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  • 1
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    COMPARISON AMONG ENDO‐CYTOSCOPY, CYTOLOGY AND HISTOLOGY OF AN ESOPHAGEAL INTRAEPITHELIAL CARCINOMA
    Wiley ; 2007
    In:  Digestive Endoscopy Vol. 19, No. s1 ( 2007-07)
    Details
    In: Digestive Endoscopy, Wiley, Vol. 19, No. s1 ( 2007-07)
    Abstract: Endo‐cytoscopy enables real‐time microscopic observation of living cells. However, it is not clear what the obtained images represent. Therefore the purpose of the present paper was to compare endocytoscopic images with stump cytological images and horizontal histological images of an esophageal intraepithelial carcinoma, which showed that not only cellular atypia but also structural atypia of the epithelium could be assessed on endocytoscopic imaging. This finding shows that conventional histopathological knowledge is applicable to establish endocytoscopic diagnosis, which means that endoscopic biopsy could be replaced by endocytoscopy to some extent in the near future.
    Type of Medium: Online Resource
    ISSN: 0915-5635 , 1443-1661
    URL: Issue
    URL: Article
    DOI: 10.1111/den.2007.19.issue-s1
    DOI: 10.1111/j.1443-1661.2007.00709.x
    Language: English
    Publisher: Wiley
    Publication Date: 2007
    detail.hit.zdb_id: 2020071-7
    detail.hit.zdb_id: 1171589-3
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  • 2
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    Modified N score is helpful for identifying patients who need endoscopic intervention among those with black stools without hematemesis
    Wiley ; 2022
    In:  Digestive Endoscopy Vol. 34, No. 6 ( 2022-09), p. 1157-1165
    Details
    In: Digestive Endoscopy, Wiley, Vol. 34, No. 6 ( 2022-09), p. 1157-1165
    Abstract: Although black stools are one of the signs of upper gastrointestinal bleeding, not all patients without hematemesis need endoscopic intervention. There is no apparent indicator to select who needs treatment thus far. The aim of this study was to establish a novel score that predicts the need for endoscopic intervention in patients with black stools without hematemesis. Methods We retrospectively enrolled 721 consecutive patients with black stools without hematemesis who underwent emergency endoscopy from two facilities. In the development stage (from January 2016 to December 2018), risk factors that predict the need for endoscopic intervention were determined from the data of 422 patients by multivariate logistic regression analysis, and a novel scoring system, named the modified Nagoya University score (modified N score), was developed. In the validation stage (from January 2019 to September 2020), we evaluated the diagnostic value of the modified N score for 299 patients. Results Multivariate logistic regression analysis revealed four predictive factors for endoscopic intervention: syncope, the blood urea nitrogen (BUN) level, and the BUN/creatinine ratio as positive indicators and anticoagulant drug use as a negative indicator. In the validation stage, the area under the curve of the modified N score was 0.731, and the modified N score showed a sensitivity of 82.0% and a specificity of 58.8%. Conclusions Our modified N score, which consists of only four factors, can identify patients who need endoscopic intervention among those with black stools without hematemesis.
    Type of Medium: Online Resource
    ISSN: 0915-5635 , 1443-1661
    URL: Issue
    URL: Article
    DOI: 10.1111/den.v34.6
    DOI: 10.1111/den.14323
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2020071-7
    detail.hit.zdb_id: 1171589-3
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  • 3
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    Endoscopic submucosal dissection for early gastric cancer using the tip of an electrosurgical snare (thin type)
    Wiley ; 2004
    In:  Digestive Endoscopy Vol. 16, No. 1 ( 2004-01), p. 34-38
    Details
    In: Digestive Endoscopy, Wiley, Vol. 16, No. 1 ( 2004-01), p. 34-38
    Abstract: Background:  Although the strip biopsy method and aspiration method are popular endoscopic mucosal resection techniques for its convenience and reliability, they have limitations in resectable tumor size and location. Endoscopic submucosal dissection techniques using the diathermic needle knife or the insulated‐tip diathermic knife have been introduced to overcome this disadvantage, but they have high risks for bleeding and perforation. Therefore, we have developed a new endoscopic submucosal dissection technique using the tip of an electrosurgical snare (thin type) and assessed its efficacy. Methods:  Fifty‐nine lesions with differentiated‐type gastric cancer without ulceration were treated with our technique at the University Hospital. The tip of an electrosurgical snare (thin type) was used for mucosal incision and submucosal dissection as a flexible diathermic knife. Results:  The size of tumor was 5–85 mm in diameter (mean size: 29 mm) and the location varied from cardia to antrum. Among 59 lesions, 56 lesions (56/59, 95%) were resected completely in an en‐bloc fashion with much less perforation (2/59, 3.4%) and bleeding (1/59, 1.7%) regardless of their size and location. Conclusion:  New endoscopic submucosal dissection technique using the tip of an electrosurgical snare (thin type) is safe and reliable. We were able to resect early gastric cancer with a much higher en‐bloc resection rate and fewer complications using this technique.
