consider that post-ESD ulcer closure using a loop snare and clipping is one of the most effective ways of preventing delayed perforation. Duodenal ESD requires a high level of skill due to its technical difficulty and the increased risk of perforation associated with the procedure ; however, we consider that it is very effective. In addition, ESD is less invasive than open surgery.

DOI： 10.11641/pde.85.1_58

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その他リンク： http://search.jamas.or.jp/link/ui/2015124746

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MOSBY-ELSEVIER  

Background: Surgical gastrojejunostomy is associated with relatively high morbidity and mortality rates. However, current experimental EUS-guided gastrojejunostomy information is limited.
Objective: To evaluate a novel EUS-guided gastrojejunostomy technique using a new enteric balloon and lumen-apposing metal stent.
Design: Animal experiment.
Setting: Animal laboratory at a referral center. Subjects and Interventions: In 5 pigs, gastrojejunostomies were created under EUS guidance. Fully covered lumen-apposing stents were placed between the stomach and the jejunum.
Main Outcome Measurements: Technical success and adverse events of EUS-guided gastrojejunostomy.
Results: All stents, with 1 exception, were successfully deployed without any adverse events. The mean time to stent placement was 44.2 minutes (range 28-64 minutes). All animals showed normal eating behavior without signs of infection for 1 month after the procedure. Endoscopic imaging of the stomach site showed the stent to be patent and stable, without dislodgment, in all of the pigs. Necropsy showed complete adhesion between the stomach and the jejunum wall.
Limitations: Pilot study.
Conclusions: Creation of an EUS-guided gastrojejunostomy by using a novel enteric balloon and metal stent appears to be promising as a minimally invasive treatment.

DOI： 10.1016/j.gie.2013.09.025

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

BACKGROUND: Certain tumor characteristics may pose challenges when endoscopically determining the horizontal extent of early gastric cancers (EGC). In the present study, clinicopathological features related to inaccurate endoscopic evaluation of horizontal extent of intestinal-type EGC were analyzed. PATIENTS AND METHODS: We analyzed 431 lesions with intestinal-type EGC treated by endoscopic submucosal dissection (ESD) at our hospital. We focused on whether pretreatment demarcation was accurate by comparing positional relationships between marking dots and tumor edges in resected specimens, and factors related to inaccurate evaluation were analyzed. Gender, age, tumor size, location, circumference, depth, ulceration, macroscopic type, presence of a flat (0-IIb) component, predominant histological type, mixture of diffuse-type adenocarcinoma, mixed histology, and use of magnification endoscopy with narrow band imaging were analyzed. Reasons for inaccurate evaluation were also investigated by re-examining endoscopic images and prepared histological slides. RESULTS: Rate of inaccurate evaluation of horizontal extent was 7.4% (32/431 lesions). Multivariate analysis revealed the following significant independent variables contributing to inaccurate endoscopic evaluation: presence of a flat component, large size, and predominant histological findings of moderately differentiated adenocarcinoma. Re-examination of prepared histological slides of inaccurately evaluated cases revealed a marginal flat spreading area in 28 of the 32 lesions (87.5%). In 14 of the 32 lesions (43.8%), tumor margins were composed of moderately differentiated adenocarcinoma. CONCLUSIONS: For lesions with a flat component, large lesions, and moderately differentiated adenocarcinoma, determination of the horizontal extent can be challenging in EGC indicated for ESD, even with the best available endoscopic tools.

DOI： 10.1111/den.12043

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

There is general agreement as to the value of postoperative surveillance and the effectiveness of colonoscopy in the early detection of metachronous colorectal lesions. In the present case, a 56-year-old woman with no family history of colon cancer underwent surveillance colonoscopy in which a metachronous flat adenoma was detected following an interval of 23 years after a colectomy and 20 years subsequent to treatment for uterine cancer. A second metachronous flat lesion histopathologically determined to be a submucosal (sm) deep invasive cancer with lymphovascular involvement was detected 12 months later. This second metachronous lesion was suspected of having developed rapidly in the rectal remnant accounting for its sm deep invasion. The findings of this case suggest colonoscopy surveillance guidelines proposed for individuals at high risk should be evaluatedbased on cancer history and an analysis of possible mismatch repair gene mutations. In addition, the first metachronous lesion was located directly on the suture line of the anastomosis. Endoscopic submucosal dissection (ESD) was indicated despite severe fibrosis into the sm layer. This case also demonstrates the successful use of improved ESD instruments, sm injection agents and technique refinements in the treatment of a technically difficult lesion with a high risk of complications.

