Publications by authors named "Kyosuke Tanaka"

94 Publications

Utility of the narrow-band imaging international colorectal endoscopic classification for optical diagnosis of colorectal polyp histology in clinical practice: a retrospective study.

BMC Gastroenterol 2021 Aug 28;21(1):336. Epub 2021 Aug 28.

Department of Gastroenterology and Hepatology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.

Background: Narrow-band imaging (NBI) highlights the surface structures and vessels of colorectal polyps and is useful for determining the polyp histology. The narrow-band imaging international colorectal endoscopic (NICE) classification is a diagnostic tool for determining colorectal polyp histology based on NBI without optical magnification. In this study, we aimed to investigate the value of each type of the NICE classification for determining colorectal polyp histology using endoscopy data accumulated in a clinical setting.

Methods: Endoscopy data for 534 colorectal polyps (316 patients) treated at our facility were retrospectively analyzed. First, we investigated the diagnostic performance of each type of the NICE classification for the optical diagnosis of colorectal polyp histology. The procedures were performed by experienced endoscopists using high-definition colonoscopy without optical magnification. Second, inter-observer and intra-observer agreements were assessed after providing experts and non-experts with a short lecture on the NICE classification. Using 50 fine NBI images of colorectal polyps without optical magnification, the inter-observer and intra-observer agreements between five experts and five non-experts were assessed.

Results: The sensitivity, specificity, and accuracy values were 86.0%, 99.6%, and 98.5% for NICE type 1 lesions; 99.2%, 85.2%, and 97.8% for NICE type 2 lesions; and 81.8%, 99.6%, and 99.3% for NICE type 3 lesions, respectively. The inter-observer and intra-observer agreements ranged from substantial to excellent for both experts and non-experts.

Conclusions: The NICE classification had good diagnostic ability in terms of determining the polyp histology and demonstrated a high level of reproducibility among experts and non-experts. Thus, the NICE classification is a useful clinical tool that can be used without optical magnification.
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http://dx.doi.org/10.1186/s12876-021-01898-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8401034PMC
August 2021

Efficacy of a small-caliber colonoscope for pain in female patients during unsedated colonoscopy: a randomized controlled study.

Endosc Int Open 2021 Jul 17;9(7):E1055-E1061. Epub 2021 Jun 17.

Department of Gastroenterology and Hepatology, Mie University Hospital, Tsu, Japan.

 Female sex has been identified as a factor increasing patients' pain during colonoscopy. The aim of this randomized controlled study was to investigate the efficacy of a small-caliber colonoscope, PCF-PQ260 L, for limiting pain in women during unsedated colonoscopy.  Women who underwent unsedated colonoscopy were randomly allocated to either the small-caliber or standard colonoscope group. The primary outcome was overall pain and secondary outcomes were maximum pain and procedural measures. In addition, the effects of colonoscope type were analysed using analysis of covariance and logistic regression with adjustment for stratification factors, age and prior abdomino-pelvic surgery.  A total of 220 women were randomly assigned to the small-caliber (n = 110) or standard (n = 110) colonoscope groups. Overall and maximum pain scores were significantly lower in the small-caliber colonoscope group than the standard colonoscope group (overall pain, 20.0 vs. 32.4, P < 0.0001; maximum pain, 28.9 vs. 47.2, P < 0.0001). The small-caliber colonoscope group achieved a superior cecal intubation rate (99 % vs. 93 %, P = 0.035). The rate of patient acceptance of unsedated colonoscopy in the future was higher in the small-caliber colonoscope group than in the standard colonoscope group (98 % vs. 87 %, P = 0.003). In addition, the small-caliber colonoscope was superior with respect to reducing pain and improving the rate of patient acceptance of unsedated colonoscopy with adjustment.  This study demonstrates the efficacy of the small-caliber colonoscope for reducing pain in women and improving their rate of acceptance of unsedated colonoscopy.
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http://dx.doi.org/10.1055/a-1464-0780DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8211489PMC
July 2021

Plexin domain containing protein 2 is more expressed within the invasive area of human colorectal cancer tissues.

Hum Cell 2021 Sep 19;34(5):1580-1583. Epub 2021 Jun 19.

Department of Gastroenterology and Hepatology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.