    Type of Medium: Online Resource
    ISSN: 0915-5635 , 1443-1661
    URL: Issue
    URL: Article
    DOI: 10.1111/den.2004.16.issue-1
    DOI: 10.1111/j.1443-1661.2004.00313.x
    Language: English
    Publisher: Wiley
    Publication Date: 2004
    detail.hit.zdb_id: 2020071-7
    detail.hit.zdb_id: 1171589-3
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  • 4
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    APPROPRIATE MIXTURE OF HYALURONIC ACID, GLUCOSE AND GLYCERIN FOR A SUBMUCOSAL FLUID CUSHION DURING ENDOSCOPIC SUBMUCOSAL DISSECTION IN THE DOG STOMACH
    Wiley ; 2007
    In:  Digestive Endoscopy Vol. 19, No. 1 ( 2007-01), p. 26-31
    Details
    In: Digestive Endoscopy, Wiley, Vol. 19, No. 1 ( 2007-01), p. 26-31
    Abstract: Background:  A mixture of a 1% 1900 KDa hyaluronic acid (HA) preparation (Suvenyl) and a 10% glycerin with 5% fructose and 0.9% saline preparation (Glyceol) to make a 0.125% HA is considered to be the best ready‐made submucosal fluid cushion (SFC). When the concentration of glycerin is changeable, a more appropriate SFC may be created. Methods:  For two beagles, 1 mL of 10%, 15%, 20%, 25%, and 50% glycerin per stomach was submucosally injected to investigate mucosal damage. After the results, 1 mL of a mixture of 0.125% 1900 KDa HA, 10% glucose, and glycerin of the recommended concentration was submucosally injected onto each stomach of two additional beagles to investigate mucosal lifting and damage. 10% glucose was added to increase the viscoelasticity of HA. Furthermore, endoscopic submucosal dissection (ESD) was performed using the mixture in the rest of the stomachs and the feasibility was investigated. Results:  20% or more concentration of glycerin showed apparent damage and 10% was considered to be a recommended concentration. The mixture of HA and glucose with 10% glycerin showed sufficient mucosal lifting without damage. ESD was completed successfully and no apparent damage was observed in the ESD specimens and its related ulcers. Conclusion:  Although the mixture of 0.125%1900 KDa HA, 10% glucose, and 10% glycerin may create a more appropriate SFC than ready‐made ones, the fact that 10% is a recommended concentration of glycerin may mean the usefulness of alternative use of a commercially available glycerin solution, Glyceol, as an appropriate mixture with HA.
