Publications by authors named "Kengo Takimoto"

23 Publications

  • Page 1 of 1

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

Reply to Murakami et al.

Endoscopy 2020 01 18;52(1):77. Epub 2019 Dec 18.

Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

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http://dx.doi.org/10.1055/a-1026-6136DOI Listing
January 2020

Reply to Wang et al.

Endoscopy 2019 12 27;51(12):1184. Epub 2019 Nov 27.

Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

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http://dx.doi.org/10.1055/a-1013-4254DOI Listing
December 2019

Endoscopic tissue shielding to prevent bleeding after endoscopic submucosal dissection: a prospective multicenter randomized controlled trial.

Endoscopy 2019 07 12;51(7):619-627. Epub 2019 Mar 12.

Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

Background: Bleeding after endoscopic submucosal dissection (ESD) is a severe adverse event. Recent reports have described the efficacy of the endoscopic shielding method with polyglycolic acid (PGA) sheets and fibrin glue for the prevention of adverse events after ESD. The aim of the present study was to investigate whether the PGA shielding method provides additional benefit in preventing post-ESD bleeding compared with standard care.

Methods: This was a prospective, multicenter, randomized controlled trial. Patients at high risk of post-ESD bleeding were enrolled in the study. Before ESD, patients were randomized to either the PGA group or the control group. After completing ESD in the PGA group, PGA sheets were placed onto the ulcer floor and adhered with fibrin glue. The primary end point was the post-ESD bleeding rate.

Results: 140 eligible patients were enrolled from September 2014 to September 2016, and 137 were included in the intention-to-treat analysis (67 in the PGA group and 70 in the control group). Post-ESD bleeding occurred in three patients (4.5 %) in the PGA group and in four patients (5.7 %) in the control group; there was no significant difference between the two groups ( > 0.99). Post-ESD bleeding tended to occur later in the control group than in the PGA group (median 12.5 days [range 8 - 14] vs. 2 days [range 0 - 7], respectively).

Conclusion: The PGA shielding method did not demonstrate a significant effect on the prevention of post-ESD bleeding.
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http://dx.doi.org/10.1055/a-0860-5280DOI Listing
July 2019

Enormous postoperative perforation after endoscopic submucosal dissection for duodenal cancer successfully treated with filling and shielding by polyglycolic acid sheets with fibrin glue and computed tomography-guided abscess puncture.

Clin J Gastroenterol 2017 Dec 1;10(6):524-529. Epub 2017 Nov 1.

Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan.

A female in her 70s underwent esophagogastroduodenoscopy (EGD) for screening, and a 0-IIa lesion measuring approximately 15 mm was detected in the descending portion of the duodenum. Due to the malignant potency of the lesion, endoscopic submucosal dissection (ESD) was performed. Microperforation occurred during ESD. The lesion was removed en bloc and the post-ESD ulcer bed was closed with clips. The next day, the patient had abdominal pain and computed tomography (CT) revealed a small amount of free air in the retroperitoneal space. Since there were no findings to suggest panperitonitis, conservative medical management including fasting and antibiotics was continued. Abdominal pain subsequently improved. However, EGD on the 8th day after ESD for follow-up showed shedding of the post-ESD ulcer that penetrated the retroperitoneal space. A surgical approach was not indicated because a few days may have already passed since postoperative perforation occurred and the spread of inflammation to the retroperitoneum was suspected. In an attempt to promote closure of the perforated cavity, we patched polyglycolic acid sheets and fibrin glue to the cavity wall on days 17, 18, and 20 after ESD. The formation of granulation tissue was detected in the cavity one week later. CT showed an abscess in the right retroperitoneum, for which CT-guided abscess puncture was performed. Thereafter, the cavity gradually decreased. After the initiation of oral intake on postoperative day (POD) 63, the general condition of the patient was stable and she was discharged on POD 87. Polyglycolic acid sheets with fibrin glue and CT-guided abscess puncture were useful for closing the large cavity that developed after duodenal postoperative perforation.
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http://dx.doi.org/10.1007/s12328-017-0791-7DOI Listing
December 2017

ENDOSCOPIC SHIELDING OF RECTOURETHRAL FISTULA AFTER LAPAROSCOPIC RADICAL PROSTATECTOMY; REPORT OF A CASE.