DOI： 10.1111/den.12094

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(株)東京医学社  

大腸ESDの適応基準を定めるには、対象病変の臨床病理学的特徴やEMR/ESDに関する技術的特徴を考慮する必要がある。ESDには、病変の一括切除による正確な病理診断と、高い臓器温存性および根治性を患者に提供できる大きなメリットがある一方、大腸上皮性腫瘍の多くはEMRで対応できることができる点、およびEMRと比べたときの高いコスト、長い手技時間、偶発症の高さというデメリットも指摘されているためである。今回の臨床病理学的検討、およびEMR/ESDの技術的考察より、大腸ESDの適応は、術前深達度診断SM1までの(1)LST-NG(陥凹を有する)≧20mm、(2)LST-G(MIX)≧40mm、(3)non-lifting sign陽性、(4)局所遺残再発病変≧10mm、(5)回盲部や歯状線に進展する病変が基本になると考えられた。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)医学書院  

大腸の粘膜下層の線維化の成因には,(1)癌の粘膜下層への浸潤,(2)人為的要因(術前生検,局注の既往,EMR後局所遺残・再発),(3)腸管の蠕動運動,(4)慢性炎症(炎症性腸疾患など)が挙げられる.大腸ESDは,このようなEMRでは切除困難もしくは不可能な病変に対して,技術的に困難ではあるものの,一括切除が期待できる手技である.しかし,穿孔の危険性がより高く,長時間の手技となることがある粘膜下層の線維化を有する病変に対するESDには,高い技術と経験が必要である.大腸ESDを安全かつ確実に完遂するには,病変の困難性を術前に予測したうえで,術者は技量および経験とのバランスを図る必要がある.(著者抄録)

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記述言語：日本語   出版者・発行元：(株)日本メディカルセンター  

ESDは,EMRでは切除困難もしくは不可能な粘膜下層に線維化を伴う病変に対しても,一括切除が期待できる手技である.しかし,線維化症例に対するESDは,難易度や,穿孔の危険性がより高く,長時間の手技となることがあり,高い技術と経験が必要とされる.このような難易度の高い大腸ESDを安全かつ確実に完遂するには,治療の困難性を術前に評価することが必要であり,十分な技量をもった術者のみが治療に当たるべきである.(著者抄録)

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記述言語：日本語   出版者・発行元：(有)科学評論社  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

Evidences on diagnostic ability of esophagogastroduodenoscopy (EGD), CT, and endoscopic ultrasonography (EUS) for gastric submucosal tumor (SMT) are insufficient. For investigating a suitable diagnostic strategy, we retrospectively investigated diagnostic accuracy of EGD and CT for SMT, in comparison to EUS findings.
Ninety-three consecutive lesions in which gastric SMT was suspected by EGD were investigated by EUS from March 2009 to June 2011, including 55 lesions evaluated also by CT 4 months before or after EUS. Frequency of possibly malignant SMTs as a detection rate of EGD, and sensitivity and specificity of CT in detection of SMT were retrospectively analyzed. Factors influencing the ability for CT to detect SMT were also investigated.
EUS revealed possibly malignant SMT in 60 cases (64.5%). In 32 out of 55 cases, possibly malignant SMT was suspected by CT. Sensitivity and specificity of CT was 80.6% and 84.2%, respectively. The mean size of possibly malignant SMT detected and not detected by CT was 27.4 and 11.0 mm, respectively, with a statistically significant difference (p = 0.0001).
This study elucidated that approximately one-third of suspected SMTs by EGD might not need clinical care. EUS for suspected SMTs is indispensable for extracting possibly malignant SMTs from others, and CT may be insufficient as an alternative to EUS in detecting especially small ones.

DOI： 10.1007/s00261-012-9928-9

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

Aims: Endoscopic submucosal dissection (ESD) has several advantages over conventional endoscopic mucosal resection, including a higher en bloc resection rate and more accurate pathological estimation. However, ESD is a complex procedure that requires advanced endoscopic skills. The aim of our study is to evaluate the efficacy of endoscopic mucosal resection with a ligation device (EMR-L) compared to ESD for rectal carcinoid tumors. Methods: Between September 2003 and April 2011, 24 rectal carcinoid tumors in 24 patients treated by ESD or EMR-L were retrospectively analyzed. The indications for endoscopic treatment were node-negative rectal carcinoid tumors. We compared the therapeutic outcomes of the ESD group (n = 13) and the EMR-L group (n = 11). Results: Both groups had similar mean tumor sizes (ESD: 5.5 +/- 2.1 mm; EMR-L: 4.4 +/- 2.2 mm). The rates of en bloc and complete resection were, respectively, 100% and 92.3% for ESD, and 100% and 100% for EMR-L. Perforations did not occur in either group. Postoperative bleeding occurred in one EMR-L case, and it was endoscopically managed. However, there were no differences in therapeutic outcomes between the two groups. The mean procedure time was longer in the ESD group (28.8 +/- 16.2 min) than in the EMR-L group (17.4 +/- 4.4 min), without a significant difference. The mean hospitalization period was significantly shorter in the EMR-L group (1.8 +/- 3.1 day) than in the ESD group (6.2 +/- 2.1 day), and eight EMR-L cases were treated in an outpatient setting. Conclusions: EMR-L is a simple and effective procedure that compares favorably to ESD for small rectal carcinoid tumors.

