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阿部 洋文医学部附属病院 消化器内科助教
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■ 論文- BACKGROUND AND AIMS: Pediatric achalasia and peroral endoscopic myotomy (POEM) are not well investigated. This study aimed to examine the clinical characteristics of pediatric achalasia and evaluate the long-term outcomes of POEM. METHODS: We conducted a multicenter study across 14 high-volume centers, comparing the clinical characteristics of children (aged < 18 years) diagnosed with achalasia to those of adults (aged < 65 years). The POEM procedures and outcomes were also compared between the two groups. RESULTS: Of the 3421 patients with achalasia, 50 (1.5%) were children. Compared with adults, children had a shorter period to diagnosis (1.0 vs. 3.4 years; p < 0.001) and were more likely to be severely underweight (body mass index: 17.8 vs. 20.9 kg/m2; p < 0.001). However, children exhibited less esophageal dilation (46.0% vs. 64.1%; p = 0.013) and higher lower esophageal sphincter pressure (37.3 vs. 29.9 mmHg; p = 0.002). Notably, a significant failure to thrive was not observed in the pediatric group. The POEM procedure time was shorter for children compared to adults (58.0 vs. 83.0 min; p < 0.001). Clinical success rates were not significant between the two groups. Over the 5-year follow-up period, children had a lower incidence of reflux esophagitis following POEM compared to adults (11.0% vs. 26.4%; p = 0.013). CONCLUSIONS: Pediatric achalasia is rare and typically presents with early-stage manometric and esophagogastric features, along with severe systemic symptoms requiring an early diagnosis. POEM is a durable and effective treatment for pediatric achalasia, offering advantages such as shorter procedural times and a lower incidence of postprocedure reflux compared to adults.2025年03月, Journal of gastroenterology and hepatology, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Patients with esophageal motility disorders (EMDs) sometimes develop bacterial pneumonia (BP). However, factors associated with BP in patients with EMDs and whether peroral endoscopic myotomy (POEM) reduces BP development are unclear. Therefore, this study aimed to identify factors associated with BP development and evaluate the preventive potential of POEM in patients with EMDs. METHODS: This study included 623 patients diagnosed with EMDs at our institution between April 2015 and March 2023. Factors associated with BP were analyzed by comparing characteristics between patients who developed BP within 1 year before diagnosis using multivariable analysis. The potential of POEM to prevent BP development was assessed using Cox regression analysis, considering treatment status as a time-varying covariate. RESULTS: Of the 623 patients, 31 (5.0%) developed BP within 1 year before diagnosis. Older age (odds ratio [OR] = 1.29, 95% confidence interval [CI] 1.04-1.59, p = 0.019; 10-year increments), lower body mass index (OR = 0.87, 95% CI 0.78-0.98, p = 0.026), and manometric diagnosis of spastic esophageal disorders (OR = 2.97, 95% CI 1.24-7.16, p = 0.015) were significantly associated with BP. Treatment status of POEM was proved to be a significant factor for developing BP using Cox regression analysis (hazard ratio = 0.17, 95% CI 0.039-0.75, p = 0.019). CONCLUSIONS: Risk factors associated with BP in patients with EMDs were older age, lower body mass index, and manometric diagnosis of spastic esophageal disorders. POEM could decrease spasm-related bolus reflux, improve patients' nutritional status through resolution of transit disturbance, and reduce respiratory complications, suggesting that POEM could help prevent BP development.2025年03月, Journal of gastroenterology, 英語, 国内誌[査読有り]研究論文（学術雑誌）
- BACKGROUND: EG-840TP is a novel small-caliber therapeutic endoscope with a large working channel. We aimed to evaluate the treatment outcomes of peroral endoscopic myotomy using EG-840TP compared to those using a conventional therapeutic endoscope (GIF-H290T). METHODS: Patients who underwent peroral endoscopic myotomy for achalasia and non-achalasia esophageal motility disorders were enrolled between March 2021 and March 2023. Procedure times and other treatment outcomes were compared between patients treated with EG-840TP and GIF-H290T using propensity score matching analysis. In the subgroup analysis, patients were divided into subsets based on myotomy length, morphology, esophageal dilation, and operator skill, and the procedure time was compared between the matched groups. RESULTS: A total of 154 patients were enrolled in this study, and 39 patients treated using each type of scope were matched. The EG-840TP group tended to have a shorter procedure time than the GIF-H290T group. There were no significant differences between the groups in terms of short-term clinical success or perioperative adverse events. In the subgroup analysis, the procedure time of the EG-840TP group was significantly shorter than that of the GIF-H290T group when patients had a straight esophagus (44 min vs. 54 min, p = 0.0015) and the operator was a non-expert (49 min vs. 64 min, p = 0.031). CONCLUSIONS: POEM using EG-840TP showed procedure time, clinical success, and adverse events equivalent to those of a conventional therapeutic endoscope. However, EG-840TP potentially contributed to a shorter procedure time in patients with a straight esophagus or in non-expert operators than GIF-H290T.2025年02月, Esophagus, 英語, 国内誌研究論文（学術雑誌）
- BACKGROUND: The distribution of body weight in patients with achalasia and after peroral endoscopic myotomy (POEM) has not been investigated. The role of body weight assessment after treatment remains unclear. METHODS: Using the multicenter achalasia cohort, the frequency of underweight (body mass index [BMI] < 18.5 kg/m2) and overweight (BMI ≥ 25.0 kg/m2) and their associated clinical characteristics were analyzed. After POEM, risk factors for insufficient- (underweight persistently) and excessive- (responded to overweight) weight gainers were investigated. The correlation between BMI-increase rate and severity of esophageal symptoms post-POEM was evaluated. RESULTS: Among 3,410 patients, 23.0% and 15.7% were underweight and overweight, respectively. Factors associated with underweight were higher age, female sex, severe symptoms, high lower esophageal sphincter (LES) pressure, and non-dilated esophagus (all p < 0.01). Longitudinal analyses revealed that weight gain post-POEM was achieved after a long duration (≥ 12 months; p < 0.01). In 528 patients post-POEM, the frequency of underweight reduced to 8.3% (p < 0.01). Risk factors for insufficient-weight gain (36.1% of underweight patients) included low BMI (p < 0.01) and high LES pressure (p = 0.03) and conversely for excessive-weight gain. Machine learning models based on patient characteristics successfully predicted insufficient- and excessive-weight gainers with an area under the curve value of 0.74 and 0.75, respectively. Esophageal symptoms post-POEM did not correlate with BMI increase. CONCLUSION: Underweight is not solely a condition of advanced achalasia. After POEM, insufficient- or excessive-weight gainers are not rare and can be predicted preoperatively. Body weight change is an independent nutrition parameter rather than a part of the assessment of residual esophageal symptoms.2024年12月, Journal of gastroenterology, 英語, 国内誌研究論文（学術雑誌）
- 2024年12月, Endoscopy, 56(S 01) (S 01), E522-E523, 英語, 国際誌研究論文（学術雑誌）
- 2024年12月, Endoscopy, 56(S 01) (S 01), E74-E75, 英語, 国際誌研究論文（学術雑誌）
- OBJECTIVES: Early identification of patients needing hospital-specific interventional care (HIC) following endoscopic treatment is valuable for optimizing postoperative hospital stays. We aimed to develop and validate a risk-scoring system for predicting HIC in patients who underwent peroral endoscopic myotomy (POEM). METHODS: This study included patients with esophageal motility disorders who underwent POEM at our hospital between April 2015 and March 2023. HIC was defined as any of the following situations: fasting for gastrointestinal rest to manage adverse events (AEs); intravenous administration of medications such as antibiotics and blood transfusion; endoscopic, radiologic, and surgical interventions; intensive care unit management; or other life-threatening events. A risk-scoring system for predicting HIC after postoperative day (POD) 1 was developed using multivariable logistic regression and was internally validated using bootstrapping and decision curve analysis. RESULTS: Of the 589 patients, 50 (8.5%) experienced HIC after POD1. Risk scores were assigned for four factors as follows: age (0 points for <70 years, 1 point for 70-79 years, 2 points for ≥80 years), preoperative prognostic nutritional index (0 points for >45, 1 point for 40-45, 4 points for <40), postoperative surgical site AEs on second-look endoscopy (7 points), and postoperative pneumonia on chest radiography (6 points). The discriminative ability (concordance statistics, 0.85; 95% confidence interval, 0.78-0.91) and calibration (slope 1.00; 0.74-1.28) were satisfactory. The decision curve analysis demonstrated its clinical usefulness. CONCLUSION: This risk-scoring system can predict the HIC after POD1 and provide useful information for determining discharge.2024年09月, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Symptom