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http://dx.doi.org/10.1007/s13577-021-00570-8DOI Listing
September 2021

Increased Reflux Esophagitis after Eradication Therapy in Cases Undergoing Endoscopic Submucosal Dissection for Early Gastric Cancer.

Cancers (Basel) 2021 Apr 8;13(8). Epub 2021 Apr 8.

Department of Gastroenterology and Hepatology, Mie University Faculty and Graduate School of Medicine, Edobashi 2-174, Tsu, Mie 514-8507, Japan.

Background: The role of in the pathogenesis of reflux esophagitis is controversial. This study investigated the frequency of reflux esophagitis before and after eradication in patients having endoscopic submucosal dissection for early gastric cancer.

Methods: This study included 160 patients that fulfilled the study's criteria. Endoscopy was performed before and after eradication, and reflux esophagitis was evaluated during the follow-up period.

Results: Seropositivity for in patients with early gastric cancer was 68.8%, 101 of them received eradication therapy. During the follow-up period, the incidence of reflux esophagitis increased from 3.1% to 18.8% in the successful eradication group but no case of reflux esophagitis was observed in the failed eradication group. The univariate and multivariate analyses showed a significant correlation between successful eradication rate and the development of reflux esophagitis.

Conclusions: This study demonstrated that a successful eradication therapy is a risk factor for newly developed reflux esophagitis in patients with endoscopic submucosal dissection for early gastric cancer.
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http://dx.doi.org/10.3390/cancers13081779DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8068244PMC
April 2021

Primary rectal squamous cell carcinoma resembling a submucosal tumor.

JGH Open 2021 Apr 26;5(4):517-519. Epub 2021 Feb 26.

Department of Endoscopy Mie University Hospital Tsu Japan.

Primary rectal squamous cell carcinoma is an extremely rare tumor and, in most cases, detected at an advanced stage. In our case, the tumor was at an early stage and had a submucosal appearance. Thus, the tumor was difficult to differentiate from other rectal submucosal tumors and, it was removed by endoscopic submucosal dissection for excisional biopsy.
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http://dx.doi.org/10.1002/jgh3.12514DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8035460PMC
April 2021

A Middle-Aged Woman with Elevated Serum CA19-9 and Lymphadenopathy.

Am J Med 2021 08 1;134(8):e459-e460. Epub 2021 Apr 1.

Department of Gastroenterology and Hepatology.

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http://dx.doi.org/10.1016/j.amjmed.2021.02.030DOI Listing
August 2021

Early central nervous system relapse of monomorphic epitheliotropic intestinal T-cell lymphoma after cord blood transplantation.

Int J Hematol 2021 Jul 1;114(1):129-135. Epub 2021 Mar 1.

Department of Hematology and Oncology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.

Monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL) is a rare subtype of intestinal T-cell lymphoma that occurs mostly in Asia. CHOP-like therapy is usually selected, but the prognosis is very poor. This report concerns a 43-year-old woman with newly diagnosed stage IVA MEITL. The patient obtained a partial response after 4 cycles of GDP (gemcitabine, dexamethasone, cisplatin) and achieved a complete response (CR) after cord blood transplantation (CBT) conditioned with total body irradiation, cyclophosphamide, and cytarabine. Seven months after transplantation, the patient experienced cognitive impairment. Magnetic resonance imaging of the brain showed a high-intensity lesion in the right cerebral peduncle and internal capsule. A cerebrospinal fluid examination confirmed central nervous system (CNS) relapse of MEITL. After 3 cycles of MPV (methotrexate, procarbazine, vincristine) followed by whole-brain radiotherapy, her cognitive impairment improved. Due to disease progression, she died 6 months after CNS relapse. Given the CNS relapse after achieving a CR with GDP and CBT in this patient, CNS prophylaxis during first-line therapy may be beneficial in the treatment of MEITL.
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http://dx.doi.org/10.1007/s12185-021-03107-9DOI Listing
July 2021

Adult hypertrophic pyloric stenosis that improved by spontaneous double channel pylorus formation.

JGH Open 2021 Feb 2;5(2):317-319. Epub 2020 Dec 2.

Department of Endoscopy Mie University Hospital Tsu Japan.

