Publications by authors named "Ken Ohata"

105 Publications

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

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

A new classification for the diagnosis of superficial non-ampullary duodenal epithelial tumors using endocytoscopy: A prospective study.

J Gastroenterol Hepatol 2021 Jun 17. Epub 2021 Jun 17.

Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan.

Background And Aim: Although the frequency of endoscopic diagnosis of superficial non-ampullary duodenal epithelial tumors (SNADETs) has been increasing in recent years, no criteria for the endoscopic diagnosis of these tumors have been established yet. The aim of this study was to assess the usefulness of endocytoscopy for diagnosis SNADETs and to establish new criteria.

Methods: This prospective study was conducted at the NTT Medical Center Tokyo from May 2019 to July 2020, and a total of 100 consecutive SNADETs were enrolled. All the endocytoscopic images of the lesions and surrounding normal mucosa were classified into three groups according to the degree of structural atypia and the nuclear morphology and size. The endocytoscopic diagnoses using endocytoscopic classification was compared with the final histopathological diagnoses.

Results: Data of 93 patients with 98 lesions were included in the analysis. The preoperative diagnosis by endocytoscopy coincided with the final histopathological diagnosis in 85 (86.7%) of 98 SNADETs. In addition, the sensitivity and specificity for VCL 4/5 were 87.7% and 85.4%, respectively. In contrast, the accuracy, sensitivity, and specificity of preoperative diagnosis by biopsy were 64.3%, 50.9%, and 82.9%, respectively. Preoperative diagnosis by endocytoscopy showed significantly superior accuracy and sensitivity as compared with preoperative biopsy diagnosis (P < 0.001, respectively).

Conclusions: This new classification (endocytoscopic classification) allows prediction of the tumor histopathology in real time, during endocytoscopy without biopsy, and is expected to be of help in determining the appropriate therapeutic strategies for individual cases of SNADETs. (Clinical trial registration number: UMIN000038643.).
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http://dx.doi.org/10.1111/jgh.15585DOI Listing
June 2021

Endoscopic transcecal appendectomy under laparoscopic single-port assistance.

VideoGIE 2021 Jun 19;6(6):269-271. Epub 2021 Mar 19.

Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan.

Video 1Endoscopic transcecal appendectomy under laparoscopic single-port assistance.
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http://dx.doi.org/10.1016/j.vgie.2021.02.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8187129PMC
June 2021

Endoscopic and histological features of negative differentiated gastric adenocarcinoma arising in the antrum.

JGH Open 2021 Apr 2;5(4):470-477. Epub 2021 Mar 2.

Department of Surgical Pathology Sapporo Kosei General Hospital Sapporo Japan.

Background And Aim: With the increasing prevalence of persons without (HP) infection, cases of HP-negative gastric cancer are increasing. Although rare, cases of differentiated adenocarcinoma of the antrum have been reported in HP-negative patients. We collected cases with such lesions and investigated their endoscopic and histological features.

Methods: Of 1965 consecutive patients with early gastric cancer who underwent endoscopic resection between January 2009 and December 2017, we extracted 9 cases of HP-negative differentiated adenocarcinoma located in the antrum (HPN-DAA). The clinical data, endoscopic findings, and histopathological findings were reviewed.

Results: Of the nine patients with HPN-DAA, seven were male, and the median age was 53.8 years. The tumor arose from the pyloric gland mucosa in all cases. According to the endoscopic findings, the lesions were flat-elevated or depressed, mimicking varioliform gastritis. Magnifying endoscopy with narrow-band imaging showed the absence of a clear demarcation line or an irregular microvessel/surface pattern. As for the histopathological findings, eight of the nine lesions were diagnosed as high-grade dysplasia/intraepithelial neoplasia, while the remaining case was diagnosed as tubular adenocarcinoma with submucosal infiltration. The findings of immunohistochemistry confirmed that three cases were of the intestinal mucin phenotype and six were of the mixed gastric and intestinal mucin phenotype.