scales for achalasia after per-oral endoscopic myotomy (POEM) are lacking. This study aimed to propose a new scale based on the conventional Eckardt score (c-ES) and evaluate persistent symptoms that impair patients' quality of life (QOL) post-POEM. METHODS: Dysphagia, regurgitation, and chest pain frequencies were assessed using a 6-point scale modified-ES (m-ES) after POEM, with "occasional" symptoms on the c-ES further subdivided into three-period categories on m-ES. Symptom severity was further evaluated using a 5-point scale ranging from 1 to 5 points, with a score ≥ 3 points defined as persistent symptoms impairing QOL. We analyzed the correlation between the m-ES and severity score, diagnostic performance of the m-ES for persistent symptoms, and overlaps between each residual symptom. RESULTS: Overall, 536 patients (median follow-up period, 2.9 years) post-POEM were included in this multicenter study. Significant correlations were observed between the m-ES and severity scores for dysphagia (r = 0.67, p < 0.01), regurgitation (r = 0.73, p < 0.01), and chest pain (r = 0.85, p < 0.01). Twenty-six patients (4.9%) had persistent symptoms post-POEM, and 23 of them had m-ES-specific symptom frequency ≥ once a month, which was determined as the optimal frequency threshold for screening persistent symptoms. The total m-ES predicted persistent symptoms more accurately than the total c-ES (area under the curve: 0.95 vs. 0.79, p < 0.01). Furthermore, dysphagia and chest pain were the major residual symptoms post-POEM covering 91.4% of regurgitation. CONCLUSIONS: The new post-POEM scale successfully evaluated the QOL-based patient symptom severities. Our study implied the possibility of a simpler scale using residual dysphagia and chest pain.2024年05月, Journal of gastroenterology, 英語, 国内誌研究論文（学術雑誌）
- INTRODUCTION: Peroral endoscopic myotomy (POEM) is a minimally invasive endoscopic procedure for achalasia; its indication has expanded from adults to children. We aimed to evaluate the postoperative efficacy and antireflex status of POEM in young children with achalasia aged 12 years or younger. PATIENTS: AND METHODS: Pediatric patients with achalasia aged 18 years or younger who underwent POEM in our hospital between 2016 and 2021 were included and divided into two age groups: group A (≤ 12 years) and group B (13-18 years). The success rate (Eckardt score ≤ 3), endoscopic reflux findings, and antiacid use at 1 year postoperatively were compared between the groups. RESULTS: Ten patients (four boys and six girls; Chicago classification type I: five, type II: four, and unclassified: one) were included. Mean age and preoperative Eckardt scores in groups A (n = 4) and B (n = 6) were 9.2 ± 3.0 versus 15.6 ± 0.6 years (p = 0.001) and 5.5 ± 3.9 versus 7.2 ± 3.7 (p = 0.509), respectively, and mean operative time and myotomy length were 51.3 ± 16.6 versus 52.5 ± 13.2 minutes (p = 0.898) and 10.8 ± 4.6 versus 9.8 ± 3.2 cm (p = 0.720), respectively. The 1-year success rate was 100% in both groups. Mild esophagitis (Los Angeles classification B) was endoscopically found in one patient in each group (16.7 vs. 25.0%, p = 0.714), and antiacid use was required in three patients (group A, two; group B, one; 50.0 vs. 16.7%, p = 0.500). CONCLUSION: The success rate of POEM within 1 year in young children with achalasia aged 12 years or younger was equal to that in adolescent patients. However, young children tended to require antiacids 1 year postoperatively; therefore, long-term follow-up is necessary.2024年02月, European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift fur Kinderchirurgie, 34(1) (1), 97 - 101, 英語, 国際誌研究論文（学術雑誌）
- (一社)日本消化管学会, 2024年01月, 日本消化管学会雑誌, 8(Suppl.) (Suppl.), 148 - 148, 日本語食道アカラシアを含む食道運動異常症の診療最適化を目指した多施設後ろ向き・前向き研究
- 2023年12月, VideoGIE[査読有り]研究論文（学術雑誌）
- 2023年12月, Endoscopy, 55(S 01) (S 01), E672-E673, 英語, 国際誌研究論文（学術雑誌）
- OBJECTIVES: High-resolution manometry (HRM) and esophagography are used for achalasia diagnosis; however, achalasia phenotypes combining esophageal motility and morphology are unknown. Moreover, predicting treatment outcomes of per-oral endoscopic myotomy (POEM) in treatment-naïve patients remains an unmet need. METHODS: In this multicenter cohort study, we included 1,824 treatment-naïve patients diagnosed with achalasia. In total, 1,778 patients underwent POEM. Clustering by machine learning (ML) was conducted to identify achalasia phenotypes using patients' demographic data, including age, sex, disease duration, body mass index, and HRM/esophagography findings. ML models were developed to predict persistent symptoms (Eckardt score ≥3) and reflux esophagitis (RE) (Los Angeles grades A to D) after POEM. RESULTS: ML identified three achalasia phenotypes: phenotype 1, type I achalasia with a dilated esophagus (n=676; 37.0%); phenotype 2, type II achalasia with a dilated esophagus (n=203; 11.1%); phenotype 3, late-onset type I-III achalasia with a non-dilated esophagus (n=619, 33.9%). Types I and II achalasia in phenotypes 1 and 2 exhibited different clinical characteristics from those in phenotype 3, implying different pathophysiologies within the same HRM diagnosis. A predictive model for persistent symptoms exhibited an area under the curve (AUC) of 0.70. Pre-POEM Eckardt score ≥6 was the greatest contributing factor for persistent symptoms. The AUC for post-POEM RE was 0.61. CONCLUSION: Achalasia phenotypes combining esophageal motility and morphology indicated multiple disease pathophysiologies. ML helped develop an optimal risk stratification model for persistent symptoms with novel insights into treatment resistance factors.2023年10月, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society, 英語, 国際誌研究論文（学術雑誌）
- OBJECTIVES: Endoscopic submucosal dissection (ESD) for superficial esophageal squamous cell carcinoma (ESCC) is performed for the treatment of lesions with varied backgrounds and factors. However, the predictive factors associated with the technical difficulty of ESD remain unknown in patients with varied lesions. Therefore, this study aimed to identify the predictive factors associated with the technical difficulty of ESD for ESCC using a retrospective cohort. METHODS: This multicenter, retrospective study was conducted in 10 hospitals in Japan. Consecutive patients who underwent esophageal ESD between January 2013 and December 2019 were enrolled. Lesions of subepithelial tumors, adenocarcinoma, and adenoma were excluded. Difficult lesions were defined as ESD requiring a long procedure time (≥120 min), perforation development, piecemeal resection, or discontinued ESD. In the present study, the clinical factors were assessed to identify the technical difficulty of ESD using univariate and multivariate analyses. RESULTS: Among 1708 lesions treated with esophageal ESD, eight subepithelial tumors, 44 adenocarcinomas, and two adenomas were excluded. Finally, 1505 patients with 1654 lesions were analyzed, and 217 patients with 217 lesions (13.1%) were classified as patients with difficult lesions. In multivariate analysis, the predictive factors associated with the technical difficulty of ESD were as follows: tumors with varices, tumors with diverticulum, antiplatelet use (discontinued), circumference of tumor (≥1/2), preoperative tumor size ≥30 mm, trainee, and nonhigh-volume center. CONCLUSION: This multicenter retrospective study identified the predictive factors associated with the technical difficulty of ESD for ESCC with varied backgrounds and factors.2023年08月, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society, 英語, 国際誌研究論文（学術雑誌）
- Abstract M2 macrophages contribute to the progression of oesophageal squamous cell carcinoma (ESCC); however, the roles of M2 macrophages in early ESCC remain unclear. To clarify the biological mechanisms underlying the interaction between M2 macrophages and oesophageal epithelial cells in early‐stage ESCC, in vitro co‐culture assays between the immortalised oesophageal epithelial cell line Het‐1A and cytokine‐defined M2 macrophages were established. Co‐culture with M2 macrophages promoted the proliferation and migration of Het‐1A cells via the mTOR–p70S6K signalling pathway activated by YKL‐40, also known as chitinase 3‐like 1, and osteopontin (OPN) that were hypersecreted in the co‐culture supernatants. YKL‐40 and OPN promoted the above phenotypes of Het‐1A by making a complex with integrin β4 (β4). Furthermore, YKL‐40 and OPN promoted M2 polarisation, proliferation, and migration of macrophages. To validate the pathological and clinical significances of in vitro experimental results, immunohistochemistry of human early ESCC tissues obtained by endoscopic submucosal dissection (ESD) was performed, confirming the activation of the YKL‐40/OPN–β4–p70S6K axis in the tumour area. Moreover, epithelial expression of β4 and the number of epithelial and stromal infiltrating YKL‐40‐ and OPN‐positive cells correlated with the Lugol‐voiding lesions (LVLs), a well‐known predictor of the incidence of metachronous ESCC. Furthermore, the combination of high expression of β4 and LVLs or high numbers of epithelial and stromal infiltrating YKL‐40‐ and OPN‐positive immune cells could more clearly detect the incidence of metachronous ESCC than each of the parameters alone. Our results demonstrated that the YKL‐40/OPN–β4–p70S6K axis played important roles in early‐stage ESCC, and the high expression levels of β4 and high numbers of infiltrating YKL‐40‐ and OPN‐positive immune cells could be useful predictive parameters for the incidence of metachronous ESCC after ESD. © 2023 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.Wiley, 2023年07月, The Journal of Pathology研究論文（学術雑誌）