Adult hypertrophic pyloric stenosis (AHPS) is a rare disease and presents as pyloric obstruction. Double pylorus is also a rare condition due to a gastroduodenal fistula connecting from the gastric antrum to the duodenum. A 42-year-old woman without a history of vomiting in infancy presented with postprandial abdominal distension and repeated vomiting. Abdominal computed tomography showed gastric dilatation and wall thickening of the distal stomach. Endoscopy and contrast gastrography revealed gastric outlet obstruction due to stenosis and an ulcer in the antral and pyloric region. Endoscopic ultrasonography revealed circumferential thickening of the muscularis propria layer of the pylorus. Her symptoms improved with treatment consisting of drainage, fasting, and a proton pump inhibitor. Two weeks after onset, follow-up endoscopy revealed a healing ulcer and double channel pylorus. Based on her clinical course and findings of clinical images, she was diagnosed with gastric outlet obstruction due to AHPS that was improved by double channel pylorus formation. In conclusion, AHPS that was improved by double channel pylorus formation is an extremely rare condition, and we should be aware of this disease entity.
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http://dx.doi.org/10.1002/jgh3.12458DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7857292PMC
February 2021

Usefulness of an artificial intelligence system for the detection of esophageal squamous cell carcinoma evaluated with videos simulating overlooking situation.

Dig Endosc 2021 Jan 27. Epub 2021 Jan 27.

AI Medical Service Inc, Tokyo, Japan.

Objectives: Artificial intelligence (AI) systems have shown favorable performance in the detection of esophageal squamous cell carcinoma (ESCC). However, previous studies were limited by the quality of their validation methods. In this study, we evaluated the performance of an AI system with videos simulating situations in which ESCC has been overlooked.

Methods: We used 17,336 images from 1376 superficial ESCCs and 1461 images from 196 noncancerous and normal esophagi to construct the AI system. To record validation videos, the endoscope was passed through the esophagus at a constant speed without focusing on the lesion to simulate situations in which ESCC has been missed. Validation videos were evaluated by the AI system and 21 endoscopists.

Results: We prepared 100 video datasets, including 50 superficial ESCCs, 22 noncancerous lesions, and 28 normal esophagi. The AI system had sensitivity of 85.7% (54 of 63 ESCCs) and specificity of 40%. Initial evaluation by endoscopists conducted with plain video (without AI support) had average sensitivity of 75.0% (47.3 of 63 ESCC) and specificity of 91.4%. Subsequent evaluation by endoscopists was conducted with AI assistance, which improved their sensitivity to 77.7% (P = 0.00696) without changing their specificity (91.6%, P = 0.756).

Conclusions: Our AI system had high sensitivity for the detection of ESCC. As a support tool, the system has the potential to enhance detection of ESCC without reducing specificity. (UMIN000039645).
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http://dx.doi.org/10.1111/den.13934DOI Listing
January 2021

Clinical utility of endoscopic submucosal dissection using the pocket-creation method with a HookKnife and preoperative evaluation by endoscopic ultrasonography for the treatment of rectal neuroendocrine tumors.

Surg Endosc 2021 Jan 25. Epub 2021 Jan 25.

Department of Gastroenterology and Hepatology, Mie University Hospital, Tsu, Japan.

Background: Various endoscopic methods have been developed to remove small rectal neuroendocrine tumors (NETs). This study aimed to evaluate the clinical utility of endoscopic submucosal dissection using the pocket-creation method (ESD-PCM) with a HookKnife, following preoperative evaluation by endoscopic ultrasonography (EUS), for the treatment of rectal NETs.

Methods: We analyzed retrospectively consecutive patients who underwent ESD-PCM with a HookKnife for the removal of rectal NETs, with a size less than 10 mm, at Mie University Hospital between June 2015 and December 2019. All the rectal NETs were resected by ESD-PCM with a HookKnife. The R0 resection rate, procedure time, adverse event rate, diagnostic accuracy of tumor size and invasion depth evaluated by preoperative EUS, and follow-up outcome were evaluated retrospectively.

Results: The study group comprised 12 patients with 12 resected lesions. The median tumor size of the resected specimens was 5 mm and the size and invasion depth of each tumor was approximately equal to that predicted by preoperative EUS. R0 resection was achieved in all cases, without adverse events. The median procedure time was 50.5 min, which did not differ from previous studies. No recurrence was observed during the median follow-up period of 34.4 months (range, 5.2-60.0 months).

