Publications by authors named "Hironori Yamamoto"

366 Publications

Endoscopic ultrasound-guided tissue acquisition for the histopathological diagnosis of autoimmune pancreatitis.

J Med Ultrason (2001) 2021 Oct 20. Epub 2021 Oct 20.

Division of Gastroenterology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.

Autoimmune pancreatitis (AIP) is a disease concept that originated in Japan. It is characterized by diffuse pancreatic enlargement and irregular narrowing of the main pancreatic duct. Although the usefulness of the histological diagnosis of AIP using endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) and EUS-guided fine-needle biopsy (FNB) has been reported, enhanced diagnostic performance is expected with improvements in tissue collection methods and fine-needle techniques. Guidance for establishing the tissue diagnosis of AIP has been developed and is useful for histological evaluation. Histopathological diagnosis by EUS-FNA/FNB is expected to play a central role in AIP diagnosis in the future.
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http://dx.doi.org/10.1007/s10396-021-01144-9DOI Listing
October 2021

Electrolyte-free gel immersion endoscopic submucosal dissection of gastric lesions.

Endoscopy 2021 Oct 15. Epub 2021 Oct 15.

Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan.

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http://dx.doi.org/10.1055/a-1559-1863DOI Listing
October 2021

Low-pressure endoscopy using the gel immersion method facilitates endoscopic hemostasis of duodenal diverticular bleeding.

Endoscopy 2021 Oct 1. Epub 2021 Oct 1.

Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan.

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http://dx.doi.org/10.1055/a-1625-5596DOI Listing
October 2021

Small bowel: Device-assisted endoscopy.

Dig Endosc 2021 Sep 24. Epub 2021 Sep 24.

Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan.

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http://dx.doi.org/10.1111/den.14131DOI Listing
September 2021

Long-Term Outcomes in Patients with Post-Bulbar Ulcer Bleeding Compared to Bulbar Ulcer Bleeding in the Duodenum.

Digestion 2021 Sep 22:1-7. Epub 2021 Sep 22.

Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.

Background: Duodenal ulcers are classified into bulbar and post-bulbar ulcers. The aim of this study is to compare the long-term outcomes of patients with post-bulbar ulcer bleeding and those with bulbar ulcer bleeding.

Methods: A total of 272 patients with hemorrhagic duodenal ulcers requiring hospitalization were included. Their medical records were retrospectively reviewed.

Results: All patients were categorized as bulbar or post-bulbar bleeding ulcer groups. The post-bulbar ulcer group had more patients of advanced age, concurrent malignancy, diabetes mellitus, hypertension, cirrhosis, and chronic kidney disease undergoing hemodialysis. We performed long-term follow-up for an average of 2.6 years. The mortality rate during the follow-up period in the post-bulbar ulcer group was significantly higher than that in the bulbar ulcer group (p < 0.001). The PNED score was a better predictor of 30-day mortality compared to the complete Rockall score and the Glasgow-Blatchford Score. Predictors of mortality were evaluated using a Cox proportional hazards regression model. In multivariate analysis, post-bulbar ulcer, concurrent malignancy, cirrhosis, antiplatelet/anticoagulant use, and transfusion were significant predictors of mortality.

Conclusions: Patients with post-bulbar ulcers have a poorer prognosis than those with bulbar ulcers. After the diagnosis of hemorrhagic post-bulbar duodenal ulcer, close follow-up is necessary.
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http://dx.doi.org/10.1159/000519293DOI Listing
September 2021

Predictors and timing for the development of symptomatic gastroesophageal reflux disease after successful eradication therapy.

Scand J Gastroenterol 2021 Sep 21:1-6. Epub 2021 Sep 21.

Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan.

Background: () eradication success increases the incidence of erosive esophagitis by normalization of gastric acid secretion. The aim of this study is to clarify predictors and timing for the development of symptomatic gastroesophageal reflux disease (GERD) after successful eradication based on long-term follow-up.

Methods: From April 2014 to October 2020, 330 patients with infections treated with a standard triple-drug regimen were enrolled, and their records retrospectively reviewed. Development of symptomatic GERD was defined as requiring proton pump inhibitor or vonoprazan therapy to treat symptoms.