    Type of Medium: Online Resource
    ISSN: 0915-5635 , 1443-1661
    URL: Issue
    URL: Article
    DOI: 10.1111/den.2007.19.issue-1
    DOI: 10.1111/j.1443-1661.2007.00682.x
    Language: English
    Publisher: Wiley
    Publication Date: 2007
    detail.hit.zdb_id: 2020071-7
    detail.hit.zdb_id: 1171589-3
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  • 5
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    Fecal incontinence and oral regurgitation during duodenal endoscopic submucosal dissection using the water pressure method
    Wiley ; 2022
    In:  Digestive Endoscopy Vol. 34, No. 3 ( 2022-03), p. 526-534
    Details
    In: Digestive Endoscopy, Wiley, Vol. 34, No. 3 ( 2022-03), p. 526-534
    Abstract: Endoscopic submucosal dissection (ESD) in the duodenum is challenging. The water pressure method (WP‐ESD) has been developed with a decreased rate of perforation. However, details of perioperative adverse events of WP‐ESD are unknown. The purpose of this study was to clarify the frequency and related factors of fecal incontinence and oral regurgitation during WP‐ESD. Methods A chart‐based retrospective analysis was performed on 43 patients who underwent duodenal WP‐ESD. The saline volume given into the body was calculated in all cases. All adverse events during WP‐ESD until 6 weeks were extracted, and factors related to intraoperative fecal incontinence or oral regurgitation were analyzed. The frequency of fecal incontinence and oral regurgitation was also compared to those of 83 conventional ESD cases. Results In WP‐ESD, intraoperative fecal incontinence occurred in 12 (28%), oral regurgitation in six (14%), and aspiration pneumonia in one patient. For fecal incontinence, the infusion speed (saline volume divided by resection time) around 17 mL/min was a significant factor in multivariable analysis. For oral regurgitation, only tumor size was a significant factor in univariate analysis ( P  = 0.027). Significant difference was observed in the frequency of fecal incontinence between WP‐ESD and conventional ESD (28% vs. 0%, P   〈  0.001), but no difference was observed in oral regurgitation or aspiration pneumonia. Conclusions Intraoperative fecal incontinence is a unique adverse event of WP‐ESD related to the infusion speed. WP‐ESD did not pose a risk for oral regurgitation, but we should be aware of the risk in large tumor cases.
    Type of Medium: Online Resource
    ISSN: 0915-5635 , 1443-1661
    URL: Issue
    URL: Article
    DOI: 10.1111/den.v34.3
    DOI: 10.1111/den.14070
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2020071-7
    detail.hit.zdb_id: 1171589-3
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  • 6
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    Technical feasibility of endoscopic submucosal dissection for gastric neoplasms in the elderly Japanese population
    Wiley ; 2007
    In:  Journal of Gastroenterology and Hepatology Vol. 22, No. 3 ( 2007-03), p. 311-314
    Details
    In: Journal of Gastroenterology and Hepatology, Wiley, Vol. 22, No. 3 ( 2007-03), p. 311-314
    Abstract: Background and Aim:  Endoscopic submucosal dissection (ESD) is gaining acceptance among endoscopists for its efficacy, especially in Japan. Elderly patients often have operative risk due to comorbid diseases, and the feasibility of this treatment for such patients should be investigated. The aim of this study is to evaluate the efficacy and safety of ESD in elderly patients. Methods:  Among 308 gastric neoplasms treated by ESD from 2000 to 2004 in one hospital, 49 lesions were discovered in 42 elderly patients who were 75 years of age or older. Indication criteria for ESD were gastric neoplasms with no apparent massive submucosal invasion diagnosed by endoscopy. The en bloc plus R0 resection rate and complications were assessed in comparison with younger patients. Results:  The average age of the patients was 78.9 years (range 75–88 years). Of these patients, 24 (57%) had comorbid diseases. The complete en bloc plus R0 resection rate was 96% (47/49). Postoperative bleeding requiring emergency endoscopy occurred in three patients (7%). Perforation during ESD occurred in one patient (2%), and was immediately closed with endoclips and managed by conservative medical treatment. The en bloc plus R0 resection rate and complication rate in elderly patients were not significantly different from those of younger patients. Conclusions:  These results indicate that ESD could be a safe and reliable treatment for gastric neoplasms in elderly patients.