DOI： 10.1111/j.1443-1661.2012.01303.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

The colorectum is known to be the most difficult organ to perform endoscopic submucosal dissection (ESD), however, the training has not been sufficiently established. In our hospital, the essential condition to start colorectal ESD was to experience at least 30 gastric ESD and to have sufficient knowledge and techniques beforehand. Rectal ESD were initially performed under supervision of ESD experts. According to their technical acquisition, the ESD experts allocated lesions to the trainees from smaller lesions in the distal colon to larger lesions in the proximal colon. We retrospectively investigated the outcomes of 92 and 23 colorectal ESD performed by two trainee endoscopists (A/B) who gained experience on our training scheme. The rates of en bloc/complete resection for A and B were 92.4%/73.9% and 95.7%/65.2%, respectively. The rates of bleeding/perforation, which occurred only with A, were 1.1%/3.3%, respectively. Intraoperative perforation occurred in one case (4.3%) in the later period. In the later period, en bloc resection rate remained high in spite of the difficult lesions. Our training scheme enabled trainees to perform colorectal ESD effectively and safely from the initial period. Step-by-step accumulation of cases such as from the rectum to the colon may be desirable for the introduction of colorectal ESD.

DOI： 10.1111/j.1443-1661.2012.01251.x

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

Bleeding is a major complication after gastric endoscopic submucosal dissection (ESD). An evidence-based strategy for postoperative care related to delayed bleeding is required. We conducted a multicenter survey to assess the current status of management after gastric ESD.
A total of 1,814 gastric epithelial neoplasms in 2009 at ten tertiary referral centers were enrolled. The current status of the management after gastric ESD (use of an antisecretory drug, food intake, and second-look endoscopy) at participating hospitals was assessed. Furthermore, the rate of post-ESD bleeding and the differences in each parameter were retrospectively analyzed.
Postoperative bleeding occurred in 100 cases (5.5%), which included 62 cases of bleeding within 24 h after ESD. In all of the hospitals, proton pump inhibitors (PPIs) were used. The median administration period was 56 days (range 14-60 days). Food intake was resumed from postoperative day (POD) 1 in 4 hospitals and from POD 2 in 6 hospitals. Second-look endoscopy was performed for almost all cases, fewer cases, and rarely or none in 6, 2, and 2 hospitals, respectively. The day of second-look endoscopy varied among hospitals. There was no statistical relationship between the postoperative bleeding rate and the differences in these three parameters.
Post-ESD management (duration of PPI use, resumption of food intake, and performance of second-look endoscopy) varied among the medical centers; thus, randomized controlled trials are required for an optimal strategy after gastric ESD.

DOI： 10.1007/s10620-011-1886-5

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BIOMED CENTRAL LTD  

Background: The aim of this study is evaluating the correlation of postprandial fullness with chronic gastritis or rapid inflow of gastric content into duodenum, based on double-contrast barium X-ray imaging.
Methods: 253 healthy subjects who underwent upper gastrointestinal barium X-ray examination were analyzed. Chronic gastritis was judged from mucosal atrophy and hypertrophic thickened folds on barium X-ray images. For the gastric excretion, the tips of barium flow on the single-contrast frontal barium X-ray images of the stomach were classified into four categories; V type (all the barium remained in the stomach), V-H type (some barium had flowed into the duodenum but the tip of barium remained in the proximal half of the duodenal bulb), H-V type (some barium had flowed into the duodenum and the tip of barium was in the distal half of duodenal the bulb, but no barium was observed in the descending part of the duodenum), and H type (some barium had flowed into the descending part of the duodenum). The chi-square test and Cochran-Mantel-Haenzel test were used for evaluation.
Results: Chronic gastritis was observed in 72 subjects, among which 21 subjects (29.2%) presented with postprandial fullness. For the remaining 181 subjects without chronic gastritis, 53 subjects (29.3%) complained of postprandial fullness. There is no significant correlation between chronic gastritis and postprandial fullness (p = 0.973). For the rapid flow of gastric content into duodenum, all the 253 subjects comprised 136 subjects with V type (in the stomach), 40 subjects with V-H type (in the proximal half of the duodenal bulb), 21 subjects with H-V type (in the distal half of the duodenal bulb), and 56 subjects with H type (in the descending part of the duodenum). Postprandial fullness was present in 30 subjects with V type (22.1%), 9 subjects with V-H type (22.5%), 8 subjects with H-V type (38.1%), and 27 subjects with H type (48.2%). There is a distinct correlation between postprandial fullness and gastric barium excretion on barium X-ray imaging (p = 0.002).
Conclusions: Bothersome postprandial fullness correlates with rapid inflow of gastric content into duodenum, but not with chronic gastritis.