Results: The mean follow-up period was 2.8 years, and symptomatic GERD developed in 41 (12%) patients during the study period. Overall rates of GERD-symptom free patients at 6 months, 1, and 2 years after eradication were 97%, 93%, and 89%, respectively. We evaluated predictors for the development of symptomatic GERD using a Cox proportional hazards regression model. In multivariate analysis, being a current smoker, having functional dyspepsia, hiatal hernia, and severe gastric atrophy were identified as significant predictive factors. The GERD domain score in the Izumo scale was significantly decreased 1 month after vonoprazan therapy consistent with effective treatment of symptomatic GERD.

Conclusions: The rate of development of symptomatic GERD after successful eradication is low over long-term follow-up and is easily controlled by vonoprazan therapy. However, patients with smoking habits, functional dyspepsia, hiatal hernia, or severe gastric atrophy should be followed carefully after eradication.
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http://dx.doi.org/10.1080/00365521.2021.1975310DOI Listing
September 2021

Low-pressure endoscopy using the gel immersion method facilitates endoscopic variceal ligation of ruptured esophageal varices.

Endoscopy 2021 Sep 17. Epub 2021 Sep 17.

Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan.

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http://dx.doi.org/10.1055/a-1559-2120DOI Listing
September 2021

The pocket-creation method facilitates gastric endoscopic submucosal dissection and overcomes challenging situations.

VideoGIE 2021 Sep 28;6(9):390-394. Epub 2021 May 28.

Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan.

Video 1Demonstration of gastric endoscopic submucosal dissection using the pocket-creation method at the angle along the lesser curvature and fornix.
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http://dx.doi.org/10.1016/j.vgie.2021.05.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8433391PMC
September 2021

The Efficacy and Safety of Balloon Enteroscopy-Assisted Endoscopic Retrograde Cholangiography in Pediatric Patients with Surgically Altered Gastrointestinal Anatomy.

J Clin Med 2021 Aug 31;10(17). Epub 2021 Aug 31.

Department of Medicine, Division of Gastroenterology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.

Balloon enteroscopy-assisted endoscopic retrograde cholangiography (BEA-ERC) is useful and feasible in adults with pancreatobiliary diseases, but its efficacy and safety have not been established in pediatric patients. We compared the success rate and safety of BEA-ERC between adults and pediatric patients. This single-center retrospective study reviewed 348 patients (pediatric: 57, adult: 291) with surgically altered gastrointestinal anatomies who underwent BEA-ERC for biliary disorders from January 2007 to December 2019. The success rate of reaching the anastomosis or duodenal papilla was significantly lower in pediatric patients than in adult patients (66.7% vs. 88.0%, < 0.01). The clinical success rate was also significantly lower in pediatric patients (64.9% vs. 80.4%, = 0.014). The rate of adverse events was significantly higher in pediatric patients than in adults (14.2% vs. 7.7%, = 0.037). However, if the anastomotic sites were reached in pediatric patients, the treatment was highly successful (97.3%). The time of reaching target site was significantly longer in pediatric patients than in adult patients. This study shows that BEA-ERC in pediatric patients is more difficult than that in adult patients. However, in patients where the balloon enteroscope was advanced to the anastomosis, clinical outcomes comparable to those in adults can be achieved.
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http://dx.doi.org/10.3390/jcm10173936DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8432188PMC
August 2021

Outcomes of endoscopic resection for superficial duodenal tumors: 10 years' experience in 18 Japanese high-volume centers.

Endoscopy 2021 Sep 8. Epub 2021 Sep 8.

Cancer Center, School of Medicine, Keio University, Tokyo, Japan.

Background And Study Aim: There is no enough data for endoscopic resection (ER) of superficial duodenal epithelial tumors (SDETs) due to its rarity. There are two main kinds of ER techniques for SDETs: EMR and ESD. In addition, modified EMR techniques, underwater EMR (UEMR) and cold polypectomy (CP), are getting popular. We conducted a large-scale retrospective multicenter study to clarify detailed outcomes of duodenal ER.

Patients And Methods: Patients with SDETs who underwent ER at 18 institutions from January 2008 to December 2018 were included. The rates of en bloc resection and delayed adverse events (AEs) (defined as delayed bleeding or perforation) were analyzed. Local recurrence was analyzed using Kaplan-Meier method.