Nihon Hinyokika Gakkai Zasshi 2016 ;107(1):39-43

Department of Urology, Uji-Tokusyukai Medical Center.

Rectourethral fistulais a relatively rare complication of radical prostatectomy but is extremely difficult to treat. We report a case with post-laparoscopic radical prostatectomy rectourethral fistula, treated with only endoscopic shielding.A 75-year-old man had undergone laparoscopic radical prostatectomy for prostate cancer, cT2cN0M0. Although there was no finding of rectal injury during the operation, pneumaturia, pyuria and diarrhea appeared at postoperative day 21 and diagnosed rectourethral fistula by colonoscopy and amidotrizoic acid enema. The fistula did not close spontaneously. Four months after the prostatectomy, we treated with endoscopic shielding by use of polyglycolic acid sheets and fibrin glue. The fistula have not recurred for 20 months after the endoscopic procedure.This method is simple and less-invasive for patients. We think it is worth trying this method before surgical management for narrow rectourethral fistula following radical prostatectomy.
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http://dx.doi.org/10.5980/jpnjurol.107.39DOI Listing
August 2018

A basic study of the effect of the shielding method with polyglycolic acid fabric and fibrin glue after endoscopic submucosal dissection.

Endosc Int Open 2016 Dec;4(12):E1298-E1304

Division of Medical Life System, Department of Medical Life System, Doshisha University, Kyotanabe, Kyoto, Japan.

Recently, the shielding method with polyglycolic acid (PGA) fabric and fibrin glue (P-F method) has been reported to prevent serious complications after endoscopic submucosal dissection (ESD). However, the effectiveness and mechanism to prevent complications by this method remain unclear and the corresponding basic research has not been fully conducted. We examined the effectiveness and mechanism of the P-F method, using a surgical ESD model of canine stomach and experiments. In the model experiment treated by P-F method or no treatment (control), ulcer perforation or penetration occurred only in the control group, but not in the P-F group. Microscopically, the P-F group showed less damages of the ulcer lesion than that of the control group, showing thicker granulation tissues including PGA fibers on the third day and excellent mucosal regeneration on the fourteenth day. culture experiments showed that fibroblasts proliferated at a significantly higher rate on PGA than on fibrin or a complex thereof. However, under hydrochloric acid treatment, fibroblasts were protected by fibrin, followed by the complex of both, and PGA. The P-F method exhibited a protective effect against gastric juice by fibrin glue to reduce tissue damages and a scaffold function of PGA fabric to induce better granulation formation at the earlier phase, resulting in excellent long-term tissue repair, on ulcer lesion following ESD, although the results were based on basic experiments.
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http://dx.doi.org/10.1055/s-0042-118208DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5161138PMC
December 2016

Filling and shielding for postoperative gastric perforations of endoscopic submucosal dissection using polyglycolic acid sheets and fibrin glue.

Endosc Int Open 2016 Jun;4(6):E661-4

Doshisya University, Faculty of Life and Medical Sciences, Kyoto, Japan.

Background And Study Aims: Many medical institutions in Japan perform endoscopic mucosal dissection (ESD) to treat early gastric cancer. Perforations can occur during ESD, and clipping has been reported as useful for treating small pinhole perforations. However, it is often difficult to close postoperative perforations because they usually have large diameters, and the muscle layer around the perforated region is often fragile, so additional open surgery is the only currently used method to treat large perforations and delayed perforations. Another method for large perforation is needed to treat perforations endoscopically. Ono et al. reported a case in which a postoperative perforation was closed using a polyglycolic acid (PGA) sheet and fibrin glue. In addition, it has been used by the authors' group to repair duodenal injuries that occur during ESD. We report 3 cases in which PGA sheets and fibrin glue were successfully used to repair postoperative gastric perforations endoscopically. This method is simple, safe, and effective, and is a new way to treat large perforations and delayed perforations that occur following ESD.
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http://dx.doi.org/10.1055/s-0042-105867DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4993898PMC
June 2016

Endoscopic tissue shielding method with polyglycolic acid sheets and fibrin glue to prevent delayed perforation after duodenal endoscopic submucosal dissection.

Dig Endosc 2014 Apr;26 Suppl 2:46-9

Department of Gastroenterology, Takeda General Hospital, Kyoto, Japan.

