SEARCH
検索詳細
吉﨑 哲也医学部附属病院 光学医療診療部助教
研究活動情報
■ 論文- 2026年09月, Gastric Cancer研究論文（学術雑誌）
- 2026年07月, Surgical Endoscopy研究論文（学術雑誌）
- 2026年06月, Biochemical and Biophysical Research Communications研究論文（学術雑誌）
- BACKGROUND AND AIMS: Endoscopic submucosal dissection (ESD) is a technically demanding curative treatment for early gastric cancer. The EndoTrac traction device was designed to enhance maneuverability during ESD. This study evaluated whether EndoTrac-assisted ESD (ET-ESD) improves outcomes versus conventional ESD (C-ESD) in patients with superficial gastric neoplasms. METHODS: In this multicenter, single-blind, randomized controlled trial, 142 patients from 11 Japanese centers were assigned to undergo ET-ESD (n=72) or C-ESD (n=70). The primary endpoint was ESD procedure time. Secondary endpoints included efficacy, safety, and device-related outcomes. Operator experience, lesion characteristics, knife type, and institutional ESD volume were recorded and analyzed. RESULTS: Median procedure times were 53.5 minutes for ET-ESD and 57.0 for C-ESD (P=0.56). Among trainees, ET-ESD was associated with a shorter procedure time than C-ESD (59.0 vs. 85.5 minutes; P=0.02). In subgroup analyses of trainee cases, shorter times with ET-ESD were associated with several scenarios (e.g., lesions ≤20 mm, upper/middle third of the lesser curvature, needle-type knife, and low-volume centers). In a multivariable analysis among trainees, ET-ESD remained independently associated with shorter procedure time (B= -24.8 minutes; 95% CI, -43.8 to -5.8; P=0.012). In the overall cohort, en bloc and R0 resection rates, adverse events, and device-related complications were similar between groups. CONCLUSIONS: ET-ESD did not significantly shorten procedure time in the overall cohort. Nonetheless, exploratory subgroup analyses suggested potential benefits among trainees, small lesions, technically challenging locations, and low-volume centers.2025年12月, Digestion, 1 - 32, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: We aimed to reveal the outcomes of endoscopic resection (ER) for locally recurrent early gastric cancer (LRGC) after ER using the data obtained in a Japanese multicenter prospective cohort study of ER for early gastric cancer (EGC) using Web registry (J-WEB/EGC). METHODS: Short-term and long-term outcomes were compared between 125 LRGCs (119 patients) and 9387 primary EGCs of naive stomach (8455 patients) enrolled in this study at 41 centers between July 2010 and June 2012. We calculated 5-year overall survival rates (OS) and disease-specific survival rates (DSS) for LRGC, divided ERs into curative and noncurative resections, and calculated hazard ratios (HR) for all-cause mortality with Cox regression analysis. RESULTS: For LRGCs and primary EGCs, median resection times were 100 and 77 min (p<0.0001), en-bloc resection rates were 97.6% and 99.5% (p<0.05), and R0 resection rates were 86.4% and 93.3% (p<0.05), respectively. There were no significant differences for adverse events between LRGC and primary EGC. Five-year OS and DSS for LRGC cases were 89.9% and 100%. Compared to curatively resected primary EGC cases, HR for all-cause mortality of curatively resected LRGC, noncuratively resected primary EGC and noncuratively resected LRGC cases were 0.58 (95% CI 0.24-1.41), 1.46 (1.25-1.7) and 3.02 (1.43-6.36), respectively. CONCLUSIONS: A curative ER for LRGC offers the same long-term prognosis as primary EGC. ER for LRGC can offer a secure and radical treatment.2025年11月, Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association, 英語, 国内誌研究論文（学術雑誌）
- BACKGROUND AND AIM: Endoscopic resection (ER) is widely used for the treatment of superficial esophageal squamous cell neoplasia (ESCN), including cases with metachronous lesions. However, repeated ER procedures are complicated by post-treatment fibrosis, strictures, and patient comorbidities. This study aimed to identify clinical characteristics of patients unsuitable for repeat ER and to evaluate their long-term outcomes. METHODS: We conducted a retrospective observational study involving 226 patients with metachronous ESCN following initial ER between 2003 and 2023 at Kobe University Hospital. Patients were classified into an ER completion group (n=181) and an ER unsuitable group (n=45) based on multidisciplinary treatment decisions. Clinical factors were compared, and multivariate logistic regression was used to determine independent factors associated with ER unsuitability. Time-varying Cox regression analysis was employed to compare overall and