Results: In total, 3107 patients (including 1017 receiving ESD) were included. En bloc resection rates were 79.1%, 78.6%, 86.8%, and 94.8%, and delayed AE rates were 0.5%, 2.2%, 2.8%, and 7.3% for CP, UEMR, EMR and ESD, respectively. The delayed AE rate was significantly higher for ESD group than non-ESD group among lesions less than 19 mm (7.4% vs 1.9%, p<0.0001), but not among lesions larger than 20 mm (6.1% vs 7.1%, p=0.6432). The local recurrence rate was significantly lower in ESD group than non-ESD group (p<0.001). Furthermore, for lesions larger than 30 mm, the cumulative local recurrence rate at 2 years was 22.6% in non-ESD group compared to only 1.6% in ESD group (p<0.0001).

Conclusions: ER outcomes for SDETs were generally acceptable. ESD by highly experienced endoscopists might be an option for very large SDETs.
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http://dx.doi.org/10.1055/a-1640-3236DOI Listing
September 2021

Metachronous Krukenberg tumor from adenocarcinoma in a Meckel's diverticulum: a case report.

J Surg Case Rep 2021 Aug 31;2021(8):rjab374. Epub 2021 Aug 31.

Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Tochigi, Japan.

Adenocarcinoma in a Meckel's diverticulum is rare and difficult to diagnose preoperatively. We report the first case of a metachronous Krukenberg tumor from adenocarcinoma in a Meckel's diverticulum. A 45-year-old woman was admitted for recurrent abdominal pain. Computed tomography scan showed a lesion with contrast enhancement, and a Meckel's diverticulum-associated tumor was suspected. Double-ballon enteroscopy revealed intestinal stenosis and biopsy showed adenocarcinoma. Operative findings showed a Meckel's diverticulum with tumor. Histopathological evaluation revealed well-differentiated adenocarcinoma, interrupted by ectopic gastric mucosa, diagnosed as adenocarcinoma in a Meckel's diverticulum. Two years postoperatively, a multi-cystic mass with contrast enhancement was observed in the pelvis on imaging evaluation and oophorectomy performed. Histological examination of the resected ovary showed proliferation of atypical glandular ducts, consistent with metastatic adenocarcinoma. This case demonstrates that adenocarcinoma in a Meckel's diverticulum may result in distant metastases and requires appropriate follow-up.
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http://dx.doi.org/10.1093/jscr/rjab374DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8407034PMC
August 2021

How we do deep enteroscopy.

Gastrointest Endosc 2021 09 12;94(3):452-456. Epub 2021 Jul 12.

Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan.

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http://dx.doi.org/10.1016/j.gie.2021.05.023DOI Listing
September 2021

How we do deep enteroscopy.

Endoscopy 2021 09 12;53(9):943-946. Epub 2021 Jul 12.

Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan.

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http://dx.doi.org/10.1055/a-1512-5426DOI Listing
September 2021

Appropriate Color Enhancement Settings for Blue Laser Imaging Facilitates the Diagnosis of Early Gastric Cancer with High Color Contrast.

J Gastric Cancer 2021 Jun 17;21(2):142-154. Epub 2021 Jun 17.

Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.

Purpose: Screening image-enhanced endoscopy for gastrointestinal malignant lesions has progressed. However, the influence of the color enhancement settings for the laser endoscopic system on the visibility of lesions with higher color contrast than their surrounding mucosa has not been established.

Materials And Methods: Forty early gastric cancers were retrospectively evaluated using color enhancement settings C1 and C2 for laser endoscopic systems with blue laser imaging (BLI), BLI-bright, and linked color imaging (LCI). The visibilities of the malignant lesions in the stomach with the C1 and C2 color enhancements were scored by expert and non-expert endoscopists and compared, and the color differences between the malignant lesions and the surrounding mucosa were assessed.

Results: Early gastric cancers mainly appeared orange-red on LCI and brown on BLI-bright or BLI. The surrounding mucosae were purple on LCI regardless of the color enhancement but brown or pale green with C1 enhancement and dark green with C2 enhancement on BLI-bright or BLI. The mean visibility scores for BLI-bright, BLI, and LCI with C2 enhancement were significantly higher than those with C1 enhancement. The superiority of the C2 enhancement was not demonstrated in the assessments by non-experts, but it was significant for experts using all modes. The C2 color enhancement produced a significantly greater color difference between the malignant lesions and the surrounding mucosa, especially with the use of BLI-bright (P=0.033) and BLI (P<0.001). C2 enhancement tended to be superior regardless of the morphological type, status, or the extension of intestinal metaplasia around the cancer.