Conclusions: ESD-PCM with a HookKnife provides a favorable clinical utility for removing rectal NETs, with high R0 resection rate and good follow-up outcome. In addition, EUS is useful for evaluating preoperatively the size and invasion depth of rectal NETs.
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http://dx.doi.org/10.1007/s00464-021-08292-6DOI Listing
January 2021

Acute liver injury secondary to hemophagocytic lymphohistiocytosis triggered by Epstein-Barr virus infection.

JGH Open 2021 Jan 22;5(1):166-168. Epub 2020 Oct 22.

Department of Endoscopy Mie University Hospital Tsu Japan.

We present a 23-year-old man with hemophagocytic lymphohistiocytosis (HLH) triggered by Epstein-Bar virus (EBV) infection. This patient presented with persistent fever and acute liver injury 6 weeks after having an infectious mononucleosis associated with EBV infection. He had hypofibrinogenemia, hyperferritinemia, increased soluble interleukin-2 receptor, elevated prothrombin time, and pancytopenia. Bone marrow examination for evaluation of pancytopenia revealed that macrophages had phagocytosed mature erythrocytes. Based on these findings, we suspected an HLH triggered by EBV infection (EBV-HLH). To distinguish from HLH triggered by malignant lymphomas accompanying EBV infection, we performed a percutaneous liver biopsy, which revealed that atypical T-lymphocytes had infiltrated the liver tissues. The T-lymphocytes were positive for EBV-encoded RNA in situ hybridization, and no distinct monoclonal T-cell receptor chain gene rearrangement was detected. These findings indicated EBV hepatitis and, accordingly, malignant lymphoma was ruled out. We finally made a diagnosis of EBV-HLH. The patient was treated with corticosteroid and etoposide, according to HLH-2004 guideline recommendations, and the patient's symptoms and laboratory values improved. After that, he experienced no recurrence. Prompt recognition and initiation of treatment remains the key to the survival of patients with EBV-HLH, and the liver biopsy was helpful in making the diagnosis.
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http://dx.doi.org/10.1002/jgh3.12439DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7812516PMC
January 2021

Continuous warfarin administration versus heparin bridging therapy in post colorectal polypectomy haemorrhage: a study protocol for a multicentre randomised controlled trial (WHICH study).

Trials 2021 Jan 7;22(1):33. Epub 2021 Jan 7.

Department of Gastroenterology and Hepatology, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan.

Background: Endoscopic removal of colorectal adenoma is considered an effective treatment for reducing the mortality rates associated with colorectal cancer. Warfarin, a type of anticoagulant, is widely used for the treatment and prevention of thromboembolism; however, bleeding may increase with its administration after polypectomy. In recent times, a high incidence of bleeding after endoscopic polypectomy has been reported in patients receiving heparin bridge therapy. However, previous studies have not compared the bleeding rate after endoscopic colorectal polypectomy between patients who continued with anticoagulant therapy and those who received heparin bridge therapy. We hypothesised that endoscopic colorectal polypectomy under the novel treatment with continuous warfarin is not inferior to endoscopic colorectal polypectomy under standard treatment with heparin bridge therapy with respect to the rate of postoperative bleeding. This study aims to compare the efficacy of endoscopic colorectal polypectomy with continuous warfarin administration and endoscopic colorectal polypectomy with heparin bridge therapy with respect to the rate of postoperative bleeding.

Methods: We will conduct a prospective multicentre randomised controlled non-inferiority trial of two parallel groups. We will compare patients scheduled to undergo colorectal polypectomy under anticoagulant therapy with warfarin. There will be 2 groups, namely, a standard treatment group (heparin bridge therapy) and the experimental treatment group (continued anticoagulant therapy). The primary outcome measure is the rate of postoperative bleeding. On the contrary, the secondary outcomes include the rate of cumulative bleeding, rate of overt haemorrhage (that does not qualify for the definition of haemorrhage after endoscopic polypectomy), incidence of haemorrhage requiring haemostasis during endoscopic polypectomy, intraoperative bleeding during endoscopic colorectal polypectomy requiring angiography, abdominal surgery and/or blood transfusion, total rate of bleeding, risk factors for postoperative bleeding, length of hospital stay, incidence of thromboembolism, prothrombin time-international ratio (PT-INR) 28 days after the surgery, and incidence of serious adverse events.

