Publications by authors named "Fumio Itoh"

192 Publications

Evaluation of a new point-of-care quantitative reverse transcription polymerase chain test for detecting severe acute respiratory syndrome coronavirus 2.

J Clin Lab Anal 2021 Sep 14:e23992. Epub 2021 Sep 14.

Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is rapidly spreading worldwide, and the resultant disease, coronavirus disease (COVID-19), has become a global pandemic. Although there are multiple methods for detecting SARS-CoV-2, there are some issues with such tests, including long processing time, expense, low sensitivity, complexity, risk of contamination, and user friendly. This study evaluated the reproducibility and usability of a new point-of-care test (POCT) using real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR) for detecting SARS-CoV-2.

Methods: Samples from 96 patients with suspected SARS-CoV-2 infection were assessed using the real-time qRT-PCR-based POCT and the conventional real-time qRT-PCR method based on the Japanese National Institute of Infectious Diseases guidelines (registration number: jRCT1032200025).

Results: The real-time qRT-PCR-based POCT had a positive agreement rate of 90.0% (18/20), a negative agreement rate of 100% (76/76), and a total agreement rate of 97.9% (94/96), and the significantly high score of questionnaire survey (total score p < 0.0001). In the two cases in which real-time qRT-PCR-based POCT results did not match conventional real-time qRT-PCR test results, the SARS-CoV-2 RNA copy numbers were 8.0 copies per test in one case and below the detection limit in the other case when quantified using conventional real-time qRT-PCR. All patients could be triaged within 1 day using the real-time qRT-PCR-based POCT without invalid reports.

Conclusions: The real-time qRT-PCR-based POCT not only had high reproducibility and useability but also allowed rapid patient triage. Therefore, it may be helpful in clinical settings.
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http://dx.doi.org/10.1002/jcla.23992DOI Listing
September 2021

A novel endoscopic suturing device after endoscopic full-thickness resection of gastric submucosal tumor.

Endoscopy 2021 Sep 8. Epub 2021 Sep 8.

Department of Internal Medicine, Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan.

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http://dx.doi.org/10.1055/a-1581-7679DOI Listing
September 2021

Clinical Outcomes of Early Endoscopic Transpapillary Biliary Drainage for Acute Cholangitis Associated with Disseminated Intravascular Coagulation.

J Clin Med 2021 Aug 16;10(16). Epub 2021 Aug 16.

Department of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan.

Acute cholangitis (AC) is often associated with disseminated intravascular coagulation (DIC), and endoscopic transpapillary biliary drainage (EBD) under endoscopic retrograde cholangiopancreatography (ERCP) is a treatment of choice. However, no evidence exists on the outcomes of EBD for AC associated with DIC. Therefore, we retrospectively evaluated the treatment outcomes of early EBD and compared endoscopic biliary stenting (EBS) and endoscopic nasobiliary drainage (ENBD). We included 62 patients who received early EBD (EBS: 30, ENBD: 32) for AC, associated with DIC. The rates of clinical success for AC and DIC resolution at 7 days after EBD were 90.3% and 88.7%, respectively. Mean hospitalization period was 31.7 days, and in-hospital mortality rate was 4.8%. ERCP-related adverse events developed in 3.2% of patients (bleeding in two patients). Comparison between EBS and ENBD groups showed that the ENBD group included patients with more severe cholangitis, and acute physiology and chronic health evaluation II score, systemic inflammatory response syndrome score, and serum bilirubin level were significantly higher in this group. However, no significant difference was observed in clinical outcomes between the two groups; both EBS and ENBD were effective. In conclusion, early EBD is effective and safe for patients with AC associated with DIC.
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http://dx.doi.org/10.3390/jcm10163606DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8396990PMC
August 2021

Efficient Colonoscopic Identification of Colonic Bleeding Diverticulum Using Intradiverticular Water Injection with a Nontraumatic Tube.

J Anus Rectum Colon 2021 29;5(3):313-318. Epub 2021 Jul 29.

Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kawasaki, Japan.

Objectives: The colonoscopic identification of stigmata of recent hemorrhage (SRH) in patients with colonic diverticular bleeding (CDB) is difficult. Factors that influence the identification of SRH in the diagnosis of CDB were investigated.

Methods: This was a retrospective study of 487 early colonoscopy patients with acute lower gastrointestinal bleeding who were diagnosed with CDB. Comorbidities, medications, bowel preparation, use of a transparent cap, use of a water-jet scope, colonoscopy by an expert colonoscopist, and use of a nontraumatic (NT) tube were assessed. A multivariate analysis was used to estimate the odds ratio and 95% confidence interval.

Results: Of the 487 colonoscopy patients diagnosed with CDB, 191 (39%) were definitively identified with SRH. The use of a transparent cap, a water-jet scope, an expert colonoscopist, and an NT tube were independent predictive factors for SRH on univariate analysis. A multivariable logistic regression model showed that colonoscopy by an expert colonoscopist and the use of an NT tube were predictive factors for SRH.