Conclusions: Appropriate color enhancement settings improve the visibility of malignant lesions in the stomach and color contrast between the malignant lesions and the surrounding mucosa.
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http://dx.doi.org/10.5230/jgc.2021.21.e13DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8255299PMC
June 2021

Endoscopic ultrasound-guided pancreatic sampling for the histopathological diagnosis of autoimmune pancreatitis.

Dig Endosc 2021 Jul 7. Epub 2021 Jul 7.

Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan.

Autoimmune pancreatitis (AIP), which is characterized by pancreatic enlargement and irregular narrowing of the main pancreatic duct, is difficult to differentiate from malignancy. The irregular narrowing of the pancreatic duct, which can be detected via endoscopic retrograde cholangiopancreatography, is a characteristic feature of AIP; however, distinguishing between localized AIP and pancreatic cancer based on pancreatic duct imaging is difficult. This study overviews the efficacy of endoscopic ultrasound (EUS)-guided pancreatic sampling for the histopathological diagnosis of AIP. Recent enhancements in needle biopsy methodologies and technologies have contributed to improvement in the diagnostic efficacy of this technique. The guidance provided in this study for the histological diagnosis of AIP is anticipated to further advance in the histopathological diagnosis of AIP using EUS-guided pancreatic sampling.
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http://dx.doi.org/10.1111/den.14076DOI Listing
July 2021

The pocket-creation method facilitates endoscopic submucosal dissection of gastric neoplasms involving the pyloric ring.

Endosc Int Open 2021 Jul 17;9(7):E1062-E1069. Epub 2021 Jun 17.

Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan.

Endoscopic submucosal dissection (ESD) of superficial gastric lesions involving the pyloric ring is difficult. The pocket-creation method (PCM) with a small-caliber-tip transparent hood can overcome this difficulty by compressing the pyloric sphincter applying both traction and counter-traction. The aim of this study is to clarify the usefulness of the PCM for ESD of superficial gastric neoplasms involving the pyloric ring compared to the conventional method (CM). From October 2006 to August 2019, 66 gastric lesions requiring duodenal submucosal dissection beyond the pyloric ring in 66 patients were resected. The CM was mainly performed in the first period (CM group, n = 46) and the PCM in the second period (PCM group, n = 20). We retrospectively reviewed their medical records. Although no significant differences were observed in resection rates between the two groups, the PCM group had a significantly higher R0 resection rate than the CM group (  = 0.047). There were no holes in resected specimens in the PCM group while three specimens in the CM group had a hole. The dissection speed in the PCM group tended to be higher than in the CM group, although it did not reach statistical significance (  = 0.148). No significant differences were observed for the incidence of adverse events. This is the first study reporting the advantages of the PCM over the CM for ESD of gastric lesions involving the pyloric ring. We believe that the PCM is an effective strategy to compress the pyloric sphincter and facilitates R0 resection.
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http://dx.doi.org/10.1055/a-1403-1153DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8211472PMC
July 2021

Development of a gel dedicated to gel immersion endoscopy.

Endosc Int Open 2021 Jun 27;9(6):E918-E924. Epub 2021 May 27.

Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan.

Gel immersion endoscopy is a novel technique to secure the visual field during endoscopy. The aim of this study was to develop a dedicated gel for this technique. To identify appropriate viscoelasticity and electrical conductivity, various gels were examined. Based on these results, the dedicated gel "OPF-203" was developed. Efficacy and safety of OPF-203 were evaluated in a porcine model. experiments showed that a viscosity of 230 to 1900 mPa·s, loss tangent (tanδ) ≤ 0.6, and hardness of 240 to 540 N/cm were suitable. experiments showed electrical conductivity ≤ 220 μS/cm is appropriate. experiments using gastrointestinal bleeding showed that OPF-203 provided clear visualization compared to water. After electrocoagulation of gastric mucosa in OPF-203, severe coagulative necrosis was not observed in the muscularis but limited to the mucosa. OPF-203 is useful for gel immersion endoscopy.
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http://dx.doi.org/10.1055/a-1396-4236DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8159604PMC
June 2021

Successful control of portal hypertension-related complications after two embolization procedures for multiple and large spontaneous portosystemic shunts in a patient with liver cirrhosis.

Clin J Gastroenterol 2021 Aug 16;14(4):1227-1232. Epub 2021 May 16.

Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi, 329-0498, Japan.