Discussion: The results of this randomised controlled trial will provide valuable information for the standardisation of management of anticoagulants in patients scheduled to undergo colorectal polypectomy.

Trial Registration: UMIN-CTR UMIN000023720 . Registered on 22 August 2016.
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http://dx.doi.org/10.1186/s13063-020-04975-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7791998PMC
January 2021

Hereditary Hemorrhagic Telangiectasia Induced Portosystemic Encephalopathy: A Case Report and Literature Review.

Intern Med 2021 May 22;60(10):1541-1545. Epub 2020 Dec 22.

Department of Endoscopy, Mie University Hospital, Japan.

Hereditary hemorrhagic telangiectasia (HHT) is a rare disorder characterized by telangiectasias and arteriovenous malformations (AVMs), which can involve multiple organ systems. Although hepatic involvement is common, the development of portosystemic encephalopathy is extremely rare. We herein report a 72-year-old woman with HHT-induced portosystemic encephalopathy secondary to hepatic arteriovenous malformations. She presented with disturbance of consciousness, and her serum ammonia level was elevated at 270 mg/dL. Color Doppler ultrasonography and contrast-enhanced computed tomography showed hepatic AVMs and shunts, which were useful for making the definite diagnosis. Portosystemic encephalopathy should be considered as a differential diagnosis in HHT patients presenting with disturbance of consciousness.
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http://dx.doi.org/10.2169/internalmedicine.5670-20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8188034PMC
May 2021

Syndrome of Inappropriate Secretion of Antidiuretic Hormone After Endoscopic Procedure.

Am J Med 2021 05 2;134(5):e325-e326. Epub 2020 Nov 2.

Department of Endoscopy, Mie University Hospital, Tsu, Japan.

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http://dx.doi.org/10.1016/j.amjmed.2020.09.042DOI Listing
May 2021

Difficulty in differentiating between IgG4-related hepatic inflammatory pseudotumor and intrahepatic cholangiocarcinoma.

Clin J Gastroenterol 2021 Feb 9;14(1):263-268. Epub 2020 Oct 9.

Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.

A 71-year-old man on prednisolone for immunoglobulin (Ig) G4-related renal disease showed increased carbohydrate antigen (CA) 19-9 level; abdominal enhanced computed tomography (CT) showed a lesion in the left lateral segment and dilatation of the peripheral biliary duct. He was referred to our hospital for detailed examination for suspected intrahepatic cholangiocarcinoma. CT and magnetic resonance imaging findings were similar to those for intrahepatic cholangiocarcinoma. However, endoscopic retrograde cholangiopancreatography showed a smooth narrowing of the bile duct which suggested inflammatory disease. Liver biopsy was performed; IgG4-related hepatic inflammatory pseudotumor (IPT) was diagnosed. IgG4-related hepatic IPTs are rare diseases that develop in association with the development of sclerosing cholangitis. Most of these lesions develop in the hepatic hilum and the imaging findings of these tumors are similar to those of hilar cholangiocarcinomas. Thus, hepatic IPTs are difficult to differentiate from malignancy; in some cases, surgical resection has been considered for establishing the diagnosis. In the present case, we could diagnose hepatic IPT on the basis of liver biopsy, which is the recommended approach in cases of suspected hepatic IPT.
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http://dx.doi.org/10.1007/s12328-020-01245-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7886829PMC
February 2021

Cystic lymphangioma of the hepatoduodenal ligament: a rare intra-abdominal tumor mimicking hematoma.

Clin J Gastroenterol 2021 Feb 29;14(1):212-217. Epub 2020 Sep 29.

Department of Gastroenterology and Hepatology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.