DOI： 10.1186/1471-230X-11-140

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記述言語：日本語   出版者・発行元：(株)日本メディカルセンター  

57歳男。上部消化管内視鏡で胃穹窿部の粘膜下腫瘍を指摘され当院紹介となった。上部消化管内視鏡で胃穹窿部後壁に20mm大の隆起性病変を認め、表面平滑で正常な胃粘膜に覆われ粘膜色調に変化なく、食道には異常所見を認めなかった。生検鉗子圧迫にてcushion sign陽性であった。超音波内視鏡UE-260を用いた観察では、病変の主座は第3層に存在し、境界明瞭でない部は比較的均一な無エコーを呈していた。ドップラー超音波検査では、豊富な血流が描出され、壁外の血管と連続していた。造影CTでは胃穹窿部後壁に造影効果を伴う静脈瘤を認め、左胃静脈を経て門脈に連続し、また胃腎短絡路も認め門脈は求肝性血流を呈し、孤立性胃静脈瘤と診断した。Cushion sign陽性の粘膜下腫瘍を呈する病変は安易に生検せず、超音波内視鏡や造影CTなどの画像診断による精査が重要と考えられた。

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記述言語：日本語   出版者・発行元：(株)ヴァンメディカル  

ESDは低侵襲と高い根治性を両立した優れた治療法であり、特に高齢者においては消化管機能温存によるメリットは大きい。しかし加齢に伴い、身体的、心理的なさまざまな問題が生じることから、元来の生命予後の点からも、臨床現場では早期胃癌に対する治療方針の決定に迷うことは多い。高齢者に対しても非高齢者と同等の安全性と根治性でESDは施行可能であるが、加齢による変化は個人差が大きいため、治療適応の判断にはリスクとベネフィットのバランスを十分考慮し、個々の症例に応じたオーダーメイド治療を行うことが望ましい。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)日本メディカルセンター  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：EDITORIAL OFFICE GUT & LIVER  

Background/Aims: The relationship between the appearance of an ulcer and postoperative bleeding after gastric endoscopic submucosal dissection (ESD) is not well understood. To explore this potential relationship, we retrospectively analyzed the short-term healing process of ESD. Methods: A total of 520 consecutive lesions in 434 patients seen between January 2004 and December 2009 were retrospectively investigated. At the second-look endoscopy, which occurred between 1 and 8 days after ESD, artificial ulcers were categorized into 6 patterns according to Forrest's classification: spurting bleeding, oozing bleeding, non-bleeding visible vessel, adherent clot, black base/spot, and clean base. From these data, a short-term healing model of the artificial ulcer was generated. Results: Ulcer base changed gradually from a bloody to a clean one. The bleeding or non-bleeding visible vessel categories, which occurred in approximately one quarter of the ulcers within 3 days of ESD, were rarely observed 4 days after ESD. Conclusions: Ulcers that occur after gastric ESD heal in line with a specific time course, and it appears that most healing occurs without massive bleeding. (Gut Liver 20115:293-297)

DOI： 10.5009/gnl.2011.5.3.293

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(株)日本メディカルセンター  

46歳男。肝彎曲に0-IIa+IIcを指摘されたが放置していた。今回、近医で下部消化管内視鏡検査を行ったところ、生検ではHigh grade tubular adenomaであったものの、壁硬化を伴う内視鏡像から粘膜下層高度浸潤を伴うadenocarcinomaの可能性が高いと判断され、手術目的に当院入院となった。下部消化管内視鏡では、肝彎曲に中央陥凹を伴う径20mmの扁平隆起性病変を認め、通常観察の送気では、ひだの伸展が得られない壁硬化を伴っており、インジゴカルミン散布下において中央陥凹部では、周囲隆起成分からの明らかな段差を伴っており、SM高度浸潤癌の可能性が高いと考えられた。クリスタルバイオレット染色下での拡大観察では隆起部のpitはIIIL型、陥凹部はIIIS型が主体で、明らかな無構造局面(VN型pit)は認めず、SM高度浸潤癌を示唆する所見を認めなかった。拡大観察の所見を考慮して内視鏡的粘膜下層剥離術を施行した。局注による病変の挙上は良好で、口側から徐々に切開・剥離を加えたが粘膜下層の明らかな線維化などは認めなかった。腸管蠕動のために剥離継続が困難となったが、スネアリングを行い病変の一括切除を得ることができた。病理所見は、-IIa+IIc病変で、隆起部および陥凹部の粘膜内に高分化型腺癌を認めたが、粘膜下層への浸潤は認めなかった。M癌、脈管侵襲陰性、水平・垂直断端は陰性であった。