Liver cirrhosis is frequently complicated by spontaneous portosystemic shunt (SPSS) due to portal hypertension. Shunt embolization is considered when symptoms related to SPSSs are refractory to endoscopic and/or medical therapies. However, little information is available on the treatment of patients with multiple and large SPSS. We report a successfully managed case in which patient with such SPSS received two embolization procedures within 6 months. A 57-year-old man with alcoholic liver cirrhosis was transferred to our hospital due to a ruptured gastric varix. CT examination showed gastrorenal and splenorenal shunts of 8 mm and 11 mm in diameter, respectively. In addition, multiple hepatocellular carcinomas (HCCs) were noted. First, balloon-occluded retrograde transvenous obliteration (BRTO) was performed for the gastrorenal shunt, resulting in the disappearance of the varix, followed by transcatheter arterial chemoembolization (TACE) for HCCs. However, the hepatic encephalopathy worsened after the BRTO and TACE, and the splenorenal shunt enlarged to 18 mm in diameter. Although the shunt was tortuous and had another drainage vein, we completed the embolization for the shunt using metallic coils without any events. The patient's hepatic encephalopathy and hepatic function were ameliorated after embolization for the splenorenal shunt, and the patient was free from hepatic encephalopathy.
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http://dx.doi.org/10.1007/s12328-021-01441-3DOI Listing
August 2021

Colorectal endoscopic submucosal dissection using the pocket-creation method with single clip traction: a feasibility study.

Endosc Int Open 2021 May 22;9(5):E653-E658. Epub 2021 Apr 22.

Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan.

The pocket-creation method (PCM) facilitates dissection of the central part of a tumor. We previously developed the PCM with clip traction (PCM-CT) to facilitate opening the mucosal pocket, which otherwise could become cumbersome. In the present study, we aimed to examine the feasibility of PCM-CT for colorectal endoscopic submucosal dissection (ESD). PCM-CT was performed on 30 patients with early colorectal tumors from October 2019 to April 2020. PCM-CT allows efficient opening of the mucosal pocket by using the PCM to dissect the center of the lesion and then apply traction with a single clip after making a circumferential mucosal incision. The median specimen major axis length, ESD time, ESD speed, and en bloc resection rate were 48 mm, 84 minutes, 20 mm /min, and 100 % (30/30), respectively. The success rates for the traction clip and median single-clip-traction time were 100 % (30/30) and 1.5 minutes, respectively. Colorectal ESD using PCM-CT is a simple and promising method.
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http://dx.doi.org/10.1055/a-1372-3740DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8062220PMC
May 2021

Hemostasis of an actively bleeding lesion at the ileocecal valve by low-pressure endoscopy using the gel immersion technique.

VideoGIE 2021 Apr 23;6(4):184-186. Epub 2021 Mar 23.

Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Tochigi, Japan.

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http://dx.doi.org/10.1016/j.vgie.2020.11.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8058511PMC
April 2021

Pancreatic Ductal Adenocarcinoma: Epidemiology and Risk Factors.

Diagnostics (Basel) 2021 Mar 20;11(3). Epub 2021 Mar 20.

Department of Medicine, Division of Gastroenterology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.

The number of new cases of pancreatic ductal adenocarcinoma is increasing with a cumulative total of 495,773 cases worldwide, making it the fourteenth most common malignancy. However, it accounts for 466,003 deaths per year and is the seventh leading cause of cancer deaths. Regional differences in the number of patients with pancreatic ductal adenocarcinoma appear to reflect differences in medical care, as well as racial differences. Compared to the prevalence of other organ cancers in Japan, pancreatic ductal adenocarcinoma ranks seventh based on the number of patients, eighth based on morbidity, and fourth based on the number of deaths, with a continuing increase in the mortality rate. Risk factors for developing pancreatic ductal adenocarcinoma include family history, genetic disorders, diabetes, chronic pancreatitis, and intraductal papillary mucinous neoplasms. An issue that hinders improvement in the prognosis of patients with pancreatic ductal adenocarcinoma is the development of a strategy to identify patients with these risk factors to facilitate detection of the disease at a stage when intervention will improve survival.
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http://dx.doi.org/10.3390/diagnostics11030562DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8003883PMC
March 2021

Current status of diagnostic and therapeutic colonoscopy in Japan: The Japan Endoscopic Database Project.