Conclusions: Intradiverticular water injection with an NT tube by an expert colonoscopist is useful in identifying CDB, and may help achieve effective endoscopic hemostasis.
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http://dx.doi.org/10.23922/jarc.2021-012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8321589PMC
July 2021

The Influence of Pre-Procedural Imaging and Cystic Duct Cholangiography on Endoscopic Transpapillary Gallbladder Drainage in Acute Cholecystitis.

Diagnostics (Basel) 2021 Jul 16;11(7). Epub 2021 Jul 16.

Department of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kawasaki 216-8511, Kanagawa, Japan.

Endoscopic transpapillary gallbladder drainage (ETGBD) for acute cholecystitis is challenging. We evaluated the influence of pre-procedural imaging and cystic duct cholangiography on ETGBD. Patients who underwent ETGBD for acute cholecystitis were retrospectively examined. The rate of gallbladder contrast on cholangiography, the accuracy of cystic duct direction and location by computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP), and the relationship between pre-procedural imaging and the technical success of ETGBD were investigated. A total of 145 patients were enrolled in this study. Gallbladder contrast on cholangiography was observed in 29 patients. The accuracy of cystic duct direction and location (proximal or distal, right or left, and cranial or caudal) by CT were, respectively, 79%, 60%, and 58% by CT and 68%, 55%, and 58% by MRCP. Patients showing gallbladder contrast on cholangiography underwent ETGBD with a significantly shorter procedure time and a lower rate of cystic duct injury. No other factors affecting procedure time, technical success, and cystic duct injury were identified. Pre-procedural evaluation of cystic duct direction and location by CT or MRCP was difficult in patients with acute cholecystitis. Patients who showed gallbladder contrast on cholangiography showed a shorter procedure time and a lower rate of cystic duct injury.
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http://dx.doi.org/10.3390/diagnostics11071286DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8307666PMC
July 2021

Efficacy of endoscopic large balloon dilation extended for 2 minutes in bile duct stone removal: A multicenter retrospective study.

J Hepatobiliary Pancreat Sci 2021 Jul 30. Epub 2021 Jul 30.

Department of Gastroenterology and Hepatology, School of Medicine, St. Marianna University, Kawasaki, Japan.

Background/purpose: There is no evidence regarding the optimal balloon dilation time during endoscopic papillary large balloon dilation (EPLBD). The study aim was to evaluate the efficacy of 2-minute extended balloon dilation for EPLBD.

Methods: Two hundred and five patients who underwent EPLBD during endoscopic retrograde cholangiopancreatography (ERCP) for bile duct stones at three tertiary centers were included in the analysis. Clinical outcomes and the adverse events were compared between the 0-minute group (n = 94, balloon deflated immediately after waist disappearance) and the 2-minute group (n = 111, balloon dilation maintained for 2 minutes after waist disappearance). The risk factors of post-ERCP pancreatitis (PEP) after EPLBD were assessed.

Results: There were no significant differences in the stone removal rates and hospitalization periods between the two groups. However, the total ERCP procedure time was significantly shorter in the 2-minute group (40.6 vs 48.9 min, P = .03). The incidence of PEP was 7.4% in the 0-minute group and significantly lower at 0.9% in the 2-minute group (P = .04). Multivariate analysis identified without 2-minute extended EPLBD as a significant risk factor of PEP (OR: 9.9, P = .045).

Conclusions: Extension of EPLBD for 2 minutes helped prevent PEP and shortened the procedure time.
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http://dx.doi.org/10.1002/jhbp.1029DOI Listing
July 2021

A novel mask to prevent aerosolized droplet dispersion in endoscopic procedures during the coronavirus disease pandemic.

Medicine (Baltimore) 2021 Jul;100(26):e26048

Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.

Abstract: Endoscopic procedures increase the risk of transmission of severe acute respiratory syndrome coronavirus 2 to medical staff, because aerosols are generated during upper gastrointestinal endoscopy. There have been several reported studies on devices for infection prevention; however, few reports have validated them. Therefore, we developed a novel mask to prevent the diffusion of aerosol droplets from patients undergoing endoscopy.We compared microdroplet dispersion during coughing episodes when using the novel mask with microdroplet dispersion when using the conventional mouthpiece alone.The mean number of microdroplets was significantly smaller in the group that used the novel mask (57.9 ± 122.91 vs 933.6 ± 119.80 droplets; P = .01).The novel mask may aid in reducing the degree of exposure of medical personnel to microdroplets and the risk of subsequent infection.
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http://dx.doi.org/10.1097/MD.0000000000026048DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8257832PMC
July 2021

Effect of spraying l-menthol on peristalsis resumption during endoscopic submucosal dissection of gastric tumors.

JGH Open 2021 Jun 6;5(6):653-657. Epub 2021 May 6.

Department of Endoscopy Cancer Institute Hospital Gastroenterology Center Tokyo Japan.