- BACKGROUND AND AIM: Absent contractility (AC) and ineffective esophageal motility (IEM) are esophageal hypomotility disorders diagnosed using high-resolution manometry (HRM). Patient characteristics and disease course of these conditions and differential diagnosis between AC and achalasia are yet to be elucidated. METHODS: A multicenter study involving 10 high-volume hospitals was conducted. Starlet HRM findings were compared between AC and achalasia. Patient characteristics including underlying disorders and disease courses were analyzed in AC and IEM. RESULTS: Fifty-three patients with AC and 92 with IEM were diagnosed, while achalasia was diagnosed in 1784 patients using the Chicago classification v3.0 (CCv3.0). The cut-off integrated relaxation pressure (IRP) value at 15.7 mmHg showed maximum sensitivity (0.80) and specificity (0.87) for differential diagnosis of AC from type I achalasia. While most ACs were based on systemic disorders such as scleroderma (34%) and neuromuscular diseases (8%), 23% were sporadic cases. The symptom severity of AC was not higher than that of IEM. Regarding the diagnosis of IEM, the more stringent CCv4.0 excluded 14.1% of IEM patients than the CCv3.0, although patient characteristics did not change. In patients with the hypomotile esophagus, concomitance of reflux esophagitis was associated with low distal contractile integral and IRP values. AC and IEM transferred between each other, paralleling with the underlying disease course, although no transition to achalasia was observed. CONCLUSION: A successful determination of the optimal cut-off IRP value was achieved using the starlet HRM system to differentiate AC and achalasia. Follow-up HRM is also useful for differentiating AC from achalasia. Symptom severity may depend on underlying diseases instead of hypomotility severity.2023年06月, Journal of gastroenterology and hepatology, 英語, 国際誌研究論文（学術雑誌）
- INTRODUCTION: Favorable long-term outcomes of endoscopic submucosal dissection (ESD) for early remnant gastric cancer (ERGC) have been reported in single-center studies from advanced institutions. However, no studies have examined the long-term outcomes using a multicenter database. This study aimed to investigate the long-term outcomes of the aforementioned approach using a large multicenter database. METHODS: This retrospective multicenter cohort study included 242 cases with 256 lesions that underwent ESD for ERGC between April 2009 and March 2019 across 12 centers. We investigated the long-term outcomes of these patients with the Kaplan-Meier method, and the relationship between curability, additional treatment, or hospital category, and the survival time was evaluated using the log-rank test. RESULTS: During the median follow-up period of 48.4 months, the 5-year overall survival rate was 81.3%, and the 5-year gastric cancer-specific survival rate was 98.1%. The survival time of patients of endoscopic curability (eCura) C-2 without additional surgery was significantly shorter than the corresponding of patients of eCura A/B/C-1 and eCura C-2 with additional surgery. There was no significant difference in either overall survival or gastric cancer-specific survival rate between the high-volume and non-high-volume hospitals. CONCLUSION: The gastric cancer-specific survival of ESD for ERGC using a multicenter database was favorable. ESD for ERGC is widely applicable regardless of the hospital case volume. Management in accordance with the latest guidelines will lead to long-term survival.2023年06月, Digestion, 1 - 10, 英語, 国際誌研究論文（学術雑誌）
- (一社)日本消化器内視鏡学会, 2023年04月, Gastroenterological Endoscopy, 65(Suppl.1) (Suppl.1), 892 - 892, 日本語当院での虫垂開口部の大腸病変に対するESDの治療戦略と成績
- (一社)日本胃癌学会, 2023年02月, 日本胃癌学会総会記事, 95回, 228 - 228, 日本語胃・十二指腸ESDにおける高難度症例への対処 幽門輪に接する胃・十二指腸腫瘍に対するESD治療成績と術後合併症の検討
- INTRODUCTION: Gastric stasis due to deformation occurs after endoscopic submucosal dissection in the lower part of the stomach. Endoscopic balloon dilation can improve gastric stasis due to stenosis; however, endoscopic balloon dilation cannot improve gastric stasis due to deformation. Furthermore, the characteristics of gastric stasis due to deformation are unknown. This study aimed to evaluate the characteristics of gastric stasis due to deformation after endoscopic submucosal dissection in the lower part of the stomach, focusing on the differences between stenosis and deformation. METHODS: We retrospectively reviewed 41 patients with gastric stasis after endoscopic submucosal dissection in the lower part of the stomach. We evaluated the characteristics of cases with gastric stasis due to deformation, such as the risk factors of deformation and the rate of deformation in each group with risk factors. RESULTS: Deformation was observed in 12% (5/41) of the patients with gastric stasis. All cases of deformation had a circumferential extent of the mucosal defect greater than 3/4. The number of cases with pyloric dissection was significantly lower in the deformation group than in the non-deformation group (0% vs. 72%; p = 0.004). The deformation group also had a significantly higher number of cases with angular dissection than the non-deformation group (100% vs. 17%; p < 0.001). Moreover, the deformation cases had a significantly larger specimen diameter (p < 0.001). Deformation was observed only in cases with angular and non-pyloric dissections. Deformation was not observed in cases with angular and pyloric dissections. CONCLUSIONS: All cases of gastric stasis due to deformation had a circumferential extent of the mucosal defect greater than 3/4. Deformation was also likely to occur in cases with a larger dissection that exceeded the angular region without pyloric dissection.2023年, Digestion, 104(4) (4), 320 - 327, 英語, 国際誌研究論文（学術雑誌）
- OBJECTIVES: Peroral endoscopic myotomy (POEM) is an effective treatment for esophageal motility disorders including achalasia and its variants. However, some surgeons have encountered challenging cases. This study aimed to develop a risk-scoring system to predict challenging cases of POEM. METHODS: Consecutive patients who underwent POEM between April 2015 and March 2020 at our hospital were included in this single-center retrospective study. Challenging cases of POEM were defined as patients with any of the following: (i) procedure time ≥90 min; (ii) mucosal perforation; (iii) pneumothorax; and (iv) major bleeding. A risk-scoring system for predicting challenging cases was developed based on multivariate logistic regression and internal validation was performed using the bootstrap method. Clinical usefulness was evaluated using a decision curve analysis. RESULTS: Of the 467 patients, 59 (12.6%) had challenging POEM. A risk-scoring system consisted of four variables: duration of symptoms ≥5 years (assigned score, 1 point), antithrombotics use (1 point), manometric diagnosis of achalasia variants (2 points), and dilation grade 3 (2 points). Our scoring system showed satisfactory discrimination (area under the receiver operating characteristic curve, 0.69; 95% confidence interval [CI] 0.61-0.77) and calibration (slope, 0.99; 95% CI 0.65-1.35). The decision curve analysis demonstrated its clinical usefulness. CONCLUSIONS: We established a risk-scoring system to predict challenging cases of POEM. This scoring system may aid the selection of patients who require treatment from experienced surgeons.2022年12月, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society, 英語, 国際誌研究論文（学術雑誌）
- 日本消化器内視鏡学会-近畿支部, 2022年11月, 日本消化器内視鏡学会近畿支部例会プログラム・抄録集, 109回, 103 - 103, 日本語経時的に形態変化を観察し得た表在性非乳頭部十二指腸上皮性腫瘍の一例
- BACKGROUND & AIMS: Peroral endoscopic myotomy (POEM) is conducted for patients with esophageal motility disorders based on high-resolution manometry (HRM) findings. However, the impact of POEM on HRM findings and the associations between post-POEM HRM and outcomes have not been clarified. METHODS: In a multicenter, observational cohort study, patients with achalasia treated by POEM received follow-up HRM. Associations between patient characteristics, POEM procedures, and post-POEM HRM findings, including integrated relaxation pressure (IRP) and distal contractile integral (DCI), were investigated. Furthermore, the outcomes of the POEM procedure were compared with the post-POEM HRM findings. RESULTS: Of 2,171 patients, 151 (7.0%) showed residual high post-POEM IRP (≥26 mmHg, Starlet). In a multivariate analysis, high pre-POEM IRPs (odds ratio [OR]=24.3) and gastric myotomy >2 cm (OR=0.22) were found to be positive and negative predictive factors of high post-POEM IRPs, respectively. Peristalsis recovery (DCI ≥500 mmHg-cm-sec, at least one swallow, Starlet) was visible in 121 (19.6%) of 618 patients, and they were type II-III achalasia. High pre-POEM IRP (OR=2.65) and DCI ≥500 (OR=2.98) predicted peristalsis recovery, while esophageal dilation (OR=0.42) predicted a risk of no recovery. Extended myotomy did not reveal a significant impact on peristalsis recovery. High or low post-POEM IRP and DCI did not increase the incidence of clinical failure, reflux esophagitis, or symptomatic gastroesophageal reflux disease. CONCLUSIONS: Extended gastric myotomy decreased IRP values, while peristalsis recovery depended on the characteristics of achalasia. A residual high post-POEM IRP does not necessarily mean clinical failure. Routine HRM follow-up is not recommended after POEM.2022年10月, Gastrointestinal endoscopy, 97(4) (4), 673 - 683, 英語, 国際誌研究論文（学術雑誌）