A 22-year-old man was referred for upper abdominal pain. Unenhanced computed tomography (CT) revealed a lesion of heterogeneous hypoattenuation, part of which showed slightly high-density in the porta hepatis. On magnetic resonance imaging (MRI), T1-weighted images showed a multiloculated hyperintense mass and part of the mass was hyperintense in T2-weighted images. Abdominal ultrasonography showed a 40 mm multilocular mass with septa, containing solid and small cystic components. In sonazoid-enhanced ultrasonography, the septa were enhanced but the solid components were not. Because of the location of tumor and the findings of CT/MRI, we suspected the lesion as hematoma of the liver. We could not exclude neoplastic disease, such as biliary cystadenoma or cystadenocarcinoma of the liver, so surgical resection was performed. The mass was a multilocular cyst arising from the hepatoduodenal ligament. Pathological examination revealed aggregation of lymph vessels and endothelial-like cells with no atypia, which were positive for the specific markers D2-40 and CD31. The histological diagnosis was abdominal lymphangioma. Intra-abdominal lymphangiomas, which originate from the hepatoduodenal ligament, are extremely rare, benign tumors. We are mindful that lymphangioma should be considered in the differential diagnosis of tumors in the abdominal cavity, mimicking a hematoma of the liver and with a cystic appearance.
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http://dx.doi.org/10.1007/s12328-020-01250-0DOI Listing
February 2021

A Strange Polyp in the Sigmoid Colon.

Clin Gastroenterol Hepatol 2020 12 26;18(13):e155-e156. Epub 2020 Sep 26.

Department of Endoscopic Medicine, Mie University Hospital, Tsu, Japan.

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http://dx.doi.org/10.1016/j.cgh.2019.09.023DOI Listing
December 2020

Mucinous cystic adenoma with inflammatory cell infiltration around the splenic artery mimicking pancreatic cancer: a case report.

Clin J Gastroenterol 2020 Dec 9;13(6):1360-1366. Epub 2020 Sep 9.

Department of Gastroenterology and Hepatology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.

A 45-year-old woman presented with upper abdominal and back pain. A cystic lesion in the pancreas and inflammation around the splenic artery were detected by computed tomography. Although imaging studies were difficult to exclude malignancy, pathological and cytological findings of a fine-needle aspiration showed no signs of malignancy. The patient was, therefore, followed-up for 3 months, during which time the cyst increased in size and developed a cyst-in-cyst structure. She was diagnosed with mucinous cyst neoplasm and underwent distal pancreatectomy. Histologically, the patient was diagnosed as low-grade mucinous cystic adenoma. Soft tissue shadows around the splenic artery were considered to indicate fibrosis and infiltration of inflammatory cells. After distal pancreatectomy, the patient has been uneventful with symptom resolution. This case highlights the potentially atypical presentation of mucinous cystic neoplasms with inflammatory cell infiltration around the splenic artery.
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http://dx.doi.org/10.1007/s12328-020-01228-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7671980PMC
December 2020

Usefulness of an additional lead shielding device in reducing occupational radiation exposure during interventional endoscopic procedures: An observational study.

Medicine (Baltimore) 2020 Aug;99(34):e21831

Department of Gastroenterology and Hepatology.

Adoption of interventional endoscopic procedures is increasing with increasing prevalence of diseases. However, medical radiation exposure is concerning; therefore, radiation protection for medical staff is important. However, there is limited information on the usefulness of an additional lead shielding device during interventional endoscopic procedures. Therefore, we aimed to determine whether an additional lead shielding device protects medical staff from radiation.An X-ray unit (CUREVISTA; Hitachi Medical Systems, Tokyo, Japan) with an over-couch X-ray system was used. Fluoroscopy-associated scattered radiation was measured using a water phantom placed at the locations of the endoscopist, assistant, nurse, and clinical engineer. For each location, measurements were performed at the gonad and thyroid gland/eye levels. Comparisons were performed between with and without the additional lead shielding device and with and without a gap in the shielding device. Additionally, a clinical study was performed with 27 endoscopic retrograde cholangiopancreatography procedures.The scattered radiation dose was lower with than without additional lead shielding at all medical staff locations and decreased by 84.7%, 82.8%, 78.2%, and 83.7%, respectively, at the gonad level and by 89.2%, 86.4%, 91.2%, and 87.0%, respectively, at the thyroid gland/eye level. Additionally, the scattered radiation dose was lower without than with a gap in the shielding device at all locations.An additional lead shielding device could protect medical staff from radiation during interventional endoscopic procedures. However, gaps in protective equipment reduce effectiveness and should be eliminated.
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http://dx.doi.org/10.1097/MD.0000000000021831DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7447393PMC
August 2020

Intestinal endometriosis in a 36-year-old woman.