Background And Aim: l-Menthol has smooth muscle-relaxing and antiperistaltic effects. We examined its effectiveness against peristalsis resumption during endoscopic submucosal dissection (ESD) of gastric tumors.

Methods: We retrospectively examined clinical data of 485 patients (501 lesions) who underwent ESD for upper gastrointestinal tumors in 2017. We included 119 patients (127 lesions) in whom peristaltic movement resumed during ESD and l-menthol was applied; 366 patients (374 lesions) without l-menthol application were used as controls. Video recordings were reviewed to determine whether l-menthol suppressed peristalsis resumption.

Results: In cases with l-menthol application, 2 (2.9%), 36 (14.3%), and 89 (71.2%) lesions were found in the upper (U), middle (M), and lower (L) regions, respectively. In the control group, the corresponding values were 66 (17.6%), 215 (57.5%), and 93 (24.9%), respectively. l-Menthol efficacy was observed in 116 of the 127 treated lesions (91.3%), over 90% of which were in the posterior wall of the U region, anterior wall and greater curvature of the M region, and anterior wall and lesser curvature of the L region. The most and least effective areas for l-menthol application were the anterior wall of gastric antrum and posterior wall of the M region, respectively. The mean time from application to peristalsis inhibition was 8.7 s. No adverse effects were observed; perforation and secondary hemorrhage were not significantly different between the groups.

Conclusion: Direct l-menthol application to the submucosal layer during mucosal resection affects smooth muscles and rapidly inhibits peristalsis resumption. Clinically, l-Menthol can be used to suppress peristalsis recurrence during ESD, without adverse effects.
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http://dx.doi.org/10.1002/jgh3.12549DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8171147PMC
June 2021

Risk Factors for Late Rebleeding of Colonic Diverticular Bleeding in Elderly Individuals.

J Anus Rectum Colon 2021 28;5(2):148-157. Epub 2021 Apr 28.

Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan.

Objectives: This study aimed to examine the clinical characteristics of colonic diverticular bleeding (CDB) in elderly individuals.

Methods: This retrospective case-control study was conducted at a single tertiary center. A total of 519 patients (356 men and 163 women; mean age of 73.1 ± 12.5 years) with CDB and hospitalized between January 2004 and May 2019 were analyzed. The subjects were divided into two groups: the elderly (274 individuals aged ≥75 years; mean age, 82.1 ± 5.3 years) and non-elderly (245 individuals aged <75 years; mean age, 63.0 ± 10.3 years) groups. Primary outcomes were early and late rebleeding rates, and secondary outcomes were the risk factors for late rebleeding in elderly individuals. Rebleeding occurring within 30 days of hospitalization was defined as early rebleeding, whereas rebleeding occurring after 31 days was defined as late rebleeding.

Results: The early rebleeding rates were 30.6% and 33.1% ( = 0.557) in the elderly and non-elderly groups, respectively. The late rebleeding rates were 42.3% and 30.6% ( = 0.005) in the elderly and non-elderly groups, respectively. The 3-year recurrence-free survival was 63.6% in the elderly group and 75.6% in the non-elderly group (log-rank test: < 0.001). Multivariate analysis revealed the use of non-steroidal anti-inflammatory drugs (NSAIDs) [odds ratio (OR), 3.55], chronic kidney disease (OR, 2.89), and presence of bilateral diverticula (OR, 1.83) as the independent risk factors for late rebleeding in elderly individuals.

Conclusions: Elderly individuals with CDB require careful follow-up even after discharge. Furthermore, it is important to consider discontinuing NSAIDs to prevent rebleeding.
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http://dx.doi.org/10.23922/jarc.2020-081DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8084535PMC
April 2021

Risk factors of interventional radiology/surgery for colonic diverticular bleeding.

JGH Open 2021 Mar 27;5(3):343-349. Epub 2021 Jan 27.

Division of Gastroenterology and Hepatology, Department of Internal Medicine St. Marianna University School of Medicine Kawasaki Japan.

Background And Aim: Colonic diverticular bleeding (CDB) stops spontaneously, but sometimes, excessive bleeding does not allow hemostasis and requires interventional radiology (IR)/surgery. We examined risk factors in patients who required IR/surgery for CDB and late recurrent bleeding rate after IR/surgery.

Methods: This retrospective case-control study was conducted at a tertiary center. We included 608 patients who required hospitalization for CDB. Patients were investigated for risk factors using logistic regression analysis. We also investigated early and late recurrent bleeding rates following IR/surgery.