- Background/Aims: ManoScan and Sandhill high-resolution manometry (HRM) systems are used worldwide; however, the diagnosis of achalasia on the Starlet HRM system is not fully characterized. Furthermore, the impact of calcium channel blockers and nitrites in treating achalasia has not been investigated using HRM. Management of recurrent cases is a priority issue, although few studies have examined patient characteristics. Methods: We conducted a multicenter, large-scale database analysis. First, the diagnosis of treatment-naive achalasia in each HRM system was investigated. Next, patient characteristics were compared between type I-III achalasia, and the impact of patient characteristics, including calcium channel blocker and nitrite use for integrated relaxation pressure (IRP) values, were analyzed. Finally, patient characteristics with recurrent achalasia were elucidated. Results: The frequency of type I achalasia with Starlet was significantly higher than that with ManoScan and Sandhill HRM systems. In achalasia, multivariate analysis identified male sex, advanced age, long disease duration, obesity, type I achalasia, and sigmoid type as risk factors related to normal IRP values (< 26 mmHg). Calcium channel blockers and nitrites use had no significant impact on the IRP values, although achalasia symptoms were indicated to be alleviated. In recurrent cases, the IRP value was significantly lower, and advanced age, long disease duration, and sigmoid type were more common than in treatment-naive patients. Conclusions: We should cautiously interpret the type of achalasia and IRP values in the Starlet HRM system. Symptoms of recurrent cases are related to disease progression rather than IRP values, which should be considered in decision making.2022年10月, Journal of neurogastroenterology and motility, 28(4) (4), 562 - 571, 英語, 国際誌研究論文（学術雑誌）
- Background and study aims Peroral endoscopic myotomy (POEM) is effective for the management of achalasia and its variants. However, this treatment can be ineffective in some patients. We aimed to develop and validate a risk scoring system for predicting the clinical failure of POEM preoperatively. Patients and methods Consecutive patients who underwent POEM in 14 high-volume centres between 2010 and 2020 were enrolled in this study. Clinical failure was defined as an Eckardt score of ≥4 or retreatment. A risk scoring system for predicting short-term clinical failure of POEM was developed using multivariable logistic regression and internally validated using bootstrapping and decision curve analysis. Results Of the 2740 study patients, 112 patients (4.1%) had clinical failure 6 months after POEM. Risk scores were assigned for three preoperative factors as follows: preoperative Eckardt score (1 point), manometric diagnosis (-4 points for type II achalasia), and a history of prior treatments (1 point for pneumatic dilation or 12 points for surgical/endoscopic myotomy). The discriminative capacity (concordance statistics, 0.68; 95% confidence interval [CI], 0.62-0.72) and calibration (slope 1.15; 95% CI, 0.87-1.40) were shown. Decision curve analysis demonstrated its clinical usefulness. Patients were categorized into low- (0-8 points: estimated risk of clinical failure <5%) and high-risk (9-22 points: ≥5%) groups. The proportions of clinical failure for the categories were stratified according to the mid-term outcomes (log-rank test; p<0.0001). Conclusions This risk scoring system can predict clinical failure of POEM preoperatively and provide useful information for making treatment decisions.2022年06月, Endoscopy, 55(3) (3), 217 - 224, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- OBJECTIVES: Patients with esophageal motility disorders (EMDs) including achalasia after gastric surgery have not been thoroughly characterized. Furthermore, the efficacy of peroral endoscopic myotomy (POEM) in this population should be clarified. METHODS: In this retrospective multicenter study of 3,707 patients with EMDs, 31 patients (0.8%) had a history of gastric surgery. Patient characteristics and POEM efficacy were compared between patients with and without previous gastric surgery. RESULTS: In patients with EMD after gastric surgery, age at EMD diagnosis was higher (72.0 years), male sex was predominant (90.3%), and the American Society of Anesthesiologists physical status score was higher (≥II, 48.4%). High-resolution manometry (HRM) findings did not reveal significant differences. In patients who underwent gastric surgery, atrophic gastritis was common (80.6%), and gastric cancer was the primary surgical indication (32.3%). Distal gastrectomy was performed in 28 patients (90.3%). POEM was effective (3.3% adverse events; 100% treatment success). The incidence rates of reflux esophagitis (RE) and symptomatic gastroesophageal reflux disease (GERD) were 60.0% and 16.7%, respectively, without significant inter-group differences, and severe RE was not observed in the long-term follow-up. Extended gastric myotomy was a risk factor for RE. CONCLUSIONS: Patients with gastric surgery often present severe disease manifestations; the surgical indication is mainly gastric cancer. HRM findings can be similarly used for diagnosis in patients with and without gastric surgery. POEM maintains safety and efficacy with acceptable RE and symptomatic GERD rates. To prevent RE, extended myotomy should be avoided.2022年06月, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society, 34(7) (7), 1394 - 1402, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- BACKGROUND AND AIMS: The etiology of chest pain in achalasia-related esophageal motility disorders (AEMDs) and the frequency and risk factors of persistent chest pain after peroral endoscopic myotomy (POEM) remain unclear. METHODS: A multicenter cohort study including 14 hospitals was conducted to elucidate the characteristics of patients with chest pain and the efficacy of POEM. RESULTS: Consecutive cases of AEMDs included 2,294 (64.2%) and 1,280 (35.8%) patients with and without chest pain, respectively. Among the 2,107 patients with chest pain who underwent POEM, we observed complete remission in 1,464 patients (69.5%) and non-remission in 643 patients (30.5%) including partial response in 619 patients (29.4%) and resistance in 24 patients (1.1%). Multivariate analysis revealed that advanced age (odds ratio [OR]:0.28), male sex (OR:0.70), prior treatment (OR:1.39), and sigmoid type (OR:0.65) were related to the prevalence of chest pain. Long disease duration (OR:0.69) and esophageal dilation (OR:0.79) were related with decreased severity. POEM improved patients' quality of life that was hindered by chest pain. Early onset (OR:1.45), advanced age (OR:0.58), male sex (OR:0.79), prior treatment (OR:1.37), and posterior myotomy (OR:1.42) were associated with non-remission after POEM; high-resolution manometry (HRM) findings and myotomy length showed no statistical significance on pain etiology and persistence after POEM. CONCLUSIONS: The prevalence and severity of chest pain were dependent on age, sex, disease duration, prior treatment, and esophageal morphology, rather than HRM findings. The efficacy of POEM is satisfactory; however, residual pain was often observed. Excessively long myotomy can be avoided, and anterior myotomy may be recommended.2022年05月, Gastrointestinal endoscopy, 96(4) (4), 620 - 629, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD) for diverticulum-associated colorectal lesions is generally contraindicated because of the high risk of perforation. Several studies on patients with such lesions treated with ESD have been reported recently. However, the feasibility and safety of ESD for lesions in proximity to a colonic diverticulum (D-ESD) have not been fully clarified. The aim of this study was to evaluate the feasibility and safety of D-ESD. METHODS: D-ESD was defined as ESD for lesions within approximately 3 mm of a diverticulum. Twenty-six consecutive patients who underwent D-ESD were included. Two strategic approaches were used depending on whether submucosal dissection of the diverticulum-related part was required (strategy B) or not (strategy A). Treatment outcomes and adverse events associated with each strategy were analyzed. RESULTS: The en bloc resection rate was 96.2%. The rates of R0 and curative resection in strategies A and B were 80.8%, 73.1%, 84.6%, and 70.6%, respectively. Two cases of intraoperative perforation and one case of delayed perforation occurred. The delayed perforation case required emergency surgery, but the other cases were managed conservatively. CONCLUSION: D-ESD may be a feasible treatment option. However, it should be performed in a high-volume center by expert hands because it requires highly skilled endoscopic techniques.2022年05月, Clinical endoscopy, 55(3) (3), 417 - 425, 英語, 国際誌研究論文（学術雑誌）