CMAJ 2020 Aug;192(33):E960

Departments of Gastroenterology and Hepatology (Hamada), and Endoscopic Medicine (Tanaka), Mie University Hospital, Tsu, Japan.

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http://dx.doi.org/10.1503/cmaj.191471DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7828968PMC
August 2020

Discovery of a Novel Class of State-Dependent Na1.7 Inhibitors for the Treatment of Neuropathic Pain.

Chem Pharm Bull (Tokyo) 2020 ;68(7):653-663

R&D Division, Daiichi Sankyo Co., Ltd.

The discovery of a novel class of state-dependent voltage-gated sodium channel (Na)1.7 inhibitors is described. By the modification of amide or urethane bond in Na1.7 blocker III, structure-activity relationship studies that led to the identification of novel Na1.7 inhibitor 2i (DS01171986) were performed. Compound 2i exhibited state-dependent inhibition of Na1.7 without Na1.1, Na1.5 or human ether-a-go-go related gene (hERG) liabilities at concentrations up to 100 μM. Further biological profiling successfully revealed that 2i possessed potent analgesic properties in a murine model of neuropathic pain (ED: 3.4 mg/kg) with an excellent central nervous system (CNS) safety margin (> 600 fold).
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http://dx.doi.org/10.1248/cpb.c20-00126DOI Listing
February 2021

Discovery of DS-1971a, a Potent, Selective Na1.7 Inhibitor.

J Med Chem 2020 09 26;63(18):10204-10220. Epub 2020 May 26.

R&D Division, Daiichi Sankyo Co., Ltd., 1-2-58 Hiromachi, Shinagawa-ku, Tokyo 140-8710, Japan.

A highly potent, selective Na1.7 inhibitor, DS-1971a, has been discovered. Exploration of the left-hand phenyl ring of sulfonamide derivatives ( and ) led to the discovery of novel series of cycloalkane derivatives with high Na1.7 inhibitory potency in vitro. As the right-hand heteroaromatic ring affected the mechanism-based inhibition liability of CYP3A4, replacement of this moiety resulted in the generation of 4-pyrimidyl derivatives. Additionally, GSH adducts formation, which can cause idiosyncratic drug toxicity, was successfully avoided by this modification. An additional optimization led to the discovery of DS-1971a. In preclinical studies, DS-1971a demonstrated highly potent selective in vitro profile with robust efficacy in vivo. DS-1971a exhibited a favorable toxicological profile, which enabled multiple-dose studies of up to 600 mg bid or 400 mg tid (1200 mg/day) administered for 14 days to healthy human males. DS-1971a is expected to exert potent efficacy in patients with peripheral neuropathic pain, with a favorable safety profile.
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http://dx.doi.org/10.1021/acs.jmedchem.0c00259DOI Listing
September 2020

High-Definition Chromoendoscopy Superior to High-Definition White-Light Endoscopy in Surveillance of Inflammatory Bowel Diseases in a Randomized Trial.

Clin Gastroenterol Hepatol 2020 08 27;18(9):2101-2107. Epub 2020 Apr 27.

Department of Medicine Solna, Karolinska Institutet, Division of endoscopy, Karolinska University Hospital, Stockholm, Sweden. Electronic address:

Background & Aims: There is debate over the optimal method for colonoscopic surveillance of patients with inflammatory bowel diseases. Guidelines recommend chromoendoscopy, but the value of chromoendoscopy in high-definition colonoscopy has not been proven. Furthermore, the value of random biopsies is controversial.

Methods: We performed a prospective study of 305 patients with ulcerative colitis or Crohn's colitis referred for surveillance colonoscopy at a university hospital in Sweden, from March 2011 through April 2016. Patients randomly assigned to a group that received high-definition chromoendoscopy with indigo carmine (HD-CE; n = 152), collection of 32 random biopsies, and targeted biopsies or polypectomies or to a group that received high-definition white light endoscopy (HD-WLE; n = 153), collection of 32 random biopsies, and targeted biopsies or polypectomies. The primary endpoint was number of patients with dysplastic lesions.