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(株)東京医学社  

消化器内視鏡における抗血栓薬の扱いに関しては各学会からガイドラインが発表されているものの、十分なエビデンスがないことより内容に統一性がなく、臨床の現場においては個々の医師や施設の判断で対応せざるを得ず、混乱した状況にあることが明らかにされている。現状では処方医と連携をとりつつ、いずれかの学会のガイドラインに従いながら個々の症例への適切な対応を模索するしかない。しかし、休薬期間中の血栓塞栓症イベントが致死的な経過を辿りうることを考えると、臨床的に問題にならない程度の出血は許容される可能性があり、今後、国内においても内服を継続したままでの処置の安全性を検討していく必要がある。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

The indications for endoscopic full-thickness resection (EFTR) are limited because transmural communication during the entire procedure, causing tumor dissemination into the abdominal space, is inevitable. We invented a new method of EFTR without transmural communication, and explored its feasibility in an ex vivo porcine model. Three explanted porcine stomachs were used. First, markings around a model lesion were made with a flexible endoscope, and 0.9% normal saline with indigocarmine was injected into the submucosa around the markings. Second, a circumferential sero-muscular incision was made from the outside with an electrocautery knife, guided by the color of the submucosal injection and intragastric navigation with the endoscope. Third, the muscle layer was linearly sutured with the lesion inverted into the inside. Finally, a circumferential muco-submucosal incision was made with an electrocautery knife employed with the endoscope. The method was performed for 3 lesions (1 anterior wall, 1 lesser curve, and 1 posterior wall of the gastric body), and all lesions were successfully resected in en-bloc fashion. The mean size of the resected specimen was 4.5 cm in diameter. Neither perforation nor apparent air leakage was seen during or after the resection. Non-exposed endoscopic wall-inversion surgery (NEWS) is thought to be effective as a minimally invasive, and minimal-size endoluminal surgery for gastric submucosal tumors with or without ulceration, or even node-negative early gastric cancer that is difficult to resect by endoscopic submucosal dissection.

DOI： 10.1007/s10120-011-0014-8

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：英語   出版者・発行元：WILEY  

Guidelines on the management of anticoagulants and antiplatelet agents for endoscopy were established by Japan Gastroenterological Endoscopy Society (JGES) in 2005. However, the permeation of the JGES guideline is reported to possibly be low. One of the important causes of this problem is the confusing situation of gaps between the guidelines of various societies. Additionally, our ongoing investigation has revealed another important cause, which is the current daily clinical practice that cessation periods before endoscopy were determined by non-gastroenterological specialists who might be unfamiliar with the JGES guidelines. Considering the low permeation of the guidelines for non-gastroenterological specialists prescribing these agents, we propose that close coordination between various specialists is mandatory to fill the gap between endoscopists and non-gastroenterological specialists.

DOI： 10.1111/j.1443-1661.2010.01042.x

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

73歳女。約11年前頃より貧血を指摘され、月1～2回の輸血を行うも改善を認めず入院となった。血液検査で高度の貧血、腎機能低下、PT-INRの延長およびBNPの上昇を認めた。上部内視鏡にて穹窿部～体中部を占める黒色調の胃石を認め、胃石は胃壁と固着表面の弾力があるが、内部に食物繊維を認め崩れやすかった。周囲胃粘膜のびらん面よりoozingを認め、これが貧血の原因と推測された。コーラのジェット送水による胃石破砕は効果不十分で、鉗子、スネアにて破砕を続けた。胃石切除面は暗赤色でそこから出血を認め、腫瘍性病変を考え生検を行った。病理所見は大部分が凝血だったが、N/C比の高い孤在性異型細胞を少量含み、cytokeratin陽性、Ki67陽性率高く、低分化型腺癌と診断した。CTでは胃体部後壁に5cm大の腫瘍性病変と多発肝転移を認めたが、心機能、腎機能低下およびADL不良のため、化学療法は行わず経過観察とした。

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2010&ichushi_jid=J04450&link_issn=&doc_id=20101216270010&doc_link_id=%2Fdw9poden%2F2010%2F007702%2F018%2F0062-0063%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdw9poden%2F2010%2F007702%2F018%2F0062-0063%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(株)アークメディア  

内視鏡的粘膜下層剥離術(ESD)トレーニングシステムを紹介し、その有効性を検討した。ESDトレーニングシステムは、第1段階:ESDの見取学習とESDの内視鏡動画によるイメージトレーニングを行う、第2段階:ブタ切除胃を用いたアニマルトレーニングを行い、処置具の使い方や特性を学ぶ、第3段階:上級医の指導下で胃体部病変の治療を開始する、第4段階:上級医の指導下で胃噴門部や直腸病変の治療を行う、第5段階:自己責任下に胃噴門部や直腸病変の治療を行い、上級医の指導下で食道病変や大腸病変の治療が許される、であった。指導に関わったエキスパート医師2名(A&B)とトレーニー2名(C&D)による各60例の治療成績を検討した。A&BとC&Dの患者背景、病変背景に有意差はなかった。一括切除率は各々90%、98%、完全一括切除率は82%、98%といずれもC&Dで有意に高く、穿孔率は7%、0%とC&Dで有意に低かった。本トレーニングシステムは有効と考えられた。