Conclusion: HPN-DAA is a very rarely occurring cancer that had never been recognized earlier. They belong to the new category of HP-negative cancers, and there seems to be a certain number of such cases.
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http://dx.doi.org/10.1002/jgh3.12518DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8035464PMC
April 2021

Continuous saliva suction tube to prevent aspiration pneumonia during upper GI endoscopy.

VideoGIE 2021 Mar 10;6(3):114-115. Epub 2020 Dec 10.

Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan.

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http://dx.doi.org/10.1016/j.vgie.2020.11.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7947250PMC
March 2021

Large duodenal pyloric gland adenoma successfully resected by endoscopic submucosal dissection.

Clin J Gastroenterol 2021 Apr 4;14(2):538-541. Epub 2021 Mar 4.

Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan.

A 71-year-old woman was given a barium meal examination as part of a workup for recurring melena and iron deficiency anemia (IDA), and it revealed a large duodenal polyp measuring 60 mm in diameter. Subsequent upper gastrointestinal endoscopy showed a large pedunculated polyp in the duodenal bulb. Magnifying endoscopy with narrow-band imaging (NBI) showed that the lesion consisted of a regular enlarged intervening part between crypts of the epithelium that resembled gastric mucosa. Although the lesion was suspected of being benign, it was resected by endoscopic submucosal dissection (ESD) to prevent the progression of the IDA. The pathology examination revealed the proliferation of mildly irregular-shaped or dilated glands lined by cuboidal cells and low columnar cells in the submucosa. The gastric glands were immunohistochemically positive for MUC6, suggesting pyloric gland differentiation. The lesion was covered by a foveolar-type epithelium, and we made a diagnosis of pyloric gland adenoma (PGA). PGAs are most common in the stomach, and they are rare in the duodenum, where endoscopic treatment is technically challenging. Here we report a case of large duodenal PGA successfully resected by ESD. Since part of PGAs has been reported to be associated with adenocarcinoma, minimally invasive treatment strategies are desirable to reduce the risk of progression to carcinoma.
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http://dx.doi.org/10.1007/s12328-021-01367-wDOI Listing
April 2021

Endoscopic resection of the lesion on the inverted appendix using an endoloop.

Dig Endosc 2021 May 21;33(4):e58-e59. Epub 2021 Feb 21.

Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan.

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http://dx.doi.org/10.1111/den.13937DOI Listing
May 2021

Palisade technique as an effective endoscopic submucosal dissection tool for large colorectal tumors.

Endosc Int Open 2021 Feb 3;9(2):E210-E215. Epub 2021 Feb 3.

Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan.

Endoscopic submucosal dissection (ESD) has become the standard treatment for colorectal ESD, but large colorectal tumors remain difficult to remove. We developed a new method, called the palisade technique, by modifying the multiple tunneling technique. In this method, a palisade of submucosal tissue is left beneath the tumor to anchor a dissected specimen, maintaining effective submucosal traction. The study included 11 patients with large colorectal tumors that were over half the circumference of the colorectal lumen which were treated using the palisade technique from August 2017 to October 2019. Overall resection outcomes were assessed. All 11 lesions were removed en bloc. The R0 resection rate was 45.6 % because of marginal burning of the specimen, but no local recurrence was found after a median observation period of 31 months. The median submucosal dissection time (SDT) and submucosal dissection speed (SDS) were 170 minutes and 23.1 mm /min, respectively. One case of post-ESD hemorrhage was successfully managed endoscopically, and two cases of post-colorectal ESD coagulation syndrome were managed conservatively. The palisade technique can be an effective and safe technique for treating large colorectal tumors that extend over half the luminal circumference.
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http://dx.doi.org/10.1055/a-1313-7026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7857962PMC
February 2021

Successful esophageal endoscopic submucosal dissection with a transoral endoscope after stepwise scope bougienage of post-endoscopic submucosal dissection stricture.