Results: In 261 patients (42.9%), the bleeding source was identified, and endoscopic hemostasis was performed; 23 (3.8%) required IR/surgery. In multivariate analysis, shock state with a blood pressure of ≤90 mmHg ( < 0.001; odds ratio [OR], 20.1; 95% confidence interval [CI], 5.08-79.5), positive extravasation on contrast-enhanced computed tomography ( < 0.001; OR 9.5, 95% CI 2.85-31.4), two or more early recurrent bleeding episodes ( = 0.002; OR 7.4, 95% CI 2.14-25.4), and right colon as the source of bleeding ( = 0.023; OR 4.1, 95% CI 1.25-14.0) were independent risk factors requiring IR/surgery. Early recurrent bleeding was observed in 0% and 28.0% patients ( < 0.001) in the IR/surgery and no IR/surgery groups, respectively, whereas late recurrent bleeding rate was observed in 43.4% and 30.7% patients ( = 0.203) in the IR/surgery and no IR/surgery groups, respectively. Four patients who required surgery experienced late recurrent bleeding at a site different from the initial CDB.

Conclusions: Although IR/surgery is an effective hemostatic treatment wherein endoscopic treatment is unsuccessful, late recurrent bleeding cannot be prevented.
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http://dx.doi.org/10.1002/jgh3.12499DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7936614PMC
March 2021

Incidence and management of cystic duct perforation during endoscopic transpapillary gallbladder drainage for acute cholecystitis.

Dig Endosc 2021 Feb 18. Epub 2021 Feb 18.

Departments of, Department of, Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kanagawa, Japan.

Background And Aim: Evidence regarding the incidence and clinical outcome of cystic duct perforation (CDP) during endoscopic transpapillary gallbladder drainage (ETGBD) is inadequate. The present study aimed to evaluate the incidence and management of CDP during ETGBD.

Methods: Between March 2011 and December 2019, 249 patients underwent initial ETGBD for acute cholecystitis. The incidence of CDP was retrospectively examined and the outcomes between the CDP and non-CDP groups were compared.

Results: CDP during ETGBD occurred in 23 (9.2%) of 249 patients (caused by guidewire in 15 and cannula in 8). ETGBD was successful in 10 patients following CDP. In 13 patients who failed ETGBD, 11 underwent bile duct drainage during the same session; nine patients underwent gallbladder decompression by other methods, such as percutaneous drainage. Clinical resolution for acute cholecystitis was achieved in 20 patients, and no bile peritonitis was noted. ETGBD technical success rates (45.3% vs. 91.2%, p < 0.001), ETGBD procedure times (66.5 vs. 54.8 min, p = 0.041), and hospitalization periods (24.5 vs. 18.7 days, p = 0.028) were significantly inferior in the CDP group (n = 23) compared with the non-CDP group (n = 216). There were no differences in clinical success and adverse events other than CDP between both groups.

Conclusions: Cystic duct perforation reduced the ETGBD technical success rate. However, even in patients with cystic duct perforation, an improvement of acute cholecystitis was achieved by subsequent successful ETGBD or additional procedures, such as percutaneous drainage.
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http://dx.doi.org/10.1111/den.13959DOI Listing
February 2021

Non-Invasive Early Molecular Detection of Gastric Cancers.

Cancers (Basel) 2020 Oct 7;12(10). Epub 2020 Oct 7.

Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan.

Gastric cancer (GC) is a significant source of global cancer death with a high mortality rate, because the majority of patients with GC are diagnosed at a late stage, with limited therapeutic choices and poor outcomes. Therefore, development of minimally invasive or noninvasive biomarkers which are specific to GC is crucially needed. The latest advancements in the understanding of GC molecular landscapes and molecular biological methods have accelerated attempts to diagnose GC at an early stage. Body fluids, including peripheral blood, saliva, gastric juice/wash, urine, and others, can be a source of biomarkers, offering new methods for the early detection of GC. Liquid biopsy-based methods using circulating sources of cancer nucleic acids could also be considered as alternative strategies. Moreover, investigating gastric juices/washes could represent an alternative for the detection of GC via invasive biopsy. This review summarizes recently reported biomarkers based on DNA methylation, microRNA, long noncoding RNA, circular RNA, or extracellular vesicles (exosomes) for the detection of GC. Although the majority of studies have been conducted to detect these alterations in advanced-stage GC and only a few in population studies or early-stage GC, some biomarkers are potentially valuable for the development of novel approaches for an early noninvasive detection of GC.
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http://dx.doi.org/10.3390/cancers12102880DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7600616PMC
October 2020

Exposure of coils to the pseudocystic cavity after embolization of a pseudoaneurysm caused by lumen-apposing metal stent placement.

Gastrointest Endosc 2021 02 10;93(2):521-522. Epub 2020 Sep 10.

Department of Gastroenterology and Hepatology, St. Marianna University, School of Medicine, Kawasaki, Japan.

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http://dx.doi.org/10.1016/j.gie.2020.09.004DOI Listing
February 2021

Pancreatic duct guidewire placement for biliary cannulation as a risk factor for stone residue after endoscopic transpapillary stone removal.

BMC Gastroenterol 2020 Aug 24;20(1):285. Epub 2020 Aug 24.

Department of Gastroenterology and Hepatology, St. Marianna University, School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, 216-8511, Japan.