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：GEORG THIEME VERLAG KG  

Background and aims: Endoscopic submucosal dissection (ESD) provides a high en bloc resection rate with less invasiveness than surgical resection for large or scarring gastrointestinal neoplasms. However, detailed outcomes in colorectal ESD are still lacking. The aim of our study was to elucidate short-and long-term outcomes of colorectal ESD.
Patients and methods: 310 consecutive colorectal epithelial neoplasms (146 adenomas, 164 carcinomas), in 290 patients, which fulfilled our indication criteria and were treated with ESD between July 2000 and December 2008 were studied. ESD was done by three skilled endoscopists. As short-term outcomes, rates of en bloc resection, en bloc plus R0 resection, and major complications were analyzed. As long-term outcomes, disease-free and overall survival were assessed in 224 patients.
Results: Rates of en bloc resection and en bloc plus R0 resection were 90.3% and 74.5%, respectively. Eight patients underwent additional colectomy due to histopathologically proven possible node-positive cancer. Intraoperative perforations occurred with 14 lesions (4.5%), which were treated successfully only by endoscopic clipping. Emergent surgery was needed for one case of postoperative perforation. Blood transfusion due to intraoperative massive bleeding was required in 1 case (0.3%). Postoperative bleeding occurred with four lesions (1.3%), and was endoscopically managed without blood transfusion. Local recurrence was detected in 4 lesions (4/202 patients, 2.0%); resection had been piecemeal in all 4. During a median follow-up of 38.7 months (range 12.8-104.2), the 3- and 5-year overall/disease-specific survivals were 97.1/100% and 95.3/100%, respectively.
Conclusions: Colorectal ESD showed favorable long-term outcomes. It may largely replace colectomy for node-negative colorectal epithelial neoplasia.

DOI： 10.1055/s-0030-1255675

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER JAPAN KK  

We report a rare case of esophageal endoscopic submucosal dissection (ESD) in a patient who underwent high-dose dexamethasone therapy for multiple myeloma shortly after ESD. A 61-year-old male was referred for treatment of esophageal superficial squamous cell carcinoma and underwent curative ESD. During his hospitalization for ESD, further examination for worsening back pain and gait disorder revealed multiple myeloma with multiple bone metastases. Consequently, high-dose dexamethasone therapy (40 mg x 4 days x 3 courses) was started on the 9th day after ESD. He was successfully treated by the subsequent peripheral blood stem cell transplantation. In the follow-up endoscopies, the artificial ulcer was shown to have re-epithelialized gradually with little or no size reduction of the ulcer bed. Minimal deformation of the lumen was observed. Histopathological assessment after surgical resection at a later date revealed thinned submucosa with minimal fibrosis of the ESD scar. This case demonstrated the effect of dexamethasone on the healing process of the artificial ulcer. Dexamethasone can be potentially useful for prevention of postoperative stricture, which is a major complication of esophageal ESD.

DOI： 10.1007/s12328-010-0147-z

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MOSBY-ELSEVIER  

Background: Endoscopic submucosal dissection (ESD) is one of the curative endoluminal surgical procedures for gastric epithelial neoplasms. There has been little research on bleeding after gastric ESD.
Objective: To investigate cases of post-ESD bleeding and to verify whether a second-look endoscopy after ESD is effective in the prevention of delayed bleeding.
Design: A retrospective study with consecutive data.
Setting: A single tertiary referral center.
Subjects: A total of 454 gastric epithelial neoplasms (386 early gastric cancers and 68 gastric adenomas).
Interventions: ESD and second-look endoscopy.
Main Outcome Measurements: Predictors on post-EST) bleeding by univariate analysis, incidence of post-ESD bleedings, and the timing of those before and after second-look endoscopy.
Results: Post-ESD bleeding occurred in 26 (5.7%) lesions. Gross type (flat or depressed type) was the only factor influencing post-ESD bleeding. All cases of post-ESD bleeding Occurred within 14 days after ESD (median 2: range 0-14), and bleeding tended to occur from the lower and Upper stomach earlier and later, respectively In 19 lesions With delayed bleeding more than 24 hours after ESD, the maximum delayed bleeding rates before and after the second-look endoscopy were 2.8% and 2.5%, respectively
Limitations: A retrospective, single-center analysis.
Conclusions: A second-look endoscopy after gastric ESD may contribute little to the prevention of delayed bleeding. (Gastrointest Endosc 2010;71:241-8.)