JGH Open 2021 Jan 22;5(1):163-165. Epub 2020 Oct 22.

Department of Gastrointestinal Endoscopy NTT Medical Center Tokyo Tokyo Japan.

Endoscopic submucosal dissection (ESD) for extensive esophageal cancer inevitably causes a post-ESD stricture. It may be difficult to perform additional ESD if a new lesion develops on the anus side of the post-ESD stricture. We sometimes perform balloon dilation of post-ESD stricture in advance, so we could perform ESD using a transoral scope; however, there is a risk of balloon dilation causing severe tearing of the lesions if it is located near the stricture. A 68-year-old man who had undergone ESD for esophageal cancer several times was diagnosed with early esophageal cancer. The lesion was located near the anus side of the post-ESD stricture. Unfortunately, the lesion was located on another post-ESD scar. Although ESD using a transnasal scope was a useful option, it was expected to be challenging as the submucosal layer was thought to have severe fibrosis. We attempted to perform ESD with a transoral endoscope after stepwise scope bougienage of post-ESD stricture.
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http://dx.doi.org/10.1002/jgh3.12437DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7812495PMC
January 2021

Safety and feasibility of laparoscopic and endoscopic cooperative surgery for duodenal neoplasm: a retrospective multicenter study.

Endoscopy 2021 10 2;53(10):1065-1068. Epub 2020 Dec 2.

Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, Sagamihara, Japan.

Background: A delayed perforation can often occur after endoscopic treatment for duodenal neoplasms and may be fatal due to leakage of pancreatic and bile juices. We aimed to evaluate the feasibility and safety of laparoscopic and endoscopic cooperative surgery for duodenal neoplasms (D-LECS) in a multicenter, retrospective study.

Methods: The clinical characteristics and surgical outcomes of 206 patients with duodenal neoplasms in whom D-LECS had initially been attempted at one of 14 institutions were reviewed retrospectively.

Results: Of the 206 patients, 63 (30.6 %), 128 (62.1 %), and 15 patients (7.3 %) had lesions at the bulb, second portion, and third portion of the duodenum, respectively. The rates of en bloc and R0 resections during D-LECS were 96.1 % and 95.1 %, respectively. Intraoperative and delayed perforations occurred in 10 (4.9 %) and 5 patients (2.4 %), respectively. No cases of recurrence were observed. Surgical duration of ≥ 180 minutes was an independent risk factor for postoperative complications.

Conclusions: The results revealed that D-LECS was performed with oncological safety and technical feasibility.
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http://dx.doi.org/10.1055/a-1327-5939DOI Listing
October 2021

Successful endoscopic submucosal dissection for a huge lipoma in the terminal ileum.

VideoGIE 2020 Nov 4;5(11):575-576. Epub 2020 Oct 4.

Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan.

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http://dx.doi.org/10.1016/j.vgie.2020.05.036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7650044PMC
November 2020

Delineating sessile serrated adenomas/polyps with acetic acid spray for a more accurate piecemeal cold snare polypectomy.

VideoGIE 2020 Nov 1;5(11):519-521. Epub 2020 Jul 1.

Department for Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan.

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http://dx.doi.org/10.1016/j.vgie.2020.05.030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7649831PMC
November 2020

Safety and Efficacy of Cold Snare Polypectomy Without Submucosal Injection for Large Sessile Serrated Lesions: A Prospective Study.

Clin Gastroenterol Hepatol 2020 Nov 2. Epub 2020 Nov 2.

Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan. Electronic address:

Background & Aims: Cold snare polypectomy (CSP) has become the standard resection method for small colorectal polyps (<10 mm). Sessile serrated lesions (SSL) have low prevalence of advanced histology irrespective of size, and thus could be amenable to CSP. In this study, we evaluated the safety and efficacy of CSP for SSLs ≥10 mm.