- Background/Aims: Patients with achalasia-related esophageal motility disorders (AEMDs) frequently present with dilated and sigmoid esophagus, and develop esophageal diverticulum (ED), although the prevalence and patients characteristics require further elucidation. Methods: We conducted a multicenter cohort study of 3707 patients with AEMDs from 14 facilities in Japan. Esophagography on 3682 patients were analyzed. Results: Straight (n = 2798), sigmoid (n = 684), and advanced sigmoid esophagus (n = 200) were diagnosed. Multivariate analysis revealed that long disease duration, advanced age, obesity, and type I achalasia correlate positively, whereas severe symptoms and integrated relaxation pressure correlate negatively with development of sigmoid esophagus. In contrast, Grade II dilation (3.5-6.0 cm) was the most common (52.9%), while grade III dilation (≥ 6 cm) was rare (5.0%). We found early onset, male, obesity, and type I achalasia correlated positively, while advanced age correlated negatively with esophageal dilation. Dilated and sigmoid esophagus were found mostly in types I and II achalasia, but typically not found in spastic disorders. The prevalence of ED was low (n = 63, 1.7%), and non-dilated esophagus and advanced age correlated with ED development. Patients with right-sided ED (n = 35) had a long disease duration (P = 0.005) with low integrated relaxation pressure values (P = 0.008) compared with patients with left-sided ED (n = 22). Patients with multiple EDs (n = 6) had lower symptom severity than patients with a single ED (P = 0.022). Conclusions: The etiologies of dilated esophagus, sigmoid esophagus, and ED are considered multifactorial and different. Early diagnosis and optimal treatment of AEMDs are necessary to prevent these conditions.2022年04月, Journal of neurogastroenterology and motility, 28(2) (2), 222 - 230, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- (一社)日本胃癌学会, 2022年03月, 日本胃癌学会総会記事, 94回, 515 - 515, 日本語ESD traineeからExpertを目指して
- (一社)日本胃癌学会, 2022年03月, 日本胃癌学会総会記事, 94回, 515 - 515, 日本語ESD traineeからExpertを目指して
- 2022年03月, Endoscopy, 54(9) (9), C13, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND : Gastroesophageal reflux disease (GERD) and reflux esophagitis remain problems after peroral endoscopic myotomy (POEM). This study aimed to elucidate the risk factors and long-term course of reflux esophagitis and symptomatic GERD after POEM. METHODS : This multicenter cohort study involved 14 high volume centers. Overall, 2905 patients with achalasia-related esophageal motility disorders treated with POEM were analyzed for reflux esophagitis, severe reflux esophagitis (Los Angeles classification C or D), and symptomatic GERD. RESULTS : Reflux esophagitis was diagnosed in 1886 patients (64.9 %). Age ≥ 65 years (risk ratio [RR] 0.85), male sex (RR 1.11), posterior myotomy (RR 1.12), esophageal myotomy > 10 cm (RR 1.12), and gastric myotomy > 2 cm (RR 1.17) were independently associated with reflux esophagitis. Severe reflux esophagitis was diagnosed in 219 patients (7.5 %). Age ≥ 65 years (RR 1.72), previous treatments (RR 2.21), Eckardt score ≥ 7 (RR 0.68), sigmoid-type achalasia (RR 1.40), and esophageal myotomy > 10 cm (RR 1.59) were factors associated with severe reflux esophagitis. Proton pump inhibitors (PPIs) were more effective for reflux esophagitis at 5-year follow-up (P = 0.03) than after 1 year (P = 0.08). Symptomatic GERD was present in 458 patients (15.9 %). Symptom duration ≥ 10 years (RR 1.28), achalasia diagnosis (RR 0.68), integrated relaxation pressure ≥ 26 (RR 0.60), and posterior myotomy (RR 0.80) were associated with symptomatic GERD. The incidence of symptomatic GERD was lower at 5-year follow-up compared with that after 1 year (P = 0.04), particularly in PPI users (P < 0.001). CONCLUSIONS : The incidence of severe reflux esophagitis was low after POEM, but excessive myotomy for older patients with previous treatments should be avoided. Early phase symptomatic GERD is non-acid reflux dependent and the natural course is favorable, basically supporting conservative treatment.2022年02月, Endoscopy, 54(9) (9), 839 - 847, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- 日本消化器病学会-近畿支部, 2022年02月, 日本消化器病学会近畿支部例会プログラム・抄録集, 116回, 124 - 124, 日本語貧血症状を契機に発見されESDにて切除し得た巨大十二指腸Brunner腺過形成の一例
- BACKGROUND: Esophageal motility disorders are sometimes misdiagnosed on endoscopic examination. We aimed to identify the proportion of patients with esophageal motility disorders missed during endoscopy and their clinical characteristics. METHODS: Patients diagnosed with either disorder with esophagogastric junction outflow obstruction or major disorders of peristalsis using high-resolution manometry in our hospital from April 2015 to March 2021 were included in this study. Missed esophageal motility disorders were defined as patients with any endoscopic misdiagnosis such as normal esophagus or esophagitis within 1 year before the manometric diagnosis. We determined the proportion of missed esophageal motility disorders and identified independent predictors of missed esophageal motility disorders using multivariate analysis. RESULTS: A total of 41/273 esophageal motility disorders (15.0%; 95% confidence interval 11.3-19.7%) were missed during endoscopy within 1 year before manometric diagnosis. In the stepwise logistic regression analysis, the following variables were selected as independent variables for patients with missed esophageal motility disorders during endoscopy: non-dilated esophagus (odds ratio = 4.87, 95% confidence interval: 1.81-13.12, p = 0.002), the presence of epiphrenic diverticulum (odds ratio = 8.95, 95% confidence interval: 1.88-42.65, p = 0.006), the use of transnasal endoscopy (odds ratio = 4.71, 95% confidence interval: 1.59-13.92, p = 0.005), and the combined use of esophagram (odds ratio = 0.023, 95% confidence interval: 0.0025-0.20, p = 0.0008). CONCLUSIONS: Based on retrospective analysis, 15% of esophageal motility disorders were missed during endoscopy. Understanding the clinical characteristics of missed esophageal motility disorders could help improve endoscopic diagnoses.2022年01月, Esophagus, 19(3) (3), 486 - 492, 英語, 国内誌[査読有り]研究論文（学術雑誌）
- 日本消化器内視鏡学会-近畿支部, 2021年12月, 日本消化器内視鏡学会近畿支部例会プログラム・抄録集, 107回, 113 - 113, 日本語低分化型腺癌と鑑別を要した乳癌胃転移の一例
- 日本消化器内視鏡学会-近畿支部, 2021年12月, 日本消化器内視鏡学会近畿支部例会プログラム・抄録集, 107回, 120 - 120, 日本語Barrett食道腺癌ESD後の異時性多発病変に対し残存Barrett粘膜を含めESDで完全切除した一例
- 日本消化器内視鏡学会-近畿支部, 2021年12月, 日本消化器内視鏡学会近畿支部例会プログラム・抄録集, 107回, 121 - 121, 日本語胃前庭部の粘膜下層剥離術後通過障害に対するバルーン拡張術無効例の検討
- OBJECTIVES: Indications for peroral endoscopic myotomy (POEM) and endoscopic submucosal dissection (ESD) in patients with achalasia concomitant with esophageal carcinoma (EC) are unclear. This study aimed to clarify the role of POEM in cases of achalasia concomitant with EC and to elucidate the indications for ESD and efficient surveillance for EC. METHODS: We conducted a multicenter cohort study at 14 hospitals in Japan, including 3707 cases of achalasia-related esophageal motility disorders (EMDs). Factors contributing to EC risk, the characteristics of EC, and clinical outcomes of POEM/ESD were analyzed. RESULTS: In patients undergoing POEM, screening and surveillance endoscopy throughout a 1-year period resulted in diagnosis of 72.1% new EC cases. Of 62 patients with 123 ECs, 40.3% had multiple or metachronous lesions within 37.5 months. EC was predominantly observed in the middle thoracic esophagus (58.5%) and posteriorly (73.2%). POEM had comparable safety and efficacy in cases of concomitant EC even after ESD. Endoscopic en bloc resection was performed in 95.8% and 89.3% of ECs diagnosed before and after POEM, respectively (P = 0.351); however, ESD on the POEM-line was impaired by fibrosis. Multivariate analysis revealed risk factors for EC, including regular alcohol consumption, a history of smoking, advanced age, and extended disease duration. Alcohol intake and smoking had a synergistic effect on EC development. CONCLUSIONS: Screening and surveillance of POEM help in detecting EC. ESD is feasible in achalasia, although on the POEM-line is challenging. Surveillance endoscopy for EC is recommended for cases with specific risks and a history of ECs.2021年11月, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society, 34(5) (5), 965 - 973, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- BACKGROUND AND AIM: Achalasia is a rare disease, with an incidence of one in 100 000. Genetic factors and autoimmune involvement have been reported in its etiology, and their involvement is strongly suspected, especially in patients with familial achalasia and those with comorbid hereditary or autoimmune diseases. However, these special types of achalasia are rare, and their frequency and clinical characteristics remain unclear. METHODS: This retrospective, multicenter cohort study included Japanese patients with a diagnosis of achalasia, treated between 2010 and 2019 across six tertiary centers in Japan. The frequency and clinical characteristics of special types of achalasia, namely, familial achalasia, achalasia with a comorbid hereditary disease, and achalasia with a comorbid autoimmune disease, were retrospectively investigated using a large-scale multicenter database. RESULTS: During the study period, 1115 patients were treated for achalasia at six tertiary centers. Familial achalasia, achalasia with a comorbid hereditary disease, and achalasia with a comorbid autoimmune disease occurred