Background: Recent improvements in stone extraction implements and apparatus have lessened the complexity of the endoscopic bile duct stone treatment. However, despite confirmation of complete removal, cases of residual stones have been reported, which can result in recurrent biliary symptoms, cholangitis, and pancreatitis and considerably increase cost given the need for repeat imaging and/or procedures. To date, risk factors for residual bile duct stones following endoscopic retrograde cholangiopancreatography (ERCP) extraction have not been thoroughly evaluated. This study retrospectively investigated the incidence and risk factors of residual bile duct stones following extraction via ERCP.

Methods: We retrospectively reviewed all ERCP cases that underwent endoscopic bile duct stone extraction between April 2014 and March 2019. A total of 505 patients were enrolled and evaluated for the incidence and risk factors of residual bile duct stones after ERCP.

Results: The rate of residual stones was 4.8% (24/505). Residual stones were detected by computed tomography (12/24) or magnetic resonance cholangiopancreatography (12/24). In univariate analyses, a large number of stones (P = 0.01), long procedure time (P = 0.005), and performance of the pancreatic duct guidewire placement method (P-GW) for selective bile duct cannulation (P = 0.01) were the factors involved in residual stones. In multiple logistic regression analysis, performing P-GW was retained as the only independent factor of residual stones (adjusted odds ratio, 3.44; 95% CI, 1.19-9.88; P = 0.02).

Conclusions: When removing bile duct stones with a pancreatic guidewire in place, paying attention to residual stones is necessary.
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http://dx.doi.org/10.1186/s12876-020-01428-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7446213PMC
August 2020

Cancer-related genetic variants of Helicobacter pylori strains determined using gastric wash-based whole-genome analysis with single-molecule real-time technology.

Int J Cancer 2021 01 11;148(1):178-192. Epub 2020 Sep 11.

Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.

Helicobacter pylori (H. pylori) are a primary factor in the pathogenesis of gastric cancer (GC); GC ranks third among cancer-related mortality. A clear understanding of the H. pylori genome factors underlying GC is necessary to develop more effective methods to prevent GC. A single-molecule real-time DNA sequencing-based H. pylori genome-wide association study analysis was performed using the H. pylori genome present in five early-stage GC (EGC) and five non-GC clinical DNA samples recovered from gastric washes. A total of 275 genes with 702 nucleotide variants (NVs) were found to be common to three or more patients with EGC but no non-GC patients (single-NV: 654/702, 93.2%; multi-NV: 40/702, 5.7%; deletion: 3/702, 0.4%; insertion: 3/702, 0.7%). Gene ontology analysis of H. pylori revealed that genes involved in the mitochondrial electron transport system, glycolytic processes and the TCA cycle were highly enriched. Cancer-related NVs were most frequently found in a member of the Helicobacter outer membrane protein family, hopL. In particular, one of the NVs in hopL was a novel six-nucleotide insertion (1159095̂1159096, TACTTC); this mutant was detected more frequently in a validation set of 50 additional EGC samples (22/50, 44.0%) than in 18 non-GC samples (3/18, 16.7%, P = .04). These results suggest that the hopL variant is associated with the development of GC and may serve as a genetic biomarker of H. pylori virulence and GC risk. Our assay can serve as a potent tool to expand our understanding of bacteria-associated tumorigenesis.
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http://dx.doi.org/10.1002/ijc.33257DOI Listing
January 2021

Intra-abdominal bleeding as a rare complication after colonic endoscopic mucosal resection in a patient taking direct oral anticoagulants.

Clin J Gastroenterol 2020 Oct 9;13(5):794-798. Epub 2020 Jul 9.

Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Sugao Street 2-16-1, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.

We describe the case of an 84-year old female who was taking rivaroxaban 30 mg/day and had a medical history of atrial fibrillation. She underwent endoscopic mucosal resection of a 5-mm adenoma located in the hepatic flexure of the transverse colon. Following the procedure, she developed gradually intensifying abdominal pain, with the appearance of small amount of blood in the feces. For that reason, she visited our facility on the 5th day post-endoscopic mucosal resection. At the time of the visit, contrast-enhanced abdominal computed tomography revealed no extravasation or free air; however, bloody ascites was confirmed in the peritoneal cavity. Thus, the patient was diagnosed with post-endoscopic mucosal resection intra-abdominal hemorrhage and hospitalized the same day. After admission, rivaroxaban was discontinued and patient condition monitored. Because subsequent abdominal computed tomography revealed no distinct increase in bloody ascites, no interventional radiological or surgical procedure was performed, and the patient was discharged after providing only conservative treatment. While hemorrhage and perforation are the main complications after colonic endoscopic mucosal resection, so far, there have been a few reports on the occurrence of intra-abdominal hemorrhage following endoscopic mucosal resection. Emergency treatment is sometimes required in patients with intra-abdominal hemorrhage. It is important to keep in mind that this complication, although very rare, may occur, particularly in patients taking anticoagulants.
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http://dx.doi.org/10.1007/s12328-020-01181-wDOI Listing
October 2020

Endoscopic transpapillary gallbladder stent placement in the presence of uncovered biliary metal stents using a through-the-mesh technique.