    Type of Medium: Online Resource
    ISSN: 0815-9319 , 1440-1746
    URL: Issue
    URL: Article
    DOI: 10.1111/jgh.2007.22.issue-3
    DOI: 10.1111/j.1440-1746.2006.04563.x
    Language: English
    Publisher: Wiley
    Publication Date: 2007
    detail.hit.zdb_id: 632882-9
    detail.hit.zdb_id: 2006782-3
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  • 7
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    Helicobacter pylori status and the extent of gastric atrophy do not affect ulcer healing after endoscopic submucosal dissection
    Wiley ; 2006
    In:  Journal of Gastroenterology and Hepatology Vol. 21, No. 10 ( 2006-10), p. 1586-1589
    Details
    In: Journal of Gastroenterology and Hepatology, Wiley, Vol. 21, No. 10 ( 2006-10), p. 1586-1589
    Abstract: Background:  Eradication therapy for Helicobacter pylori is effective in preventing peptic ulcer recurrence, but its efficacy in ulcer healing is still controversial. The effect of H. pylori on artificial ulcers after endoscopic resection is not known. The purpose of the present study was therefore to evaluate the influence of H. pylori infection on ulcer healing after endoscopic submucosal dissection (ESD). Methods:  One hundred and 10 patients who underwent ESD for gastric tumors, and for whom the infection status of H. pylori was confirmed before treatment, were included. The healing stage was studied by endoscopy performed at 8 weeks after ESD. In addition, 73 patients whose serum pepsinogen (PG) was evaluated before ESD, were divided into three groups: PG positive (PGI ≤ 70 ng/mL and I/II ≤ 3 ng/mL), strongly positive (PGI ≤ 30 ng/mL and I/II ≤ 2 ng/mL) and negative, to study the influence of atrophic gastritis on ulcer healing. Results:  Ulcer healing was observed in 85 patients (93%) who were H. pylori positive, and in 19 patients (100%) in whom H. pylori had been eradicated previously. Serum PG level had no influence on the healing process. Among 15 patients with ulceration or ulcer scar with the lesion, ulcer healing was observed in nine patients (60%), which was significantly low. Conclusions:  Infection status of H. pylori and the extent of gastric atrophy do not affect ulcer healing after ESD. Preoperative existence of fibrotic change in the submucosal layer may delay the healing process.
    Type of Medium: Online Resource
    ISSN: 0815-9319 , 1440-1746
    URL: Issue
    URL: Article
    DOI: 10.1111/jgh.2006.21.issue-10
    DOI: 10.1111/j.1440-1746.2006.04321.x
    Language: English
    Publisher: Wiley
    Publication Date: 2006
    detail.hit.zdb_id: 632882-9
    detail.hit.zdb_id: 2006782-3
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  • 8
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    Prediction model of bleeding after endoscopic submucosal dissection for early gastric cancer: BEST-J score
    BMJ ; 2021
    In:  Gut Vol. 70, No. 3 ( 2021-03), p. 476-484
    Details
    In: Gut, BMJ, Vol. 70, No. 3 ( 2021-03), p. 476-484
    Abstract: Bleeding after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) is a frequent adverse event after ESD. We aimed to develop and externally validate a clinically useful prediction model (BEST-J score: Bleeding after ESD Trend from Japan) for bleeding after ESD for EGC. Design This retrospective study enrolled patients who underwent ESD for EGC. Patients in the derivation cohort (n=8291) were recruited from 25 institutions, and patients in the external validation cohort (n=2029) were recruited from eight institutions in other areas. In the derivation cohort, weighted points were assigned to predictors of bleeding determined in the multivariate logistic regression analysis and a prediction model was established. External validation of the model was conducted to analyse discrimination and calibration. Results A prediction model comprised 10 variables (warfarin, direct oral anticoagulant, chronic kidney disease with haemodialysis, P2Y12 receptor antagonist, aspirin, cilostazol, tumour size 〉 30 mm, lower-third in tumour location, presence of multiple tumours and interruption of each kind of antithrombotic agents). The rates of bleeding after ESD at low-risk (0 to 1 points), intermediate-risk (2 points), high-risk (3 to 4 points) and very high-risk (≥5 points) were 2.8%, 6.1%, 11.4% and 29.7%, respectively. In the external validation cohort, the model showed moderately good discrimination, with a c -statistic of 0.70 (95% CI, 0.64 to 0.76), and good calibration (calibration-in-the-large, 0.05; calibration slope, 1.01). Conclusions In this nationwide multicentre study, we derived and externally validated a prediction model for bleeding after ESD. This model may be a good clinical decision-making support tool for ESD in patients with EGC.