in 7 (0.63%), 11 (0.99%), and 27 (2.4%) patients, respectively. Familial achalasia had a slightly younger age of onset (37.6 ± 12.1 years old) and a higher incidence in male patients (six patients; 85.7%). Down's syndrome was the most common hereditary comorbidity, and thyroid disease was the most common autoimmune comorbidity. CONCLUSIONS: We clarified the frequency and clinical characteristics of special types of achalasia. Although special types of achalasia are rare, these comorbidities should be considered when treating patients with achalasia.2021年10月, Journal of gastroenterology and hepatology, 36(10) (10), 2828 - 2833, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- AIM: To elucidate the impact of the coronavirus disease 2019 (COVID-19) on the practice of high-resolution manometry (HRM) and peroral endoscopic myotomy (POEM) in Japan. METHODS: We utilized a large-scale database involving 14 high-volume centers in Japan to investigate changes in the numbers of HRM and POEM procedures performed and outcomes of POEM between 2019 and 2020. A questionnaire survey was also conducted to analyze pandemic-associated changes in the HRM and POEM protocols. RESULTS: Compared to that in 2019, the number of HRM and POEM procedures decreased by 17.2% (1587-1314) and 20.9% (630-498), respectively. These declines were prominent during the state of emergency from April to May 2020, particularly in pandemic areas. HRM and POEM in nonpandemic areas were relatively unaffected. From 2019 to 2020, there was a 0.4% (254-248) decrease in POEM cases within the prefecture, but the number outside the prefecture decreased by 33.6% (372-247). During the pandemic, the safety and efficacy of POEM were maintained. The implementation of personal protective equipment (PPE) measures varied among facilities, and PPE for POEM was relatively insufficient compared to that for HRM. CONCLUSION: The COVID-19 pandemic influenced HRM and POEM practices in Japan. It is necessary to establish a sufficient system for HRM and POEM in each hospital as well as countrywide to overcome the effects of the pandemic.2021年09月, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society, 34(4) (4), 769 - 777, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- 日本消化器病学会-近畿支部, 2021年09月, 日本消化器病学会近畿支部例会プログラム・抄録集, 115回, 68 - 68, 日本語早期胃癌で発見された胎児消化管上皮類似癌の3例
- Background/Aims: The anastomotic site after distal gastrectomy is the area most affected by duodenogastric reflux. Different reconstruction methods may affect the lesion characteristics and treatment outcomes of remnant gastric cancers at the anastomotic site. We retrospectively investigated the clinicopathologic and endoscopic submucosal dissection outcomes of remnant gastric cancers at the anastomotic site.Methods: We recruited 34 consecutive patients who underwent endoscopic submucosal dissection for remnant gastric cancer at the anastomotic site after distal gastrectomy. Clinicopathology and treatment outcomes were compared between the Billroth II and non-Billroth II groups.Results: The tumor size in the Billroth II group was significantly larger than that in the non-Billroth II group (22 vs. 19 mm; p=0.048). More severe gastritis was detected endoscopically in the Billroth II group (2 vs. 1.33; p=0.0075). Moreover, operation time was longer (238 vs. 121 min; p=0.004) and the frequency of bleeding episodes was higher (7.5 vs. 3.1; p=0.014) in the Billroth II group.Conclusions: Compared to remnant gastric cancers in non-Billroth II patients, those in the Billroth II group had larger lesions with a background of severe remnant gastritis. Endoscopic submucosal dissection for remnant gastric cancers in Billroth II patients involved longer operative times and more frequent bleeding episodes than that in patients without Billroth II.The Korean Society of Gastrointestinal Endoscopy, 2021年08月, Clinical Endoscopy, 55(1) (1), 86 - 94[査読有り]研究論文（学術雑誌）
- (株)医学書院, 2021年07月, 胃と腸, 56(8) (8), 1047 - 1056, 日本語
- BACKGROUND AND AIM: There have been studies on risk factors for stenosis after pyloric endoscopic submucosal dissection (ESD). However, the most appropriate strategies for the management of cases with these risk factors have not been established. This study aimed to investigate post-ESD management by evaluating the timing of stenosis and the effectiveness of endoscopic balloon dilation (EBD) after pyloric ESD. METHODS: We retrospectively reviewed cases of pyloric ESD. We first reassessed risk factors for stenosis in multivariate analysis and receiver operating characteristic curve and defined patients with the identified risk factors as the risk group. The primary outcome was the timing of stenosis in the risk group assessed by the Kaplan-Meier method. RESULTS: We reviewed 159 cases with pyloric ESD and observed pyloric stenosis in 25 cases. Cases with circumferential mucosal defect ≥ 76% were identified as the risk group. The stenosis-free probability in the risk group was 97% (95% confidence interval [CI]: 79-100%), 94% (95% CI: 76-98%), and 85% (95% CI: 66-93%) on days 7, 14, and 21, respectively. It decreased every week thereafter and did not significantly change after day 56. Twenty-three stenosis cases, except for conservative improvement, including six whole circumferential pyloric ESD cases, were improved by EBD without complications. CONCLUSIONS: Post-ESD stenosis often developed from the third to the eighth week. In all pyloric ESD cases, including whole circumferential pyloric ESD cases, pyloric stenosis was improved following EBD without complications.2021年06月, Journal of gastroenterology and hepatology, 36(11) (11), 3158 - 3163, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- BACKGROUND: Endoscopic submucosal dissection (ESD) for remnant gastric cancer (RGC) after distal gastrectomy (DG) is considered technically challenging due to the narrow working space, and severe fibrosis and staples from the previous surgery. Technical difficulties of ESD for RGC after DG have not been thoroughly investigated. This study aimed to develop and validate a risk-scoring system for assessing the technical difficulty of ESD for RGC after DG in a large multicenter cohort. METHODS: We investigated patients who underwent ESD for RGC after DG in 10 institutions between April 2008 and March 2018. A difficult case was defined as ESD lasting ≥ 120 min, involving piecemeal resection, or the occurrence of perforation during the procedure. A risk-scoring system for the technical difficulty of the procedure was developed based on multiple logistic regression analyses, and its performance was internally validated using bootstrapping. RESULTS: A total of 197 consecutive patients with 201 lesions were analyzed. There were 90 and 111 difficult and non-difficult cases, respectively. The scoring model consisted of four independent risk factors and points of risk scores were assigned for each as follows: tumor size > 20 mm: 2 points; anastomosis site: 2 points; suture line: 1 point; and non-expert endoscopist: 2 points. The C-statistics of the scoring system for technical difficulty was 0.72. CONCLUSIONS: We developed a validated risk-scoring model for predicting the technical difficulty of ESD for RGC after DG that can contribute to its safer and more reliable performance.2021年04月, Surgical endoscopy, 36(2) (2), 1482 - 1489, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- BACKGROUND: The outcomes of peroral endoscopic myotomy for advanced achalasia are not well known. This study aimed to evaluate the outcomes of peroral endoscopic myotomy for achalasia with megaesophagus, which is one of the characteristics of advanced achalasia. METHODS: In total, 234 patients with achalasia who underwent peroral endoscopic myotomy in our hospital from April 2015 to March 2019 were included in this retrospective observational study. Megaesophagus was defined as a maximum esophageal diameter of 6 cm or more. Outcomes, including clinical success (Eckardt score ≤ 3 without retreatment) at the 1-year follow-up, technical success, and perioperative complications, were investigated and compared between patients with and without megaesophagus. RESULTS: Eleven patients (4.7%) were diagnosed with megaesophagus. The clinical success rate achieved was 63.6% in patients with megaesophagus, with a significant decrease in the Eckardt score (6 vs. 2, p = 0.003) and integrated relaxation pressure (28 mmHg vs. 9 mmHg, p = 0.028). The technical success rate was 100%. However, patients with megaesophagus had a significantly lower clinical success rate than those without megaesophagus (63.6% vs. 96.0%, p = 0.002). Furthermore, patients with megaesophagus had significantly higher rates of major adverse events than those without megaesophagus (18.2% vs. 2.7%, p = 0.048). CONCLUSIONS: Peroral endoscopic myotomy improved achalasia-related symptoms, and this was technically feasible in patients with megaesophagus. However, the clinical success rate was somewhat low, and the rate of major adverse events was high. Therefore, peroral endoscopic myotomy should be carefully performed for advanced achalasia with megaesophagus.2021年04月, Esophagus, 英語, 国内誌[査読有り]研究論文（学術雑誌）
- (一社)日本消化器内視鏡学会, 2021年04月, Gastroenterological Endoscopy, 63(Suppl.1) (Suppl.1), 910 - 910, 日本語進行食道癌に対する食道ステント留置後の食事摂取状況に関する検討