Methods: Between November 2018 and January 2020, we prospectively enrolled 300 consecutive patients who underwent CSP for 474 SSLs ≥10 mm. To delineate SSL borders, indigo carmine chromoendoscopy and/or image-enhanced endoscopy was conducted. Piecemeal CSP (pCSP) was performed in cases where en-bloc resection was difficult. Biopsy specimens were obtained from the margins of the post-polypectomy defect to confirm complete resection. Surveillance colonoscopy was performed to screen for local recurrence.

Results: All lesions were successfully resected using CSP without submucosal injection. The median diameter of the resected lesions was 14 mm, and pCSP was used to resect 106 (22%) lesions. Post-polypectomy biopsies revealed residual serrated tissue in only one case (0.2%). Adverse events included immediate bleeding in 8 (3%) patients; no delayed bleeding events occurred, irrespective of the use of antithrombotic drugs. During a 7-month median follow-up period, surveillance colonoscopies were performed for 384 lesions (81%), and no local recurrences were detected.

Conclusions: CSP without submucosal injection is a safe and effective treatment for SSLs ≥10 mm. UMIN Clinical Trials, Number: UMIN000034763.
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http://dx.doi.org/10.1016/j.cgh.2020.10.053DOI Listing
November 2020

Near-focus magnification and second-generation narrow-band imaging for early gastric cancer in a randomized trial.

J Gastroenterol 2020 Dec 6;55(12):1127-1137. Epub 2020 Oct 6.

Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

Background: Magnifying endoscopy with narrow-band imaging (NBI) is effective for the diagnosis of early gastric cancer (EGC). However, magnifying endoscopy is not yet popular globally because of the required level of skill and lack of availability. To overcome these problems, dual-focus endoscopy (standard- and near-focus (NF) modes) has been developed. In this study, we evaluated the diagnostic performance of NF with second-generation (2G)-NBI (NF-NBI) for the diagnosis of EGC.

Methods: This was a secondary analysis of a multicenter randomized controlled trial of 4523 high-risk patients who underwent gastroscopies at 13 institutions in Japan. Patients were randomly assigned to white-light imaging (WLI) followed by 2G-NBI or to 2G-NBI followed by WLI. Lesions suspicious for EGC, newly detected by non-magnifying WLI or 2G-NBI, were subsequently observed with NF-NBI. All detected lesions were biopsied or resected. The diagnostic performance of NF-NBI was compared with the final histology.

Results: A total of 870 detected lesions (145 EGC, 725 non-EGC) were analyzed. Overall diagnostic performance for EGC using NF-NBI was accuracy 87.7%, sensitivity 60.7%, specificity 93.1%, positive predictive value 63.8%, and negative predictive value 92.2%. There were no significant differences in diagnostic performance between lesions detected by WLI or 2G-NBI. For lesions diagnosed with high (333 lesions) and low (537 lesions) confidences, accuracy was 92.2% and 84.9%, sensitivity was 64.7% and 58.5%, and specificity was 90.5% and 88.8%, respectively.

Conclusion: The diagnostic performance of NF-NBI is good and acceptable for diagnosis of EGC in combination with either WLI or 2G-NBI.
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http://dx.doi.org/10.1007/s00535-020-01734-3DOI Listing
December 2020

New techniques in endocytoscopy: submucosal injection heightens the visibility.

Endoscopy 2021 07 23;53(7):E245-E246. Epub 2020 Sep 23.

Department of Gastroenterology, Yamaga Chuo Hospital, Kumamoto, Japan.

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http://dx.doi.org/10.1055/a-1252-1963DOI Listing
July 2021

Evaluation of colorectal endoscopic submucosal dissection using a multifunctional snare: a prospective clinical feasibility study (with videos).

Gastrointest Endosc 2021 03 18;93(3):671-678. Epub 2020 Sep 18.

Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan.