    Type of Medium: Online Resource
    ISSN: 0017-5749 , 1468-3288
    URL: Article
    DOI: 10.1136/gutjnl-2019-319926
    RVK:
    XA 10000
    Language: English
    Publisher: BMJ
    Publication Date: 2021
    detail.hit.zdb_id: 80128-8
    detail.hit.zdb_id: 1492637-4
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  • 9
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    Factors Related to Delayed Adverse Events of Endoscopic Submucosal Dissection in the Duodenum
    S. Karger AG ; 2023
    In:  Digestive Diseases Vol. 41, No. 1 ( 2023), p. 80-88
    Details
    In: Digestive Diseases, S. Karger AG, Vol. 41, No. 1 ( 2023), p. 80-88
    Abstract: Introduction: Endoscopic submucosal dissection for duodenal neoplasms (D-ESD) is considered a technically demanding procedure regarding the high risk of delayed adverse events. Data regarding optimal managements of ulcers after D-ESD are lacking. Methods: A retrospective analysis was performed on consecutive 145 cases of D-ESD for superficial nonampullary duodenal epithelial tumors at a single referral center. Factors related to delayed adverse events and the healing process of ulcers after D-ESD were analyzed. Results: Complete ulcer suture after D-ESD was performed in 128 cases (88%). Two delayed perforation occurred among cases with incomplete suture. Delayed bleeding occurred in 8 cases (6%) within 3 weeks. The ulcer closure rate at second-look endoscopy (SLE) was significantly low among cases with delayed bleeding (12.5% vs. 75%, p = 0.001). The bleeding rate before SLE was significantly high among patients who did not have complete ulcer closure after D-ESD (0.8% vs. 12%, p = 0.036). The ratio of lesions located in the second oral-Vater was significantly low among ulcers re-opened at SLE (38% vs. 14%, p = 0.044). Proton-pump inhibitors (PPIs) were administered for a median of 7 weeks (range 1–8 weeks). At 3 weeks, active ulcer stages were observed in a few cases, and healing or scarring was observed in most cases. Conclusions: Complete ulcer suture was related to decreased risk of delayed adverse events after D-ESD. From the bleeding period and healing process of D-ESD ulcers, the minimum required length of PPI may be 3 weeks after D-ESD.
    Type of Medium: Online Resource
    ISSN: 0257-2753 , 1421-9875
    URL: Article
    DOI: 10.1159/000522362
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2023
    detail.hit.zdb_id: 1482221-0
    detail.hit.zdb_id: 632798-9
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  • 10
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    Comparison of Endoscopic Ultrasonography and Conventional Endoscopy for Prediction of Tumor Depth in Superficial Nonampullary Duodenal Epithelial Tumors
    S. Karger AG ; 2022
    In:  Digestion Vol. 103, No. 4 ( 2022), p. 319-328
    Details
    In: Digestion, S. Karger AG, Vol. 103, No. 4 ( 2022), p. 319-328
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 The utility of endoscopic ultrasonography (EUS) in predicting tumor depth among superficial nonampullary duodenal epithelial tumors (SNADETs) is unclear. The aim was to compare EUS with conventional endoscopy (CE) for the evaluation of tumor invasion of SNADETs. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 A retrospective analysis was performed on consecutive 174 lesions/169 patients with duodenal dysplasia or adenocarcinoma with invasion up to submucosa who underwent both CE and EUS before endoscopic ( 〈 i 〉 n 〈 /i 〉 = 133) or surgical ( 〈 i 〉 n 〈 /i 〉 = 41) treatment. Endoscopic staging by CE was performed based on the characteristic endoscopic criteria of submucosal invasion (irregular surface, submucosal tumor [SMT]-like marginal elevation, and fusion of converging folds). The diagnostic performance of each test was compared with the final histology. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 The sensitivity and accuracy of estimating the depth were higher for CE compared to that of EUS (99.4% vs. 89.4%, 〈 i 〉 p 〈 /i 〉 & #x3c; 0.01 and 97.7% vs. 87.9%, 〈 i 〉 p 〈 /i 〉 & #x3c; 0.01, respectively). Univariate analysis of endoscopic factors revealed that tumor diameter, red color, SMT-like appearance, and hypoechogenicity were factors related to advanced histology. Multivariate analysis revealed that the presence of SMT-like appearance based on CE was an independent factor to predict submucosal invasion ( 〈 i 〉 p 〈 /i 〉 = 0.025). Gross morphology of the combined type was associated to incorrect diagnosis of EUS ( 〈 i 〉 p 〈 /i 〉 = 0.007). Among 3 cases in which EUS overestimated the tumor depth, carcinoma extension in submucosal Brunner’s gland or nontumorous submucosal cystic dilation was observed. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 EUS may not be necessary, and CE may be sufficient for determining the optimal therapeutic strategy for SNADETs.
    Type of Medium: Online Resource
    ISSN: 0012-2823 , 1421-9867
    URL: Article
    DOI: 10.1159/000524841
    RVK:
    XA 40650
    RVK:
    XA 10000
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2022
    detail.hit.zdb_id: 1482218-0
    detail.hit.zdb_id: 1712-7
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