- 2021年01月, Endoscopy, 53(1) (1), E9-E10, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- 2020年08月, Endoscopy, 52(8) (8), E291-E292, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- BACKGROUND AND AIMS: Peroral endoscopic myotomy (POEM) is an effective treatment for esophageal motility disorder. However, there are poor responders who will probably need retreatments such as endoscopic pneumatic dilation or re-POEM, and a scoring-system for the prediction of poor responders preoperatively remains unestablished. We aimed to develop and validate a preoperative scoring-system for predicting poor responders. METHODS: Overall, 244 patients who underwent POEM for esophageal motility disorders in our hospital from April 2015 to March 2019 were retrospectively included in this study. Poor responders were defined as patients with any of following: (1) Eckardt score ≥3 at 1-year follow-up, (2) endoscopic findings of food retention at 1-year follow-up and (3) retreatments within 1 year after POEM. A risk-scoring system for poor responders was developed based on multiple logistic regression analysis and its performance was internally validated using bootstrapping. RESULTS: Forty patients were diagnosed poor responders at the 1-year follow-up. In multivariate study, points of risk scores were assigned for 4 independent risk factors as follows: pretreatment Eckardt score (1-point increments), previous treatments (4 points), sigmoid-type esophagus (4 points), and esophageal dilation grade ≥Ⅱ (4 points). The scoring system could predict an estimated risk for poor responders and provided satisfactory discrimination (area under the receiver operating characteristic curve, 0.78 [95% confidence interval, 0.68-0.88]) and calibration (slope = 0.93 [95% confidence interval, 0.62-1.31]). CONCLUSIONS: A validated risk-scoring system for predicting poor responders preoperatively was established; this system could be useful in selecting treatment strategies and postoperative surveillance.2020年06月, Gastrointestinal endoscopy, 93(2) (2), 398 - 405, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- OBJECTIVES: This study compared the safety and efficacy of peroral endoscopic myotomy for esophageal motility disorders between octogenarians and non-octogenarians. METHODS: This retrospective observational study recruited 321 patients (28 octogenarians and 293 non-octogenarians) who underwent peroral endoscopic myotomy from two institutions. Clinical success (postoperative Eckardt score≤3), technical success (completion of gastric and esophageal myotomy), and perioperative adverse events were compared between octogenarians and non-octogenarians. Perioperative adverse events were classified into major and minor adverse events based on the International Peroral Endoscopic Myotomy Survey criteria and were subdivided into technical and non-technical adverse events according to the presence of a direct causal relationship with the procedure. RESULTS: There were no significant differences in the rates of clinical success 1-year after treatment (100% vs. 97.3%, p=0.64) and technical success (100% vs. 99.7%, p=0.91) between octogenarians and non-octogenarians. Octogenarians had a higher incidence of perioperative adverse events (28.6% vs. 10.2%, p=0.00097), particularly major adverse events (25.0% vs. 3.0%, p<0.0001). There were no significant differences in the incidence of minor adverse events (7.1% vs. 7.9%, p=0.67). Although there was no difference in the incidence of technical adverse events (10.7% vs. 9.2%, p=0.74), octogenarians had a significantly higher incidence of non-technical adverse events (17.9% vs. 1.0%, p=0.0002). CONCLUSIONS: There were no significant differences in short-term clinical success and technical success between octogenarians and non-octogenarians. However, octogenarians showed a significantly higher incidence of perioperative adverse events, particularly in major adverse events and non-technical adverse events. Peroral endoscopic myotomy for octogenarians should be carefully applied.2020年04月, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society, 33(1) (1), 110 - 117, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- Achalasia is a rare benign esophageal motility disease caused by the impaired relaxation of the lower esophageal sphincter, which results from nerve damage. Patients with achalasia are known to have a high risk of esophageal cancer. Here, we present the case of a patient with achalasia and esophageal cancer in whom the Lugol-voiding areas (LVAs) could be improved by pneumatic dilation and the extending area of esophagus cancer could become clear. In achalasia patients, LVAs are modified by inflammation and appear wider than their actual size. Moreover, some parts of LVAs in achalasia patients might be reversible by treatments that improve delayed emptying. When the spread of esophagus cancer is unclear due to the detection of numerous LVAs by Lugol chromoendoscopy, the treatments that improve delayed emptying first may be effective in accurately diagnosing the extending area of esophagus cancer.2020年04月, JGH open : an open access journal of gastroenterology and hepatology, 4(2) (2), 309 - 311, 英語, 国際誌[査読有り]
- BACKGROUND: Esophageal epiphrenic diverticulum (ED) is associated with esophageal motility disorder (EMD). If a diverticulum associated with EMD is enlarging with worsening symptoms, surgical intervention, including laparoscopic epiphrenic diverticulectomy with myotomy and fundoplication, is indicated. However, some studies suggest that myotomy alone, with less adverse events, is sufficient to improve symptoms. Additionally, peroral endoscopic myotomy (POEM) is considered effective and safe for EMD. Since theoretically, POEM is endoscopic Heller myotomy, POEM without diverticulectomy is considered a less invasive, promising treatment option for EMD and ED. We aimed to determine the efficacy and safety of POEM alone for ED with EMD. METHODS: This single-center study was retrospective. A total of 298 patients underwent POEM in Kobe University Hospital from April 2015 to October 2018. Of them, 14 patients had ED. Procedure-related outcomes and treatment outcomes 3 months post POEM were evaluated in these patients. RESULTS: The median maximum ED diameter was 29 (range 9-90) mm; and the median POEM procedure time, 77.5 (range 41-123) min. Pneumoperitoneum, which required needle decompression, occurred in one patient, but no fatal adverse events occurred. The median Eckardt score significantly decreased from 5 [range 2-11] pre POEM to 0 [range 0-2] post POEM (P < 0.0001). The median integrated relaxation pressure significantly decreased from 22.5 [13.9-34.3] mmHg pre POEM to 10.2 [0.7-23.9] mmHg post POEM (P < 0.0001). Of 14 patients, only one patient complained of gastroesophageal reflux disease symptoms, which could be controlled with a potassium-competitive acid blocker. CONCLUSIONS: POEM alone seemed effective and safe for patients with EMD and ED.2020年01月, Surgical endoscopy, 34(12) (12), 5447 - 5454, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- Although treatment for esophageal motility disorder improves dysphagia and increases body weight, the effect of the treatment on body composition is unclear. This study aimed to assess the change in body composition between before and after treatment, the preoperative predictors of muscle increase, and the association between muscle increase and quality of life. Sixty-one patients (achalasia, n = 55; spastic esophageal disorder n = 6) who underwent per-oral endoscopic myotomy were analyzed in a single-arm prospective observational study. Appendicular skeletal muscle mass was measured with dual X-ray absorptiometry before and 3 months after per-oral endoscopic myotomy. For subgroup analysis, patients with postoperative appendicular skeletal muscle mass increase were defined as the muscle-increase group and the rest as the non-muscle-increase group. Preoperative factors related to the muscle-increase group were clarified via multivariate analysis. Further, the improvement after per-oral endoscopic myotomy in health-related quality-of-life score (Short Form-36) was compared between the muscle-increase and non-muscle-increase groups. Appendicular skeletal muscle mass increased significantly 3 months after per-oral endoscopic myotomy (P = 0.0002). The patients who underwent effective treatment (postoperative Eckardt score < 3) showed a significant improvement in appendicular skeletal muscle mass compared to those who did not (P = 0.04). In the stepwise logistic regression analysis, the preoperative Eckardt score (odds ratio: 1.95, 95% confidence interval 1.30-3.26, P = 0.0005) and preoperative serum prealbumin (odds ratio: 0.83, 95% confidence interval 0.70-0.97, P = 0.02) were identified as independent factors related to postoperative muscle increase. The improvements in the Short Form-36 domains of General Health (P = 0.0007) and Vitality (P = 0.003) were significantly higher in the muscle-increase group. The findings show that effective treatment improved the body composition of patients with esophageal motility disorder and that the Eckardt score and serum prealbumin may aid the prediction of increased appendicular skeletal muscle mass after treatment, resulting in a better quality of life.2019年08月, Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus, 32(8) (8), 英語, 国際誌[査読有り]研究論文（学術雑誌）