Background And Aims: The number of colorectal endoscopic submucosal dissections (ESDs) for early colorectal cancer is expected to increase in the future; therefore, cost reduction is a clinically important issue. The SOUTEN snare (Kaneka Medics, Tokyo, Japan) is a novel multifunctional snare developed for hybrid ESD at a low price. If ESD can be performed safely using the SOUTEN snare, the same therapeutic effect can be obtained as with conventional ESD at a lower cost. The aim of this prospective, pilot, clinical feasibility study was to evaluate the safety and efficacy of ESD using the SOUTEN snare (SOUTEN-ESD).

Methods: From October 2018 to January 2019, 119 consecutive patients (121 ESD procedures, 137 colorectal neoplasms) were prospectively enrolled and treated by SOUTEN-ESD at NTT Medical Center Tokyo and Omori Red Cross Hospital. The outcomes of SOUTEN-ESD were evaluated.

Results: Among 137 neoplasms, SOUTEN-ESD was completed in all cases. No cases required conversion to hybrid ESD or to a dedicated ESD device. The mean procedure time was 26.1 ± 14.3 minutes. Both the en-bloc resection rate and R0 resection rate were 100%. The rate of perforation was 0%, the rate of delayed bleeding was 2.2%, and the rate of post-ESD coagulation syndrome was 2.9%.

Conclusions: SOUTEN-ESD was safe and had good outcomes. Although further studies are required to examine indications for SOUTEN-ESD and confirm the results of this study, effective ESD with this novel knife is feasible. The SOUTEN snare is a realistic option for colorectal ESD. (Clinical trial registration number: UMIN 000034299.).
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http://dx.doi.org/10.1016/j.gie.2020.09.019DOI Listing
March 2021

Endoscopic submucosal dissection for colorectal neoplasms in proximity or extending to a diverticulum.

Surg Endosc 2021 07 15;35(7):3479-3487. Epub 2020 Jul 15.

Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan.

Background And Aims: At specialized facilities, endoscopic submucosal dissection (ESD) has currently been performed even for difficult cases such as tumors extending to a diverticulum that previously required surgery. This study aims to classify the type of lesion according to the degree of infiltration to a diverticulum and assessed the safety and efficacy of ESD for each type of lesion.

Methods: We retrospectively reviewed ESD for lesions at NTT Medical Center Tokyo between January 2014 and April 2019. Lesions were classified as follows: Type 1: lesions in contact with or within 3 mm of the edge of a diverticulum; Type 2: lesions that partially infiltrated into a diverticulum; and Type 3: lesions that infiltrated into and completely covered the diverticulum. Furthermore, ESD strategies were divided into A and B, which indicates that a lesion was resected separately from the diverticulum and along the entire diverticulum, respectively. The clinicopathological characteristics and clinical outcomes were analyzed according to the strategy.

Results: A total of 47 lesions satisfied inclusion criteria (19 Type 1, 12 Type 2, and 16 Type 3 lesions). 19 Type 1 and 8 Type 2 lesions were resected using Strategy A, while 4 Type 2 and 16 Type 3 lesions were resected using Strategy B. En bloc resection was achieved in all cases. In Strategy A, the R0 resection rate was 96.3% and the curative resection rate was 88.9%. On the contrary, in Strategy B, the R0 resection rate was 95.0% and the curative resection rate was 90.0%. In Strategy B, one of the patients developed post-operative bleeding that required endoscopic hemostasis; another patient developed delayed perforation that required emergency surgery.

Conclusions: ESD for colorectal neoplasms in proximity or extending to a diverticulum is challenging, but this procedure can be a safe and effective therapeutic option.
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http://dx.doi.org/10.1007/s00464-020-07795-yDOI Listing
July 2021

Endoscopic submucosal dissection of large pedunculated polyps with wide stalks: a retrospective multicenter study.

Endoscopy 2021 Jan 9;53(1):77-80. Epub 2020 Jul 9.

Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan.

Background:  Endoscopic resection of large pedunculated colorectal polyps is technically difficult, especially when the polyp is large and has such a thick stalk that it is either too difficult or impossible to resect prophylactically by a conventional snare. Here, we evaluated the feasibility of ESD for large pedunculated polyps with wide stalks.