disease-specific survival. RESULTS: Of the 45 ER unsuitable cases, independent factors associated with ER unsuitability included American Society of Anesthesiologists Physical Status 3 (OR 5.4, p < 0.01), lesion size ≤ 20 mm (OR 0.08, p < 0.01), proximity to post-ER scars (OR 5.7, p < 0.01), resection area > 26 cm2 from prior ER (OR 9.6, p < 0.01), and prior circumferential resection > 75% (OR 4.1, p < 0.01). Survival analysis revealed no significant differences in overall or disease-specific survival between the two groups. CONCLUSIONS: For select patients with metachronous ESCN, repeat ER may not be feasible due to lesion complexity or systemic conditions. Adopting personalized treatment strategies that balance safety and efficacy is essential for optimal long-term management.2025年11月, Gastrointestinal endoscopy, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND AND AIMS: Chest pain affects the quality of life of patients with esophageal motility disorders (EMD). However, the natural course of EMD-related chest pain following treatment remains unclear. We aimed to elucidate the clinical course of EMD-related chest pain following peroral endoscopic myotomy (POEM). METHODS: Patients who underwent POEM for EMD between April 2016 and March 2022 were enrolled. Patients under 18 years, those without chest pain before POEM, and those without a 1-year follow-up were excluded. The frequency and intensity of chest pain were recorded annually according to the chest pain component of the Eckardt score and the numerical rating scale (NRS). Meaningful improvement was defined as a ≥ 1-point reduction in the chest pain component of the Eckardt score, and independently, as a ≥ 2-point reduction on the NRS. Clinical improvement in chest pain was defined as a meaningful improvement in either the chest pain frequency or intensity. RESULTS: In total, 168 patients were included in this study. The scores for chest pain intensity and frequency were reduced to 32% and 42% of preoperative values at 5 years after POEM. At 1 and 5 years after POEM, meaningful improvements in frequency were observed in 77% and 60% of patients, and in intensity in 92% and 81%, respectively. Clinical improvement in chest pain rate was 96% at 1 year and 87% at 5 years after POEM. CONCLUSIONS: POEM was effective in treating EMD-related chest pain, particularly in terms of intensity.2025年11月, Esophagus : official journal of the Japan Esophageal Society, 英語, 国内誌研究論文（学術雑誌）
- BACKGROUND: Gastric cancer is divided into differentiated and undifferentiated types and sometimes exhibits mixed histology. However, the risk of gastric cancer-related death after curative endoscopic resection for mixed histology remains unknown. This study evaluated the long-term prognosis of mixed histological type gastric cancers treated with endoscopic resection. METHODS: Data from a Japanese multicenter prospective cohort study were analyzed. Patients with single gastric cancer lesions who underwent curative endoscopic resection were included and divided into those with pure or mixed histological types. Patients with both types of gastric cancer were compared in terms of 5-year overall survival and 5-year disease-specific survival related to primary gastric cancers. RESULTS: Pure histological type was observed in 6434 patients with 6434 lesions, and mixed histological type was observed in 161 patients with 161 lesions. Overall survival was not significantly different between patients with both types (p = 0.415). The 5-year disease-specific survival was lower in patients with mixed histological type than in those with pure histological type (p = 0.003). After stratification by curative endoscopic resection criteria, in cases of pT1a/M, differentiated-type dominance, tumor size ≤ 3 cm with ulcerative findings, no lymphovascular invasion, and R0 resection, the 5-year disease-specific survival was significantly lower in patients with mixed histological type than in those with pure type (p < 0.001). CONCLUSIONS: The long-term prognosis in cured cases, including those with mixed histological type, was favorable. Stratification analysis showed that mixed histological types with ulcers were more likely to cause primary gastric cancer-related death than pure histological type and might need more careful surveillance. CLINICAL TRIAL REGISTRATION: UMIN Clinical Trial Registry, UMIN000005871.2025年11月, Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association, 28(6) (6), 1190 - 1200, 英語, 国内誌研究論文（学術雑誌）