- BACKGROUND: The feasibility and safety of endoscopic submucosal dissection (ESD) for superficial esophageal neoplasms extending to the cervical esophagus currently remain unknown because of the limited number of cases. We aimed to clarify the clinical outcomes of these cases. METHODS: This was a case series study conducted at a single institution that enrolled 26 consecutive patients with superficial esophageal neoplasms extending to the cervical esophagus who underwent ESD between July 2003 and December 2015. RESULTS: En bloc and complete resection rates were both 100 % and no major intraprocedural complications occurred. Thirteen patients were treated with prophylactic steroid therapy. The incidence of postoperative stricture in patients with a circumferential mucosal defect of more than three-quarters was 72.7 %. Four patients required entire circumferential resection, with perforation occurring after endoscopic balloon dilation (EBD) in two and EBD being required for more than 1 year in the other two. CONCLUSIONS: ESD including the cervical esophagus is technically feasible. Circumferential resection may cause refractory postoperative stricture or post-EBD perforation, so needs to be avoided where possible.2018年06月, Endoscopy, 50(6) (6), 613 - 617, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- Background and study aims : In order to perform peroral endoscopic myotomy (POEM) safely, retained liquid and food debris must be removed before the procedure is started. We developed a novel technique using a super-slim gastroscope, and a gastric tube to remove retained food debris in achalasia patients. In this study, the safety and efficacy of this novel technique were investigated. Patients and methods : Eleven patients with achalasia were enrolled in this study and underwent this novel method for esophageal clearance. Results: All patients had complete clearance of the retained food debris using this method. The median procedure time (range) was 13 (6 - 30) minutes. There were no serious adverse events (AEs) and one minor AE of mucosal erythema due to mucosal suctioning. Conclusion: This novel method for esophageal clearance is safe and effective in achalasia patients with large amounts of retained food debris.2018年01月, Endoscopy international open, 6(1) (1), E86-E89, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- BACKGROUND AND STUDY AIMS : Peroral endoscopic myotomy (POEM) is an evolving new treatment strategy for achalasia. Although several kinds of electrosurgical knives have been used in performing POEM, the best device has yet to be determined. The FlushKnife BT is a waterjet-emitting short needle-knife with a small ball tip (BT) that offers the potential to perform all aspects of POEM with a single device. In this study, we evaluated the safety and efficiency of the FlushKnife BT for POEM. PATIENTS AND METHODS: A total of 54 consecutive patients with achalasia and other spastic esophageal motility disorders, such as jackhammer esophagus or distal esophageal spasm, who underwent POEM between January 2016 and August 2016, were included in this retrospective study. RESULTS: The median operation time was 73.0 minutes (range 39 - 184 minutes). All procedures were completed using only the FlushKnife BT without changing to any other electrosurgical instrument. The median number of additional submucosal injections with an injection needle was 0 (range 0 - 1). Endoscopic vessel sealing was performed a mean of 3 times (range 0 - 7). The median number of bleeding episodes requiring treatment with hemostatic forceps was 0 (range 0 - 5). There were no significant adverse events. Seven of 52 patients (13.5 %) reported symptoms of gastroesophageal reflux disease such as heartburn or acid reflux at 3 month follow-up. CONCLUSIONS: The FlushKnife BT enabled POEM to be performed with very few device exchanges, either for re-injection or to control intraoperative bleeding. In this uncontrolled case series, the ability of the FlushKnife BT to perform nearly all aspects of the POEM procedure seems to make it particularly well suited to this procedure.2017年07月, Endoscopy international open, 5(7) (7), E663-E669, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- (一財)日本消化器病学会, 2022年03月, 日本消化器病学会雑誌, 119(臨増総会) (臨増総会), A382 - A382, 日本語
- 2021年, Gastroenterological Endoscopy (Web), 63(Supplement1) (Supplement1)消化器内視鏡検査従事者における新型コロナウイルスSARS-CoV-2感染症の抗体保有率調査
- 2021年, 胃と腸, 56(8) (8)早期大腸癌内視鏡治療の新展開 大腸Tlb癌を完全一括切除するために必要な内視鏡的切除技術
- 2020年, 日本小児外科学会雑誌, 56(5) (5)小児食道アカラシアに対する経口内視鏡的筋層切開術(POEM)の有用性と安全性に関する検討
- 2020年, Gastroenterological Endoscopy (Web), 62(Supplement1) (Supplement1)ガイドライン追補版導入後の抗血栓薬服用者における胃ESDの後出血に関する検討
- 2020年, Gastroenterological Endoscopy (Web), 62(Supplement1) (Supplement1)早期胃癌ESD非治癒切除例における高齢者症例の検討
- 日本消化器病学会-近畿支部, 2019年10月, 日本消化器病学会近畿支部例会プログラム・抄録集, 111回, 109 - 109, 日本語バルーン拡張術が有効であったPlummer-vinson症候群の一例
- (一社)日本消化器内視鏡学会, 2019年10月, Gastroenterological Endoscopy, 61(Suppl.2) (Suppl.2), 2131 - 2131, 日本語80歳以上の高齢食道運動機能異常患者に対する経口内視鏡的筋層切開術の有効性と安全性の検討
- (一財)日本消化器病学会, 2019年03月, 日本消化器病学会雑誌, 116(臨増総会) (臨増総会), A428 - A428, 日本語食道憩室を有する食道運動障害患者に対してPOEMの安全性及び有効性についての検討
- (一財)日本消化器病学会, 2019年03月, 日本消化器病学会雑誌, 116(臨増総会) (臨増総会), A276 - A276, 日本語食道運動機能異常患者における経口内視鏡的筋層切開術後の骨格筋量の変化に関する検討
- 2019年, Acta Gastro-Enterologica Belgica, 82(2) (2), 341 - 342Endoscopic submucosal dissection in a patient with idiopathic mesenteric phlebosclerosis速報，短報，研究ノート等（学術雑誌）
- 2019年, 日本消化器病学会近畿支部例会プログラム・抄録集, 110thNUDT15遺伝子R139C多型を背景とし,アザチオプリンによる無顆粒球症を発症した潰瘍性大腸炎の1例
- 2019年, Gastroenterological Endoscopy (Web), 61(Supplement2) (Supplement2)80歳以上の高齢食道運動機能異常患者に対する経口内視鏡的筋層切開術の有効性と安全性の検討
- 2019年, 日本消化器病学会雑誌(Web), 116食道運動機能異常患者における経口内視鏡的筋層切開術後の骨格筋量の変化に関する検討
- 2019年, 日本消化器病学会雑誌(Web), 116食道憩室を有する食道運動障害患者に対してPOEMの安全性及び有効性についての検討
- (株)東京医学社, 2018年07月, 消化器内視鏡, 30(7) (7), 859 - 867, 日本語【高リスク患者の内視鏡】上部消化管 抗血栓薬を中止できない患者に対するESDの注意点と対策記事・総説・解説・論説等（学術雑誌）
- (株)東京医学社, 2018年04月, 消化器内視鏡, 30(4) (4), 433 - 439, 日本語【ここまできた胃・十二指腸ESD-現状と今後の展望】安全に治療を行うためのセデーションとリスクマネジメント記事・総説・解説・論説等（学術雑誌）
- (一財)日本消化器病学会, 2018年03月, 日本消化器病学会雑誌, 115(臨増総会) (臨増総会), A321 - A321, 日本語食道アカラシアにおけるサルコペニア発症のリスク因子の検討
- (株)医学書院, 2018年03月, 胃と腸, 53(3) (3), 353 - 360, 日本語早期胃癌研究会症例 胃原発濾胞性リンパ腫の1例
- (NPO)日本食道学会, 2017年06月, 日本食道学会学術集会プログラム・抄録集, 71回, P39 - 4, 日本語当院におけるJackhammer esophagus 9症例の検討
- 2017年05月, GASTROINTESTINAL ENDOSCOPY, 85(5) (5), AB321 - AB321, 英語Utility and Usefulness of Gastric Endscopic Submucosal Dissection (ESD) for Elderly Patients Older Than 80 Years Old研究発表ペーパー・要旨（国際会議）
- (株)医学書院, 2017年05月, 胃と腸, 52(5) (5), 591 - 591, 日本語【図説「胃と腸」所見用語集2017】画像所見[胃] 架橋ひだ(bridging fold)
- 2016年05月, GASTROINTESTINAL ENDOSCOPY, 83(5) (5), AB450 - AB450, 英語The Usefulness of a Novel Slim Type Flush Knife-BT Compared to the Conventional Flush Knife-BT研究発表ペーパー・要旨（国際会議）
- (一社)日本消化器内視鏡学会, 2016年04月, Gastroenterological Endoscopy, 58(Suppl.1) (Suppl.1), 696 - 696, 日本語新ガイドライン導入後の抗血栓薬常用者における胃ESDの後出血リスクの検討
- 2014年12月, 松山赤十字病院医学雑誌, 39(1) (1), 21 - 26, 日本語消化器癌を合併したクローン病の2例
- 2014年12月, 松山赤十字病院医学雑誌, 39(1) (1), 27 - 32, 日本語漢方薬長期服用者にみられた特発性腸間膜静脈硬化症の2例
- (一財)日本消化器病学会, 2014年09月, 日本消化器病学会雑誌, 111(臨増大会) (臨増大会), A683 - A683, 日本語高齢者の消化管出血とその有効な対策 出血性胃十二指腸潰瘍における高齢者症例の検討
- (一社)日本消化器内視鏡学会, 2014年04月, Gastroenterological Endoscopy, 56(Suppl.1) (Suppl.1), 899 - 899, 日本語H.pylori除菌適応拡大は内視鏡診療に何をもたらすか? 当センターにおける胃十二指腸潰瘍症例のtime trend
- うず潮フォーラム事務局, 2014年03月, 消化管の臨床, 19, 55 - 58, 日本語内視鏡的止血術を要した消化管出血症例の検討
- 十二指腸MALTリンパ腫の3例当科で上部消化管内視鏡検査を施行して十二指腸に病変を認め、病理組織学的にmucosa-associated lymphoid tissue lymphoma(以下MALTリンパ腫)と診断した症例は3例であった。症例1は51歳、女性。十二指腸球部前壁に表面にびらんを伴う比較的なだらかな立ち上がりの不整な隆起性病変と、胃角後壁に褪色調のびらんを認め、生検で両者よりMALTリンパ腫を認めた。肉眼型は隆起型、Lugano国際会議分類(以下Lugano分類)に基づく臨床病期はstage Iと判断しHelicobacter pylori(以下HP)陽性のため、除菌療法を施行し、除菌2ヵ月後に完全寛解となった。症例2は63歳、男性。十二指腸球部に多発する白色調の小隆起を認め、生検でMALTリンパ腫を認めた。肉眼型はmultiple lymphomatous polyposis(以下:MLP)型、Lugano分類stage Iと判断した。HP陽性のため除菌療法を施行し、除菌6ヵ月後に部分寛解となった。症例3は38歳、女性。十二指腸球部前壁に白色調顆粒状粘膜が癒合しなだらかな隆起性病変を認め、生検でMALTリンパ腫を検出した。肉眼型は隆起型、Lugano分類stage Iと判断した。HP陽性のため除菌療法を施行し、除菌6ヵ月後に完全寛解となった。十二指腸MALTリンパ腫の本邦報告29例と自験3例を併せて検討したところ、十二指腸球部に好発するMLP型ないし隆起型の形態を呈する症例が多く、およそ3割に胃MALTリンパ腫を合併していた。臨床病期はほとんどがLugano分類stage Iであり、HP除菌が比較的よく奏功していた。(著者抄録)2013年12月, 松山赤十字病院医学雑誌, 38(1) (1), 23 - 28, 日本語
- 当センターにおける胃粘膜生検後出血の現状当センターにおける、過去4年間の胃粘膜生検後出血の現状を検討した。検討期間内に25,052例の上部消化管内視鏡検査(esophagogastroduodenoscopy:EGD)が施行され、8,174例(32.6%)に胃粘膜生検が行われた。そのうち20例(0.24%)に生検後出血を来した。年齢は35歳から89歳(中央値65.9歳)、性別は男女とも10例であった。非ステロイド性抗炎症薬(NSAIDs)服用が4例、低用量アスピリン(LDA)が1例で、抗凝固薬服用例はなかった。生検対象は腫瘍性病変が8例と最も多く、粘膜下腫瘍が4例、びらん及び潰瘍性病変が4例、正常粘膜からの生検が4例であった。生検部位はU(上部)領域が12例と最も多く、続いてL(下部)領域5例、M(中部)領域3例の順であった。20例中15例は静脈性出血で、全例にトロンビン散布が行われ予後は良好であった。20例中5例は動脈性出血を来し、そのうち4例は胃体上部小弯からの生検であった。止血法は、クリップ法、高張Naエピネフリン法(HSE法)と高周波電気凝固法が行われ、全て内視鏡的に止血し得た。2例でHb値2.0g/dL以上の低下があったが、輸血を要した症例はなかった。当センターにおける胃粘膜生検後の出血は、全て内視鏡的に止血可能で予後良好であった。しかし動脈性出血を来した症例が5例(0.06%)あり、胃体上部小弯の生検時には注意が必要と考えられた。今後は新ガイドラインの普及に伴い、生検後出血症例の実態把握がさらに重要になると思われる。(著者抄録)2012年12月, 松山赤十字病院医学雑誌, 37(1) (1), 3 - 7, 日本語
- 当センターにおけるステロイド依存・抵抗性潰瘍性大腸炎に対するインフリキシマブの寛解導入および寛解維持効果の検討潰瘍性大腸炎の臨床経過を遡及的に検討し、インフリキシマブ(IFX)による寛解導入・寛解維持効果を評価した。①寛解導入目的でIFXを投与した活動期UC49例において単回投与2週間でLichtiger indexは平均9.0から平均5.7に低下し(p<0.0001)、30例(61%)が寛解となった。②IFX単回投与で寛解導入後、維持投与未実施群(IFX単回投与群;n=21)と寛解導入後8週毎の維持投与実施群(IFX維持投与群;n=14)とに分類し、累積寛解維持率を比較した。IFX単回投与群とIFX維持投与群における累積寛解維持率は、それぞれ3ヵ月後で43%、77%、6ヵ月後で24%、39%であり、IFX維持投与群はIFX単回投与群と比較し、有意に累積寛解維持率が高かった(p=0.02)。以上より、IFXはステロイド依存・抵抗性潰瘍性大腸炎に対して、高い寛解導入・寛解維持効果を有すると考えられた。(著者抄録)2012年12月, 松山赤十字病院医学雑誌, 37(1) (1), 9 - 14, 日本語