Methods:  29 patients with large pedunculated polyps that were not resectable by polypectomy or endoscopic mucosal resection were enrolled in the study.

Results:  En bloc resection was achieved in 28/29 polyps. One suspended case was due to severe fibrosis with muscle retraction signs. The mean diameter of the 29 polyp heads was 39.7 (standard deviation 6.9) mm. Submucosal fibrosis was present in 16 polyps (9 mild; 7 severe). The stalks of severely fibrotic polyps were significantly thicker than those of polyps with no or mild fibrosis. The curative resection rate was 85.7 % without severe complications.

Conclusions:  ESD is feasible for the removal of large pedunculated polyps with wide stalks when conventional snare resection is difficult or impossible.
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http://dx.doi.org/10.1055/a-1194-4413DOI Listing
January 2021

Usefulness of a handmade distal endoscope attachment with a transparent tape.

VideoGIE 2020 Jun 31;5(6):226-228. Epub 2020 Mar 31.

Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan.

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http://dx.doi.org/10.1016/j.vgie.2020.02.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7280143PMC
June 2020

Simple scoring system for the diagnosis of superficial non-ampullary duodenal epithelial tumors.

Dig Endosc 2021 Mar 28;33(3):399-407. Epub 2020 Aug 28.

Divisions of, Division of, Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan.

Background And Aims: Differentiating superficial non-ampullary duodenal epithelial tumors (SNADETs) that harbor malignant potential is important. We developed a simple scoring system and investigated whether it enables the differentiation of low-grade adenoma and high-grade adenoma/adenocarcinoma.

Patients And Methods: We retrospectively enrolled 197 consecutive patients with 207 SNADETs who underwent endoscopic resection at NTT Medical Center Tokyo between March 2016 and May 2019. Endoscopic findings were compared between Vienna Classification (VCL) C3 and C4/5 lesions. A multivariate logistic regression analysis was performed to develop a scoring system to identify VCL C4/5 lesions. The efficacy of our scoring system was elucidated among five novice and five expert endoscopists.

Results: Of 207 SNADETs, 66 and 141 lesions were pathologically diagnosed as VCL C3 and C4/5. A multivariate logistic regression analysis identified a tumor diameter of 10-19 mm (OR, 3.81; 95% CI, 1.02-14.2; P = 0.04), a tumor diameter ≥20 mm (OR, 95.2; 95% CI, 10.4-871.0; P < 0.001), a red color (OR, 14.5; 95% CI, 3.55-59.6; P < 0.001), the presence of irregular surface pattern (OR, 12.4; 95% CI, 3.00-51.4; P < 0.001), and the presence of irregular vessel pattern (OR, 13.7; 95% CI, 4.03-46.6; P < 0.001) as independent significant predictors of VCL C4/5. Considering these results, we developed a scoring system. Using an appropriate cutoff value, the diagnostic accuracy, sensitivity and specificity were calculated as 92%, 95% and 93%. The average diagnostic accuracy did not differ between novice and expert endoscopists (86% vs 87%, P = 0.76).

Conclusions: Our scoring system was useful for differentiating VCL C3 and C4/5 lesions. UMIN Clinical Trials (No. 000039063).
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http://dx.doi.org/10.1111/den.13762DOI Listing
March 2021

Risk factors of delayed bleeding after endoscopic resection of superficial non-ampullary duodenal epithelial tumors and prevention by over-the-scope and conventional clipping.

Dig Endosc 2021 Mar 26;33(3):390-398. Epub 2020 Jun 26.

Departments of, Department of, Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan.

Objectives: This study was aimed to reveal risk factors for delayed bleeding after endoscopic resection (ER) of superficial non-ampullary duodenal epithelial tumors (SNADETs) and at exploring measures to prevent this complication.