VideoGIE 2020 Jul 15;5(7):296-299. Epub 2020 May 15.

Department of Gastroenterology and Hepatology, St. Marianna University, School of Medicine, Kawasaki, Japan.

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http://dx.doi.org/10.1016/j.vgie.2020.03.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7332764PMC
July 2020

Non-tuberculous Mycobacterial Pseudo-outbreak of an Intestinal Culture Specimen Caused by a Water Tap in an Endoscopy Unit.

Intern Med 2020 Nov 7;59(22):2811-2815. Epub 2020 Jul 7.

Department of Internal Medicine, Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Japan.

Objective Gastrointestinal lesions of non-tuberculous mycobacteria (NTM) are regarded as opportunistic infections. A large number of positive specimens of NTM were identified in an intestinal fluid culture in the endoscopy unit and it was considered to be a pseudo-outbreak. Methods We reviewed the hospital, laboratory, and colonoscopy records of 263 consecutive patients whose intestinal fluids were analyzed for a mycobacterial culture by colonoscopy at St. Marianna University Hospital, between January 2009 and December 2018. The endoscopy reprocessing procedures were reviewed and samples of water used in the endoscopy unit were cultured. Results An intestinal fluid culture of 154 (58.6%) patients tested positive for NTM (M. intracellulare; 125 cases, M. gordonae; 14 cases, M. avium; 4 cases, M. abscessus; 3 cases, and 8 other cases). In 182 cases (69.2%), an intestinal mucosal culture was performed simultaneously with a fluid culture and tested positive for NTM in 2 cases. Next, we examined the endoscopy unit for any possible environmental contamination. NTM were detected in the tap water used to prepare the antifoaming solution in the endoscopy unit. The water faucets in the endoscopy unit were considered to be the source of the contamination of NTMs. Conclusion We observed that a large number of cases tested positive due to contaminated water that had been used in an endoscopy unit, thus leading to a pseudo-outbreak of NTM.
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http://dx.doi.org/10.2169/internalmedicine.5188-20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7725637PMC
November 2020

Microsatellite instability in cancer: a novel landscape for diagnostic and therapeutic approach.

Arch Toxicol 2020 10 6;94(10):3349-3357. Epub 2020 Jul 6.

Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, 216-8511, Japan.

Defective DNA mismatch repair creates a strong mutator phenotype, recognized as microsatellite instability (MSI). Various next-generation sequencing-based methods for evaluating cancer MSI status have been established, and NGS-based studies have thoroughly described MSI-driven tumorigenesis. Accordingly, high-frequency MSI (MSI-H) has been detected in 81 tumor types, including those in which MSI was previously underrated. The findings have increased the use of immunotherapy, which is assumed to be efficient in tumors having a high mutation burden and/or neoantigen load. In MSI tumorigenesis, positively and negatively selected driver gene mutations have been characterized in colorectal cancers. Recent advancements in genome-wide studies of MSI-H cancers have developed novel diagnostic and therapeutic approaches, including CXCR2 inhibitor, a synthetic lethal therapy targeting the Werner gene and inhibition of nonsense-mediated mRNA decay. MSI is a predictive marker for chemotherapy as well as immunotherapy. Thus, analyses of MSI status and MSI-related alterations in cancers are clinically relevant. We present an update on MSI-driven tumorigenesis, focusing on a novel landscape of diagnostic and therapeutic approaches.
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http://dx.doi.org/10.1007/s00204-020-02833-zDOI Listing
October 2020

Endoscopic Transpapillary Gallbladder Drainage via the Mesh of Triple Uncovered Biliary Metal Stents Using a Soehendra Stent Retriever.

J Gastrointestin Liver Dis 2020 Jun 3;29(2):143. Epub 2020 Jun 3.

Department of Gastroenterology and Hepatology, St. Marianna University, School of Medicine, Kawasaki, Japan.

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http://dx.doi.org/10.15403/jgld-1045DOI Listing
June 2020

Hoarseness After Endoscopic Retrograde Cholangiopancreatography.

Gastroenterology 2021 01 5;160(1):e15-e16. Epub 2020 Jun 5.

Department of Gastroenterology and Hepatology, St. Marianna University, School of Medicine, Kawasaki, Japan.

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http://dx.doi.org/10.1053/j.gastro.2020.05.071DOI Listing
January 2021

Splenosis diagnosed by EUS-guided FNA.

Gastrointest Endosc 2020 Nov 3;92(5):1129-1130. Epub 2020 Jun 3.

Department of Gastroenterology and Hepatology, School of Medicine, St. Marianna University, Kawasaki, Japan.

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http://dx.doi.org/10.1016/j.gie.2020.05.037DOI Listing
November 2020

Use of washing cytology from removed self-expandable metal stents for biliary strictures: a novel cytology method.

Endosc Int Open 2020 Jun 25;8(6):E748-E752. Epub 2020 May 25.