Delayed perforation after duodenal endoscopic submucosal dissection (ESD) occurs at a high rate because the duodenal wall is very thin and the artificial ulcer after resection is exposed to bile and pancreatic juice. We investigated the application of the combination of a polyglycolic acid (PGA) sheet and fibrin glue. PGA sheets comprise materials widely used in surgery for absorbable thread. Fibrin glue is a heated blood product and is used for hemostasis during operations. We developed a combined method using both materials. We have used this method in two cases. One case involved an elevated lesion located in the lower duodenal angle of the duodenum. The other involved an elevated lesion in the second portion of the duodenum. About 1 week after ESD, the PGA sheets remained covering the ulcer and delayed perforation did not occur. We were able to easily carry out this method for several parts of the duodenum. This method may be helpful for the prevention of delayed perforation after duodenal ESD.
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http://dx.doi.org/10.1111/den.12280DOI Listing
April 2014

Endoscopic diagnosis of superficial non-ampullary duodenal epithelial tumors in Japan: Multicenter case series.

Dig Endosc 2014 Apr;26 Suppl 2:23-9

Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan.

Background And Aim: To verify the current status in Japan on endoscopic diagnosis of superficial non-ampullary duodenal epithelial tumors (SNADET) by a multicenter case series through a questionnaire survey.

Methods: Nine endoscopists and a surgeon responded to a questionnaire on endoscopic diagnosis of SNADET. The subjects of this survey were histologically confirmed SNADET that were endoscopically or surgically resected from 2007 to 2012. This survey collected data of 364 patients with 396 SNADET.

Results: Of the 396 SNADET, 121 were histologically diagnosed as low-grade dysplasia (LGD), 112 as high-grade dysplasia (HGD), and 163 as superficial adenocarcinoma (SAC) including 153 mucosal carcinomas and 10 submucosal carcinomas. Total number of SNADET increased from 125 in the first half to 271 in the second half of the survey period. Compared to LGD, a significantly greater number of HGD or SAC was found in the tumors having a diameter >5 mm as well as solitary or predominantly red color. Preoperative endoscopic diagnosis indicated significantly higher sensitivity and accuracy and significantly lower specificity for HGD or SAC of final histology than preoperative biopsy. Ten submucosal carcinomas had 0-I or 0-IIa+IIc macroscopic-type tumors with red color.

Conclusions: This multicenter case series study suggested that the number of resected SNADET is dramatically increasing in Japan. Tumor diameter >5 mm and red color seemed to be signs for tumors of HGD or SAC. Preoperative endoscopy may provide a more reliable diagnosis of final histology of HGD or SAC than preoperative biopsy. Further studies are warranted for establishing endoscopic features of submucosal carcinoma.
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http://dx.doi.org/10.1111/den.12277DOI Listing
April 2014

Sedation with dexmedetomidine hydrochloride during endoscopic submucosal dissection of gastric cancer.

Dig Endosc 2011 Apr 22;23(2):176-81. Epub 2010 Dec 22.

Gastroenterology, Takeda General Hospital, Kyoto, Japan.

Aim: Although the treatment of early gastric cancer with endoscopic submucosal dissection (ESD) has been widely carried out, a standardized method of sedation for ESD has not been established. The purpose of the present study was to evaluate the efficacy and safety of sedation with dexmedetomidine (DEX).

Methods: We conducted a randomized study involving 90 patients with gastric tumors who were intended to be treated with ESD. The patients were sedated either with DEX (i.v. infusion of 3.0 µg/kg per h over 5 min followed by continuous infusion at 0.4 µg/kg per h [n = 30]), propofol (PF [n = 30]), or midazolam (MDZ [n = 30]). In all groups, 1 mg MDZ was added i.v. as needed.

Results: En bloc resection of the gastric tumor was achieved in 88 (98%) patients. None of the DEX-sedated patients showed a significant reduction of the oxygen saturation level. The percentage of patients who showed body movement in the DEX group was significantly lower than those in the PF and MDZ groups, and the mean dose of additional MDZ in the DEX group was significantly smaller than that in the MDZ group. The rate of effective sedation was significantly higher in the DEX group compared with the MDZ or PF group. The mean length of ESD in the DEX group was 65 min, which was significantly shorter than in the other two groups. No DEX-sedated patient developed major surgical complications.