Methods: A total of 235 consecutive patients with 249 SNADETs who had undergone ER were enrolled in this study. They were divided into two groups: OTSC group, consisting of the initial 114 cases in which the defects were closed only using OTSCs; and OTSC-c group, consisting of the later 135 cases in which conventional clips were additionally used to cover the inverted submucosa after post-procedure defect closure using OTSCs. The therapeutic outcomes were then compared between the OTSC and OTSC-c groups.

Results: All lesions were successfully resected en-bloc, and the R0 resection rate was 92.4%. The complete defect closure rate was 90.0% and no delayed perforation occurred when successful defect closure was achieved. The rate of delayed bleeding was significantly higher in the OTSC group than in OTSC-c group (11.4% vs. 1.5%, P = 0.001). Multivariate logistic regression analyses revealed that tumor location distal to the ampulla (OR 10.0; 95% CI 1.24-81.0, P = 0.03) and use of a DOAC (OR 8.83; 95% CI 1.13-68.7, P = 0.04) were significant independent predictors of delayed bleeding. Propensity score-matching analysis revealed that additional use of conventional clips was associated with a significantly reduced risk of delayed bleeding (P = 0.003).

Conclusions: Additional use of conventional clips after prophylactic defect closure using OTSCs appears to be useful to reduce the risk of delayed bleeding after ER of SNADETs. UMIN Clinical Trials (No. 000035478).
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http://dx.doi.org/10.1111/den.13729DOI Listing
March 2021

Early gastric cancer detection in high-risk patients: a multicentre randomised controlled trial on the effect of second-generation narrow band imaging.

Gut 2021 01 2;70(1):67-75. Epub 2020 Apr 2.

Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan

Objective: Early detection of gastric cancer has been the topic of major efforts in high prevalence areas. Whether advanced imaging methods, such as second-generation narrow band imaging (2G-NBI) can improve early detection, is unknown.

Design: This open-label, randomised, controlled tandem trial was conducted in 13 hospitals. Patients at increased risk for gastric cancer were randomly assigned to primary white light imaging (WLI) followed by secondary 2G-NBI (WLI group: n=2258) and primary 2G-NBI followed by secondary WLI (2G-NBI group: n=2265) performed by the same examiner. Suspected early gastric cancer (EGC) lesions in both groups were biopsied. Primary endpoint was the rate of EGC patients in the primary examination. The main secondary endpoint was the positive predictive value (PPV) for EGC in suspicious lesions detected (primary examination).

Results: EGCs were found in 44 (1.9%) and 53 (2.3%; p=0.412) patients in the WLI and 2G-NBI groups, respectively, during primary EGD. In a post hoc analysis, the overall rate of lesions detected at the second examination was 25% (n=36/145), with no significant differences between groups. PPV for EGC in suspicious lesions was 13.5% and 20.9% in the WLI (50/371 target lesions) and 2G-NBI groups (59/282 target lesions), respectively (p=0.015).

Conclusion: The overall sensitivity of primary endoscopy for the detection of EGC in high-risk patients was only 75% and should be improved. 2G-NBI did not increase EGC detection rate over conventional WLI. The impact of a slightly better PPV of 2G-NBI has to be evaluated further.

Trial Registration Number: UMIN000014503.
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http://dx.doi.org/10.1136/gutjnl-2019-319631DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7788198PMC
January 2021

Endoscopic submucosal dissection with a hand-made traction method for a tumor completely covering the post-appendectomy orifice.

Dig Endosc 2020 May 27;32(4):e77-e79. Epub 2020 Mar 27.

Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan.

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http://dx.doi.org/10.1111/den.13656DOI Listing
May 2020

Endoscopic submucosal dissection for multiple gastric superficial adenocarcinomas identified in patient with familial adenomatous polyposis.

Dig Endosc 2020 May 11;32(4):e57-e58. Epub 2020 Feb 11.

Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan.

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http://dx.doi.org/10.1111/den.13607DOI Listing
May 2020
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