Language：English   Publishing type：Research paper (scientific journal)  

INTRODUCTION: Gastric subepithelial tumors (SETs) including gastrointestinal mesenchymal tumors (GIMTs) - which often appear as similar hypoechoic lesions originating from the fourth layer of the gastric wall - are difficult to distinguish with endoscopic ultrasound (EUS). We aimed to prospectively validate the utility of circularity, a surrogate indicator of roundness, as a diagnostic method for SETs. METHODS: Among 100 patients with potential GIMTs sized 1-5 cm prospectively recruited at two institutions between 2020 and 2023, those who experienced pathological diagnosis were included in the final analysis. One representative EUS image showing the tumors' maximum cross-sectional surface was selected, and the circularity was measured using an image analysis software. The circularity of the leiomyoma and other SETs suspected GIMTs was compared, and the diagnostic performance at the optimal cutoff value was evaluated. RESULTS: In the 62 patients, the number of GIST, leiomyomas, and other SETs were 46, 10, and 6, respectively. Circularity was significantly lower in the leiomyoma group than in the other SETs group (0.846 vs. 0.924). The area under the receiver operating characteristic curve of circularity for predicting leiomyomas was 0.822 when the cutoff value was set to 0.869. When the lesion was diagnosed as leiomyoma with a circularity of <0.869, the accuracy, sensitivity, and specificity were 82.3%, 70%, and 84.6%, respectively. CONCLUSION: The noninvasive diagnostic method for SETs based on circularity is useful for excluding leiomyomas in lesions of 1-5 cm in size. This diagnostic method may be a potential adjunctive option for differentiating SETs.

DOI： 10.1159/000548504

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVES: This systematic review and meta-analysis aimed to evaluate the diagnostic ability and examine the efficacy of countermeasures to adverse events of mucosal incision-assisted biopsy (MIAB) for gastric subepithelial tumors (SETs). METHODS: We performed a literature search and identified 533 relevant articles. Eleven articles, including 339 lesions, were ultimately used in the meta-analysis. The primary end-point was the pathological diagnostic rate of MIAB for gastric SETs, and the secondary end-point was the incidence of adverse events. The efficacy of acid secretion inhibitors in preventing postoperative bleeding and that of local injection before incision to prevent perforation were also examined. RESULTS: Nine studies were conducted in Japan and two in South Korea, of which only two were prospective studies. The pooled pathological diagnostic rate of MIAB for gastric SETs was 87.8% (95% confidence interval [CI] 80.2-94.0; I2 = 68.7%). The adverse event rate of the pooled population was 0.2% (95% CI 0-1.4; I2 = 0%). The acid secretion inhibitors significantly reduced postoperative bleeding (odds ratio 0.06, 95% CI 0.01-0.66, P = 0.02). Perforation occurred in 0% and 2.6% of the local and nonlocal injection cohorts, respectively, and the pathological diagnostic rates were 50% and 66.7%, respectively. CONCLUSIONS: MIAB is a reliable technique with a favorable diagnostic rate and few adverse events. Acid secretion inhibitors may effectively prevent postoperative bleeding; however, the efficacy of local injection remains unclear. This technique could be an option for tissue sampling in gastric SETs.

DOI： 10.1111/den.14933

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: An "esophageal rosette" (ER) sign is one of the endoscopic findings in primary esophageal achalasia. We investigated whether ER was associated with the therapeutic efficacy of peroral endoscopic myotomy (POEM). METHODS: The clinical characteristics and short-term outcomes of POEM were retrospectively evaluated in 69 patients who underwent the procedure for esophageal achalasia. The patients were divided into two groups according to the presence of an ER sign (ER and non-ER groups). Clinical success was defined as the post-POEM Eckardt score of three or less. RESULTS: On preoperative endoscopy, 55 (79.7%) patients exhibited ER. The patients in the ER group had a longer disease duration than those in the non-ER group (7.4 vs. 2.7 years, P = 0.0011), although the Eckardt scores before POEM were similar between the two groups. No differences were observed in POEM outcomes between the two groups, including procedure time, length of myotomy, hospital stay, and adverse events. The clinical success of POEM was more frequent in the ER group than in the non-ER group (96.2% vs. 78.6%, P = 0.027). Although the changes in the total Eckardt score and integrated relaxation pressure did not differ between the two groups, dysphagia in the Eckardt score significantly improved in the ER group. CONCLUSIONS: The data suggest that POEM for esophageal achalasia with ER could lead to favorable therapeutic outcomes, particularly dysphagia. The presence of ER may help determine the optimal treatment for esophageal achalasia.

DOI： 10.1007/s10388-024-01098-0

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND AND STUDY AIMS: Technical difficulty of endoscopic submucosal dissection (ESD) for colorectal neoplasms has not been resolved. The water pressure method (WPM) is a helpful technique for overcome difficulties with colorectal ESD. We evaluated the efficacy and safety of ESD with WPM (WPM-ESD) for colorectal neoplasms compared with conventional ESD (C-ESD). PATIENTS AND METHODS: This was a single-center, retrospective, observational study. Three hundred and eleven colorectal lesions were allocated into the WPM-ESD and the C-ESD groups, which were compared before and after propensity score matching. The main outcomes were procedure time, proportion of R0 resection, and incidence of adverse events (AEs) in the two groups. RESULTS: The WPM-ESD and C-ESD groups were allocated 134 and 177 lesions, respectively, and propensity score matching analysis created 92 matched pairs. Mean procedure time was significantly shorter in the WPM-ESD group (49 ± 26 vs. 58 ± 42 min, P = 0.032). All lesions were resected in one piece and there was no difference in the proportion of en bloc resection (100% vs. 100%) and R0 resection (92% vs. 96%, P = 0.536) or in incidence of intraoperative perforation (2.2% vs. 2.2%) in the two groups. CONCLUSIONS: WPM for colorectal ESD may shorten procedure time compared with C-ESD without increasing AEs.

DOI： 10.1055/a-2544-2654

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1002/hep4.2069

Web of Science

researchmap

Language：Japanese   Publisher：(一社)日本腹部救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化管学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化管学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器内視鏡学会-関東支部  

researchmap

Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

researchmap