Department of Gastroenterology and Hepatology, St. Marianna University, School of Medicine, Kawasaki, Japan.

Removability is one of the important features of biliary covered self-expandable metal stents (CSEMS). In this study, we evaluated the diagnostic ability of washing cytology of removed CSEMS. For 14 removed CSEMS that had been placed for the biliary strictures (12 malignant, 2 benign), the surface of CSEMS was washed with saline, and pathological examination of the washing liquid as cytology (CSEMS washing cytology) was performed. The specimen sampling rates and sensitivity for malignancy of CSEMS washing cytology were 92.9 % and 41.7 %, respectively. Sensitivity according to the primary disease was 60.0 % for bile duct cancer and 20 % for pancreatic cancer. Sensitivities based on the methods of stent removal were 16.7 % and 66.7 % for removal through the channel of the scope and with the scope, respectively. Therefore, it is possible that sensitivity of CSEMS washing cytology is higher in bile duct cancer and for removal with the scope. In conclusion, CSEMS washing cytology may have potential as a pathological diagnostic method.
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http://dx.doi.org/10.1055/a-1144-2668DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7247891PMC
June 2020

Endoscopic ultrasound-guided bilateral biliary drainage through the mesh of the metal stents using a balloon occlusion method.

Dig Endosc 2020 Jul 28;32(5):e104-e105. Epub 2020 May 28.

Department of Gastroenterology and Hepatology, School of Medicine, St. Marianna University, Kanagawa, Japan.

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http://dx.doi.org/10.1111/den.13701DOI Listing
July 2020

Mouthwash-Based Highly Sensitive Pyro-Genotyping for Nine Sexually Transmitted Human Papilloma Virus Genotypes.

Int J Mol Sci 2020 May 24;21(10). Epub 2020 May 24.

Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan.

Human papillomavirus (HPV) is a common sexually transmitted infection worldwide, which spreads via contact with infected genital, anal, and oral/pharyngeal areas (oral sex) owing to diverse manners of sexual intercourse. In this study, we devised an oral HPV detection method using mouthwash waste fluids that causes less psychological resistance to visiting the outpatient otolaryngology departments. We successfully detected only the specific unique reverse sequencing probe (using pyro-genotyping) and identified the nine genotypes of HPV targeted for vaccination by pyrosequencing the mouthwash waste fluids of non-head and neck cancer patient volunteers ( = 52). A relatively large number (11/52) of mouthwash waste fluids tested positive for HPV (21.2%; genotype 6, = 1; 11, = 1; 16, = 1; and 18, = 8). These results surpassed the sensitivity observed testing the same specimens using the conventional method (1/52, 1.9%). Our method (pyro-genotyping) was developed using nine HPV genotypes targeted for vaccination and the results were highly sensitive compared to those of the conventional method. This less expensive, high-throughput, and simple method can be used for detecting oral HPV infection with fewer socio-psychological barriers.
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http://dx.doi.org/10.3390/ijms21103697DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7279261PMC
May 2020

Endoscopic Transpapillary Gallbladder Drainage for Acute Cholecystitis After Biliary Self-Expandable Metal Stent Placement.

Surg Laparosc Endosc Percutan Tech 2020 Oct;30(5):416-423

Departments of Gastroenterology and Hepatology.

Background: Endoscopic transpapillary gallbladder drainage (ETGBD) for acute cholecystitis (AC) after self-expandable metal stent (SEMS) placement is technically challenging and there are no reports about its outcome in a several cases. This study aims to assess the outcomes of ETGBD for AC after SEMS placement.

Methods: Between April 2011 and April 2019, 314 patients underwent SEMS placement for biliary stricture. Among them, 12 of 21 patients who developed AC after SEMS placement underwent ETGBD. In general, ETGBD was performed after SEMS removal in cases in which a covered SEMS was previously placed or with the SEMS kept in place in cases in which an uncovered SEMS was previously placed. When the orifice of the cystic duct overlapped the uncovered SEMS, ETGBD was performed through the mesh of the SEMS.

Results: Among the 12 patients who underwent ETGBD, the previously placed SEMS was in the distal (n=8) or perihilar (n=4) bile duct. The type of SEMS placed in the distal bile duct was covered in 7 (fully covered: 6, partially covered: 1) and uncovered in 1, whereas that in the perihilar bile duct was uncovered for all. The technical success rate of ETGBD was 83.3% (10/12), and that according to the previous SEMS placement site was 75.0% (6/8) for the distal bile duct and 100% (4/4) for the perihilar bile duct. In the technically successful, the clinical success rate for AC was 90.0% (9/10). The rate of adverse event was 16.7% (2/12) (stent kink: 1, tube self-removal: 1).

Conclusions: ETGBD can have relatively good outcomes for AC after SEMS placement.
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http://dx.doi.org/10.1097/SLE.0000000000000802DOI Listing
October 2020

Tip-in endoscopic mucosal resection for large colorectal sessile polyps.