Dig Endosc 2021 Mar 27. Epub 2021 Mar 27.

JED (Japan Endoscopy Database) Project Committee, Japan Gastroenterological Endoscopy Society, Tokyo, Japan.

Objectives: The Japan Endoscopy Database Project was initiated to develop the world's largest endoscopy data repository. This study describes the first phase of the colonoscopy project in Japan.

Methods: Data were aggregated offline by integrating information from the endoscopy database software from January 2015 through March 2017. The study population included all patients who underwent colonoscopy at eight centers.

Results: A total of 31,395 patients who underwent 38,497 colonoscopy procedures were registered. The majority of procedures were performed for screening (n = 14,156), followed by fecal immunochemical test positivity (n = 3960), abdominal symptoms (n = 3864), post-colorectal surgery surveillance (n = 3431), post-endoscopic treatment surveillance (n = 3757), thorough pre-treatment examination (n = 2822), and therapeutic purposes (n = 6507). In the screening group, advanced cancers, early cancers, and adenomas were diagnosed endoscopically in 2.1%, 1.3%, and 28.7% of cases, respectively, while in the fecal immunochemical test-positive group, they were diagnosed in 2.5%, 1.9%, and 41.6% of cases, respectively. The incidence of complications was 0.177% and 0.152% in the screening and fecal immunochemical test-positive groups, respectively. The therapeutic procedures included 1446 cold forceps polypectomy procedures, 4770 cold snare polypectomy procedures, 368 hot biopsies, 2998 hot snare polypectomy procedures, 9775 endoscopic or piecemeal endoscopic mucosal resections, and 1660 endoscopic submucosal dissections. A total of 173 procedure-related complications (0.82%) occurred in 21,017 therapeutic procedures performed in 15,744 patients.

Conclusions: The first phase of the Japan Endoscopy Database Project established the proportions of the diagnostic and therapeutic colonoscopy procedures, and complication rates in real-world settings.
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http://dx.doi.org/10.1111/den.13980DOI Listing
March 2021

Colonoscopy screening and surveillance guidelines.

Dig Endosc 2021 May;33(4):486-519

Japan Gastroenterological Endoscopy Society, Tokyo, Japan.

The Colonoscopy Screening and Surveillance Guidelines were developed by the Japan Gastroenterological Endoscopy Society as basic guidelines based on the scientific methods. The importance of endoscopic screening and surveillance for both detection and post-treatment follow-up of colorectal cancer has been recognized as essential to reduce disease mortality. There is limited high-level evidence in this field; therefore, we had to focus on the consensus of experts. These clinical practice guidelines consist of 20 clinical questions and eight background knowledge topics that have been determined as the current guiding principles.
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http://dx.doi.org/10.1111/den.13972DOI Listing
May 2021

Duodenal sessile serrated adenoma/polyp with characteristic endoscopic and pathologic features.

Clin J Gastroenterol 2021 Apr 1;14(2):531-537. Epub 2021 Mar 1.

Division of Gastroenterology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.

Sessile serrated adenomas/polyps (SSA/Ps), recently called sessile serrated lesions, have a neoplastic pathway in the large intestine and are treated as lesions with malignant potential. There are a few reports of traditional serrated adenomas in the duodenum but no reports of duodenal SSA/Ps. A 66-year-old man underwent screening upper gastrointestinal endoscopy and was found to have a white elevated lesion in the second portion of the duodenum. Magnifying blue laser imaging showed various sized villous-like structures with dilated crypt openings in the white surface mucosa, similar to a SSA/P. Based on these images, a duodenal adenoma was suspected at the time of endoscopic resection. Pathological findings of the resected specimen showed a saw-tooth structure corresponding to basal crypt dilatation and branching with mucus and positive immunostaining for MUC6 and MUC2, similar to a colonic SSA/P. MUC5AC did not stain the glandular crypt cells. KRAS mutation was detected. Immunohistochemical expression of Annexin A10 was clearly identified in the lesion. Although not all of molecular biological features were satisfied, these findings were similar to a colonic SSA/P which has malignant potential. This is the first report of a duodenal SSA/P which should be considered when evaluating elevated duodenal lesions.
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http://dx.doi.org/10.1007/s12328-021-01358-xDOI Listing
April 2021

Long-term vonoprazan therapy is effective for controlling symptomatic proton pump inhibitor-resistant gastroesophageal reflux disease.