Conclusions: Sedation with DEX is effective and safe for patients with gastric tumors who are undergoing ESD.
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http://dx.doi.org/10.1111/j.1443-1661.2010.01080.xDOI Listing
April 2011

[A case of probable autoimmune hepatitis from which the persistence of hepatitis A IgM antibody, and the improvement was pathologically obtained by ursodeoxycholic acid medication].

Nihon Shokakibyo Gakkai Zasshi 2008 Sep;105(9):1367-74

Department of Gastroenterological Center, Ijinkai Takeda General Hospital, Japan.

We present a 68 years old woman who was referred to our department due to impaired liver function. Hepatitis A IgM antibody and anti-nuclear antibody were positive, IgG, and gamma-globulin were elevated. Percutaneous liver biopsy was performed and autoimmune hepatitis was suspected pathologically. Oral administration of ursodeoxycholic acid was started and liver function was normalized three months later. The improvement of a hepatitis image was examined by percutaneous liver biopsy one year later. Although hepatitis A IgM antibody was positive throughout the course, hepatitis A virusemia was not considered the cause of persistent positive hepatitis A. IgM antibody could not be clarified. There was a possibility of a non-specific reaction and abnormalities in antibody production control were considered possible. We present this case and discuss the previous literature.
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September 2008

Rituximab alone was effective for the treatment of a diffuse large B-cell lymphoma associated with hemophagocytic syndrome.

Int J Clin Oncol 2007 Feb 25;12(1):59-62. Epub 2007 Feb 25.

Department of Internal Medicine, Takeda General Hospital, 28-1 Ishida, Mori-minami-cho, Fushimi-ku, Kyoto 601-1495, Japan.

We report here the case of a 63-year-old man who had a diffuse large B-cell lymphoma associated with hemophagocytic syndrome (HPS). The lymphoma involved the spleen, bilateral adrenal glands, and paraaortic lymph nodes of the abdomen. In both the bone marrow and lymph nodes, hemophagocytosis was evident, and the laboratory findings were consistent with HPS. The lymphoma cells showed a CD4+, CD5+, CD10-, CD19+, CD20+, CD25+ and surface immunoglobulin microalpha/kappa+ immunophenotype. The patient was unintentionally treated with rituximab alone, resulting in complete resolution of the lymphomatous lesions as well as the features of HPS in response to the initial two doses of rituximab, although he developed gastric hemorrhage requiring vigorous resuscitation. After the completion of eight doses of rituximab, the patient remains free of disease with an excellent performance status.
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http://dx.doi.org/10.1007/s10147-006-0627-9DOI Listing
February 2007

[Case of primary malignant fibrous histiocytoma of the diaphragm discovered by liver function disorder].

Nihon Shokakibyo Gakkai Zasshi 2007 Jan;104(1):57-63

Department of Gastroenterological Center, Ijinkai Takeda General Hospital, Japan.

We present the case of a 67-year-old man with primary malignant fibrous histiocytoma (MFH) of the diaphragm. He was admitted to our hospital with anorexia and loss of body weight. High serum levels of AST, ALT, ALP and gamma-GTP were observed. Several imaging studies disclosed a large tumor on the right side of the diaphragm to the right lobe of the liver. The entire tumor was resected, and histopathological examination of the specimen revealed the characteristics of MFH. MFH originating from the diaphragm is very rare, and we present the case of this patient in addition to a discussion of previous literature.
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January 2007

Gastric fundal varices: new aspects of nonsurgical treatment in Japan.

Nat Clin Pract Gastroenterol Hepatol 2006 Jan;3(1):4-5

Department of Gastroenterology, Racto Clinic, Takehana, Kyoto, Japan.

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http://dx.doi.org/10.1038/ncpgasthep0364DOI Listing
January 2006

How should gastric fundal varices be treated after achieving hemostasis?

Gastrointest Endosc 2006 Jan;63(1):196-7; author reply 197-8

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http://dx.doi.org/10.1016/j.gie.2005.06.015DOI Listing
January 2006

Limitations of transjugular intrahepatic portosystemic shunt for management of gastric varices.

Gastroenterology 2004 Jan;126(1):380-1

Department of Gastroenterology, Takeda General Hospital, Kyoto, Japan.

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http://dx.doi.org/10.1053/j.gastro.2003.07.021DOI Listing
January 2004
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