Results: Dysplastic lesions were detected in 17 patients with HD-CE and 7 patients with HD-WLE (P = .032). Dysplasias in random biopsies (n = 9760) were detected in 9 patients: 6 (3.9%) in the HD-CE group and 3 (2.0%) in the HD-WLE group (P = .72). Of the 9 patients with dysplasia, 3 patients (33%) had primary sclerosing cholangitis-only 18% of patients (54/305) included in the study had primary sclerosing cholangitis. The number of dysplastic lesions per 10 min of withdrawal time was 0.066 with HD-CE and 0.027 with HD-WLE (P = .056).

Conclusions: In a randomized trial, we found HD-CE with collection of random biopsies to be superior to HD-WLE with random biopsies for detection of dysplasia per colonoscopy. These results support the use of chromoendoscopy for surveillance of patients with inflammatory bowel diseases. ClinicalTrials.gov no: NCT01505842.
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http://dx.doi.org/10.1016/j.cgh.2020.04.049DOI Listing
August 2020

Small gastric metastases of malignant melanoma mimicking gastric erosion (with video).

Gastrointest Endosc 2020 08 13;92(2):423-424. Epub 2020 Apr 13.

Department of Endoscopy, Mie University Hospital, Tsu, Japan; Department of Gastroenterology and Hepatology, Mie University Hospital, Tsu, Japan.

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http://dx.doi.org/10.1016/j.gie.2020.04.004DOI Listing
August 2020

Primary Colorectal Follicular Lymphoma Observed by Magnifying Endoscopy, with a Five-year Follow-up.

Intern Med 2020 Jun 12;59(11):1395-1399. Epub 2020 Mar 12.

Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, Japan.

Colorectal involvement is very rare in cases of follicular lymphoma. Colonoscopy of a 69-year-old man revealed an aggregation of multiple whitish nodules in the sigmoid colon. Magnifying endoscopy with narrow-band imaging demonstrated a coiled and elongated microvascular pattern on the surface and crystal violet staining showed a type I pit pattern. A biopsy showed follicular lymphoma (Grade 1), and no other involvement of lymphoma was detected. Following a diagnosis of primary colorectal follicular lymphoma stage I (Lugano classification), the patient was monitored by watch-and-wait therapy. We documented the endoscopic images of colorectal follicular lymphoma in the present case.
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http://dx.doi.org/10.2169/internalmedicine.3995-19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7332620PMC
June 2020

Endoscopic submucosal dissection/endoscopic mucosal resection guidelines for esophageal cancer.

Dig Endosc 2020 May;32(4):452-493

Japan Gastroenterological Endoscopy Society, Tokyo, Japan.

The Japan Gastroenterological Endoscopy Society has developed endoscopic submucosal dissection/endoscopic mucosal resection guidelines. These guidelines present recommendations in response to 18 clinical questions concerning the preoperative diagnosis, indications, resection methods, curability assessment, and surveillance of patients undergoing endoscopic resection for esophageal cancers based on a systematic review of the scientific literature.
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http://dx.doi.org/10.1111/den.13654DOI Listing
May 2020

Esophageal muscle layer tear during endoscopic submucosal dissection treated by polyglycolic acid sheets and fibrin glue.

Endoscopy 2020 06 20;52(6):E211-E212. Epub 2019 Dec 20.

Department of Gastroenterology and Hepatology, Mie University Hospital, Tsu, Japan.

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http://dx.doi.org/10.1055/a-1071-7527DOI Listing
June 2020

An Unusual Case of Rectal Submucosal Tumor.

Intern Med 2020 03 22;59(6):865-866. Epub 2019 Nov 22.

Department of Gastroenterology and Hepatology, Mie University Hospital, Japan.

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http://dx.doi.org/10.2169/internalmedicine.4040-19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7118390PMC
March 2020

Gastric metastasis resembling linitis plastica 17 years after lobular breast cancer.

Dig Liver Dis 2020 02 14;52(2):232. Epub 2019 Nov 14.

Department of Hematology and Oncology, Mie University Hospital, Tsu, Japan.

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http://dx.doi.org/10.1016/j.dld.2019.10.018DOI Listing
February 2020
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