Biomed Rep 2021 Mar 1;14(3):32. Epub 2021 Feb 1.

Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Tochigi 329-0498, Japan.

Vonoprazan, a novel potassium-competitive acid blocker, results in greater inhibition of gastric acid secretion than proton pump inhibitors (PPI). The aim of this study was to assess the long-term outcomes of patients with PPI-resistant gastroesophageal reflux disease (GERD) treated with vonoprazan. The medical records of patients with symptomatic GERD treated with vonoprazan for 1 year were retrospectively reviewed. Changes in abdominal symptoms were assessed using the Izumo scale, a self-reported questionnaire which is useful in evaluating the symptoms of GERD, epigastric pain, postprandial distress, constipation and diarrhea, and is commonly used in routine clinical practice. A total of 30 patients were included and stratified into a non-erosive (n=22) and erosive group (n=8). At baseline, postprandial distress symptoms were significantly greater in the non-erosive group compared with the erosive group (P=0.013). Even with vonoprazan therapy, symptoms of GERD in the non-erosive group were refractory compared with the erosive group, and required additional treatment in a larger proportion of patients (45 vs. 13%). GERD symptoms in the non-erosive group significantly improved from baseline and remained better after 1 year of vonoprazan therapy, similar to the erosive group. In addition, vonoprazan improved epigastric pain and postprandial distress symptoms in the non-erosive group, and 1 year of vonoprazan therapy did not aggravate constipation or diarrhea. In conclusion, 1 year of vonoprazan therapy improves GERD symptoms in patients with PPI-resistant GERD.
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http://dx.doi.org/10.3892/br.2021.1408DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7873583PMC
March 2021

Oxidized High-Density Lipoprotein Shows a Stepwise Increase as Fibrosis Progresses in Patients with Nonalcoholic Fatty Liver Disease.

Antioxidants (Basel) 2021 Feb 4;10(2). Epub 2021 Feb 4.

Center for Community Medicine, Division of Community and Family Medicine, Jichi Medical University, Shimotsuke, Tochigi 329-0498, Japan.

Patients with nonalcoholic fatty liver disease (NAFLD) show dyslipidemia and a high risk for coronary heart disease (CHD). However, conventional atherosclerotic lipids are found at low levels in NAFLD patients with advanced fibrosis, in whom the risk for CHD is extremely high. The aim of the present study was to evaluate the levels of oxidized high-density lipoprotein (oxHDL), an emerging atherosclerotic biomarker, in patients with NAFLD. A total of 32 non-NAFLD subjects and 106 patients with NAFLD were enrolled. The fibrosis grades were stratified using non-invasive methods, including the Fibrosis-4 index and NAFLD fibrosis score. Total cholesterol and low-density lipoprotein (LDL)-cholesterol levels were significantly low in patients with advanced liver fibrosis. In contrast, oxHDL levels were high in NAFLD patients and showed a stepwise increase as fibrosis progressed. These oxHDL levels were independent of the HDL cholesterol levels, and statin use did not influence the oxHDL levels. Obese patients showed no increase in oxHDL levels, whereas patients with a low handgrip strength showed high oxHDL levels in NAFLD with advanced fibrosis. In conclusion, oxHDL is a potential biomarker for assessing the status of patients with NAFLD, including CHD and metabolic/nutritional disturbance, and particular cases with advanced liver fibrosis.
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http://dx.doi.org/10.3390/antiox10020239DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7914565PMC
February 2021

A simple method to reposition a dislocated lumen-apposing metal stent during endoscopic necrosectomy.

VideoGIE 2021 Jan 24;6(1):32-34. Epub 2020 Oct 24.

Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan.

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http://dx.doi.org/10.1016/j.vgie.2020.09.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7805129PMC
January 2021

What is the background for the histological diagnosis of autoimmune pancreatitis?

Dig Endosc 2020 Dec 30. Epub 2020 Dec 30.

Division of Gastroenterology, Departments of, Department of, Medicine, Jichi Medical University, Tochigi, Japan.

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http://dx.doi.org/10.1111/den.13917DOI Listing
December 2020

Pocket-creation method enables colorectal endoscopic submucosal dissection for local recurrence with residual endoclips.

Dig Endosc 2021 Mar 28;33(3):e31-e33. Epub 2020 Dec 28.

Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan.

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http://dx.doi.org/10.1111/den.13900DOI Listing
March 2021
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