DOI： 10.1016/j.gie.2009.08.030

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記述言語：日本語   出版者・発行元：(株)東京医学社  

2000年7月から2008年10月に施行した大腸上皮性腫瘍に対するESD 283症例が301病変の治療成績を検討した。短期成績として、完全一括切除率、一括切除率、偶発症率(後出血、穿孔)、長期成績として、疾患特異的生存率を遡及的に解析した。一括切除率90.4%、完全一括切除率68.1%で、穿孔は15名(5.3%)、うち術中穿孔14名はすべて内視鏡処置にて保存的に軽快したが、術後穿孔1名は緊急手術となった。術中出血1名(0.4%)に輸血を要したが、後出血4名(1.4%)は輸血をせず、内視鏡処置にて保存的に軽快した。追加外科手術は8名に施行された。局所再発は4名(1.4%)に認め、すべて分割切除例であった。観察期間中(中央値38.7ヵ月)では、3/5年疾患特異的生存率100/100%であり、原病死は認めなかった。(著者抄録)

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記述言語：日本語   出版者・発行元：Japan Gastroenterological Endoscopy Society Kanto Chapter  

症例は67歳男性。胃体中部後壁に径20mmの境界不明瞭な褪色調の不整粘膜を指摘された。内視鏡下生検では悪性を疑う所見も認めたが，再生異型との鑑別が困難な病理像であった。確定診断をつけるため行ったNBI併用拡大内視鏡検査では境界を有した範囲に特徴的な異常血管を認め，高分化腺癌と診断でき，内視鏡的粘膜下層剥離術（ESD）で一括切除した。病理診断は内視鏡診断と一致した高分化粘膜内癌であり，内視鏡的に根治切除できた。本症例は通常内視鏡観察，内視鏡下生検で診断困難であった早期胃癌をNBI併用拡大内視鏡で診断し，内視鏡的に切除し得た貴重な症例と考えられたため，報告する。

DOI： 10.11641/pde.76.2_66

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その他リンク： http://search.jamas.or.jp/link/ui/2010236308

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER JAPAN KK  

The guideline on the management of anticoagulants and antiplatelet agents for endoscopic procedures was established by the Japan Gastroenterological Endoscopy Society in 2005. However, the degree to which this guideline has reached prescribing doctors in other fields has not, so far, been evaluated.Medical records of all patients who underwent scheduled endoscopy from January 2008 to December 2008 in the Department of Gastroenterology at the University of Tokyo were investigated retrospectively.Among 8921 patients underwent scheduled endoscopy, 1383 patients (15.5%) were receiving anticoagulants or antiplatelet agents. 324 patients (23.4%) were receiving warfarin as an anticoagulant. The most common antiplatelet agent was aspirin in 884 patients (63.9%), followed by ticlopidine in 150 patients (10.8%). Most patients taking warfarin alone (51.6%) or a combination of aspirin and ticlopidine (68.4%) underwent endoscopy without cessation. In contrast, most patients taking aspirin alone (46.0%) or ticlopidine alone (56.3%) underwent endoscopy after a cessation period of 6-7 days, indicating the low permeation of the cessation policy recommended in the guideline. Among 556 patients underwent endoscopy without a cessation period, 41 patients (7.4%) underwent invasive procedures including endoscopic mucosal resection. No bleeding complications were observed in patients who underwent invasive procedures without a cessation period.We revealed the low permeation of the guideline to prescribing doctors. Cessation before endoscopy to avoid bleeding complications can be dispensable.

DOI： 10.1007/s00535-009-0127-6

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MOSBY-ELSEVIER  

Background: The long-term outcomes of endoscopic submucosal dissection (ESD) for superficial esophageal squamous cell neoplasms (ESCNs) have not been evaluated to date.
Objective: Assess the long-term outcomes of ESD for ESCNs from our consecutive cases.
Design and Setting: Retrospective study from a single institution.
Patients and Intervention: From January 2002 to July 2008, 107 superficial ESCNs in 84 patients were treated by ESD. The enrolled patients were divided into 2 groups based on the lesion with the deepest invasion in each patient: group A, intraepithelial neoplasm or invasive carcinoma limited to the lamina propria mucosa and group B, invasive carcinoma deeper than the lamina propria mucosa.
Main Outcome Measurements: Rates of en bloc resection, complete resection, and complication were evaluated as short-term outcomes. Overall survival, cause-specific survival, and postoperative stricture rates were evaluated as long-term outcomes.
Results: The rates of en bloc resection and complete resection were 100% and 88%, respectively Perforation accompanied by mediastinal emphysema was observed in 4 (4%) patients. No patient experienced massive bleeding. During the median observation of 632 days (range 8-2358), 15 (18%) patients experienced benign esophageal stricture with dysphagia, which was successfully managed by balloon dilation for a median of 2 sessions (range 1-20). One patient had local recurrence 6 months after ESD. In 2 patients with intramucosal invasive carcinomas in the muscularis mucosa, distant metastases were observed 9 and 18 months after ESD. During the observation period, 3 patients died of esophageal carcinoma. The 5-year cause-specific survival rates of groups A and B were 100% and 85%, respectively
Limitations: This was a retrospective study with a relatively short follow-up and a small number of patients from a single institution.
Conclusion: This long-term follow-up study revealed that ESD is a potentially curative treatment for superficial ESCNs. There were substantial risks of perforation and stricture that were successfully managed endoscopically. (Gastrointest Endosc 2009;70:860-6.)