Surg Endosc 2021 04 30;35(4):1820-1826. Epub 2020 Apr 30.

Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Sugao Street 2-16-1, Miyamae-ku, Kawasaki-shi, Kanagawa, 216-8511, Japan.

Background: Tip-in endoscopic mucosal resection (EMR) is a modified EMR technique using which en bloc resection of large colorectal sessile polyps can be performed; however, its usefulness for colorectal sessile polyps of > 20 mm has not been reported. This study examined treatment outcomes of tip-in and conventional EMR for large colorectal sessile polyps of ≥ 20 mm.

Methods: This was a retrospective case-control study conducted at a single tertiary center in Japan. Subjects included those with large colorectal sessile polyps of ≥ 20 mm, excluding pedunculated-type polyps, who underwent endoscopic resection between January 2010 and January 2019. The primary outcome was endoscopic treatment outcomes when using tip-in and conventional EMR, and the secondary outcome was the local recurrence rate after endoscopic treatment.

Results: Forty-three colorectal lesions were treated using tip-in EMR and 83 using conventional EMR. Tip-in EMR had a significantly higher en bloc resection rate (90.7% vs. 69.8.%), and significantly shorter treatment duration (6.64 ± 0.64 min vs. 10.47 ± 0.81 min) than conventional EMR. However, for lesions > 30 mm, en bloc resection rate was 50.0% and 52.6% for tip-in and conventional EMR, respectively, indicating no significant difference. Perforation rates with tip-in and conventional EMR were 4.6% and 3.6%, respectively, indicating no significant difference. Local recurrence was examined in 80 cases who were followed up for > 6 months after endoscopic resection; recurrence rate was 0% and 7.0% in tip-in and conventional EMR cases, respectively, without significance difference.

Conclusions: Tip-in EMR showed high en-block resection rate, particularly in polyps of < 30 mm, and no residual tumor was found. This technique is a potential endoscopic treatment alternative for large colorectal sessile polyps of ≥ 20 mm.
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http://dx.doi.org/10.1007/s00464-020-07581-wDOI Listing
April 2021

Endoscopic transpapillary gallbladder drainage using the balloon occlusion method to advance the guidewire into the cystic duct.

Endoscopy 2020 09 18;52(9):E339-E341. Epub 2020 Mar 18.

Department of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kawasaki, Japan.

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http://dx.doi.org/10.1055/a-1125-5826DOI Listing
September 2020

A rare case of Epstein-Barr virus-positive mucocutaneous ulcer that developed into an intestinal obstruction: a case report.

BMC Gastroenterol 2020 Jan 13;20(1). Epub 2020 Jan 13.

Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, 1-30-37, Shukugawara, Tama-Ku, Kawasaki, Japan.

Background: Epstein-Barr virus-positive mucocutaneous ulcer (EBV-MCU) is a new category of mature B-cell neoplasms. Ulcers occur in the oropharyngeal mucosa, skin, and gastrointestinal tract. The onset of EBV-MCU is suggested to be related to the decreased immunity of the patient, the causes of which include the use of immunosuppressive agents and aging. EBV-MCU may regress spontaneously and it often has a benign course after the dose reduction or discontinuation of immunosuppressive agents or during follow-up. Here, we report the case of a patient who required surgical resection for the intestinal obstruction arising from EBV-MCU.

Case Presentation: A Japanese elderly male visited our hospital with chief complaints of a palpable mass and dull pain in the left upper quadrant, loss of appetite, and weight loss. Although abdominal computed tomography and total colonoscopy (TCS) revealed a tumor with circumferential ulcer in the transverse colon, histopathological analysis of a biopsy specimen of this lesion showed only nonspecific inflammation. Because the tumor spontaneously regressed during the time he underwent tests to obtain a second opinion from another hospital, TCS was reperformed on the patient. TCS revealed that the tumor decreased in size and the inflammatory changes in the surrounding mucosa tended to improve; however, tightening of the surrounding mucosa due to scarring was observed. Another histopathological analysis of a biopsy specimen showed widespread erosion of the mucosa and the formation of granulation tissue with marked infiltration of various inflammatory cells into the mucosal tissue of the large intestine. Moreover, some of the B-lymphocyte antigen CD20-positive B cells were also positive for EBV-encoded small RNA-1, suggesting the possibility of EBV-MCU. Later, the tumor developed into an intestinal obstruction; thus, the transverse colon was resected. Histopathological analysis of the resected specimen demonstrated scattered Hodgkin and Reed-Sternberg-like multinucleated large B cells in addition to EBER-1-positive cells. The patient was finally diagnosed as having EBV-MCU.

Conclusions: This is the first report of a case of EBV-MCU that developed into an intestinal obstruction requiring surgical resection. It is necessary to consider the possibility of EBV-MCU when examining an ulcerative or tumorous lesion in the gastrointestinal tract.
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http://dx.doi.org/10.1186/s12876-020-1162-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6958744PMC
January 2020
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