DOI： 10.1016/j.gie.2009.04.044

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIM: To investigate the protective effect of subserosal injection of hyaluronic acid (HA) after endoscopic resection (ER) using ex vivo and in vivo studies. METHODS: As the first examination, technical application of subserosal injection was tested 10 times using resected porcine stomachs. As the second examination, ER was applied to make six mucosal defects per stomach in three live minipigs and thermal damage was given on the proper muscle layer by using hemostatic forceps. Following the thermocoagulation, 1 mL of normal saline and HA, respectively, was injected targeting the subserosal layer in two mucosal defects each and the rest kept no injection as the control. The minipigs were recovered from the anesthesia and kept fasting until euthanasia which was carried out around 24 h after the procedures. RESULTS: Ex vivo study revealed that complete and partial subserosal injection was possible two (20%) and four (40%) times, respectively. In vivo study revealed that no postoperative perforation occurred at any point of the thermocoagulation. Apparent retention of hyaluronic acid was identified at only two (33%) points where HA was injected. CONCLUSION: This study failed to show preventative effects of subserosal injection of HA on postoperative perforation due to technical faults. However, this concept has a possibility to change strategy of ER with further technical innovation.

DOI： 10.4253/wjge.v1.i1.61

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

Background: Endoscopic submucosal dissection is a novel technique that is expected to be a curative treatment for early gastric cancers. Anti-coagulants and anti-platelet agents are widely used, especially in elderly patients, to prevent thromboembolic disease. However, the feasibility of endoscopic submucosal dissection for such patients has not been investigated.
Aims: To determine the feasibility of endoscopic submucosal dissection for patients using anti-coagulant and anti-platelet agents via retrospective investigation of clinical outcomes.
Methods: Of 408 patients with 444 early gastric cancers consecutively treated by endoscopic submucosal dissection from January 2000 to December 2007 in our hospital, 47 patients with 56 early gastric cancers were receiving anti-coagulants or anti-platelet agents. All patients were classified into groups for high and low risk of thromboembolism. In 44 low-risk patients, these agents were stopped for 1 week before and after treatment. Only three high-risk patients underwent intravenous heparin replacement during the cessation period.
Results: Comparison with other patients showed no significant differences in complete en-bloc resection (96.4%) OF perforation (1.8%). Postoperative bleeding requiring endoscopic treatment occurred for six early gastric cancers (10.7%) in the anti-coagulant and anti-platelet group; this frequency was slightly higher than that observed for other patients (5.2%). The healing of endoscopic submucosal dissection ulcers was not delayed by anti-coagulant and anti-platelet treatment (91% in the scarring stage) when checked at the 8th week after endoscopic submucosal dissection.
Conclusion: The clinical outcomes of endoscopic submucosal dissection for early gastric cancers in patients receiving anti-coagulants or anti-platelet agents indicated that endoscopicsubmucosal dissection for low-risk patients could be a reliable technique with equivalent efficacy and Fisk in comparison with that for other early gastric cancer patients. (C) 2009 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.dld.2009.01.007

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BAISHIDENG PUBLISHING GROUP INC  

This case report presents a 65-year-old man who developed early esophageal cancer with leiomyoma treated by endoscopic submucosal dissection (ESD). There have been several reports of co-existing superficial esophageal cancer and leiomyoma treated by endoscopic mucosal resection. However, there is no previous report describing the co-existing lesion treated by ESD. In order to determine treatment strategies for esophageal cancer, accurate endoscopic evaluation of the cancerous depth is essential. In the present case, the combination of endoscopic ultrasonography and narrow-band imaging system with magnifying endoscopy was extremely useful to evaluate the superficial esophageal cancer with leiomyoma, which lead to the appropriate treatment, ESD. (C) 2009 Baishideng. All rights reserved.

DOI： 10.4253/wjge.v1.i1.68

Web of Science

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記述言語：日本語   出版者・発行元：(株)東京医学社  

大腸内視鏡の普及に伴い、大腸腫瘍に対する内視鏡治療が多くの施設で施行されている。その内視鏡治療の中心となる手技が、高周波電流を通電し、腫瘍を摘除するポリペクトミー/EMRであり、その簡便さ、安全性の高さから広く普及している。しかしながら、この手技を円滑かつ安全に実施するためには、手技そのものの理解だけでなく、高周波発生装置の原理や特徴を理解する必要がある。本稿では、高周波発生装置、特に切開・剥離の原理、高周波発生装置による腫瘍の切れ方に影響を及ぼす因子や安全な処置を行うための使用上の留意点について説明する。また、現在2社から数種類の高周波発生装置が市販されているが、各機器の推奨されている設定値も記載した。これらを参考にしながら、経験豊富な指導医の元で経験を積んでいただきたい。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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