- OBJECTIVES: Blown-out myotomy (BOM) is a diverticular-like change that develops at the myotomy site after surgical or peroral endoscopic myotomy (POEM). This study aimed to elucidate BOM's incidence, clinical course, and risk factors after POEM. PATIENTS AND METHODS: This retrospective, single-center study evaluated patients who underwent POEM for achalasia or non-achalasia motility disorders at our institution between April 2015 and March 2023. Endoscopic grade at surveillance was classified as Grade 0, no diverticular-like changes; Grade 1, mild diverticular-like changes; Grade 2, obvious diverticular-like changes with a septum; and Grade 3, obvious diverticular-like changes with food retention. Grades 2 and 3 were defined as endoscopic BOM. The incidence and clinical course of BOM were evaluated using the Kaplan-Meier method, and factors associated with BOM were assessed using univariate analysis. RESULTS: Of 598 patients, 28 (4.7%) developed BOM during the study period. The 1-, 2-, and 5-year incidence rates of endoscopic BOM were 3.1%, 6.6%, and 8.1%, respectively. Progression of BOM grade mainly occurred between 1 and 3 years after POEM and then plateaued in the Kaplan-Meier curve. Male sex (71.4% vs. 48.1%, p = 0.019), a thin esophageal muscle layer during myotomy (67.9% vs. 40.4%, p = 0.005), and clinical reflux after POEM (78.6% vs. 36.8%, p < 0.001) were significantly associated with BOM. CONCLUSIONS: The incidence of BOM after POEM is low. BOM grade progression occurred within 3 years after POEM. Male sex, a thin esophageal muscle layer, and clinical reflux were associated with BOM.2025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）
- A 61-year-old woman who had been taking olmesartan for 7 years complained of epigastric pain, diarrhea, loss of appetite, and weight loss. Esophagogastroduodenoscopy revealed roughened mucosa and erosions in the stomach and duodenum. An endoscopic biopsy failed to identify the cause of the mucosal disorder. Small-bowel capsule endoscopy revealed villous atrophy in the small bowel, which led to suspicion of olmesartan-associated sprue-like enteropathy and gastritis. After the discontinuation of olmesartan, the symptoms and gastric mucosal findings improved. A final diagnosis of olmesartan-associated gastritis was confirmed. Olmesartan-associated gastritis should be considered in patients taking olmesartan for upper gastrointestinal symptoms.2025年06月, Internal medicine (Tokyo, Japan), 64(12) (12), 1843 - 1848, 英語, 国内誌研究論文（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04月, Esophagus : official journal of the Japan Esophageal Society, 22(2) (2), 264 - 271, 英語, 国内誌研究論文（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.2025年03月, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society, 37(3) (3), 247 - 256, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND/AIMS: Visualization of palisade vessels (PVs) in Barrett's esophagus is crucial for proper assessment. This study aimed to determine whether red dichromatic imaging (RDI) improves PV visibility compared with white-light imaging (WLI) and narrow-band imaging (NBI). METHODS: Five expert and trainee endoscopists evaluated the PV visibility in Barrett's esophagus using WLI, NBI, and RDI on 66 images from 22 patients. Visibility was rated on a 4-point scale: 4, excellent; 3, good; 2, fair; and 1, poor. The color difference between the most recognizable PV spots and surrounding areas with undetectable blood vessels was also analyzed. RESULTS: Mean visibility scores were 2.6±0.7, 2.3±0.6, and 3.4±0.4 for WLI, NBI, and RDI, respectively. The RDI scores were significantly higher than the WLI (p<0.001) and NBI (p<0.001) scores. These differences were recognized by trainees and expert endoscopists. Color differences in PVs were 7.74±4.96 (WLI), 10.43±5.09 (NBI), and 15.1±6.54 (RDI). The difference in RDI was significantly higher than that in WLI (p<0.001) and NBI (p=0.006). CONCLUSIONS: RDI significantly improved PV visibility compared to WLI and NBI based on objective and subjective measures.2025年03月, Clinical endoscopy, 58(2) (2), 269 - 277, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Lymphovascular invasion (LVI) or pT1b is noncurative after endoscopic resection (ER) for esophageal squamous cell carcinoma (ESCC), and therefore surgery or chemoradiotherapy (CRT) is recommended. However, there has been debate regarding which treatment has better outcomes and whether individual risks should be considered. METHODS: This was a multicenter, retrospective study conducted at 65 hospitals in Japan. The inclusion criteria were patients with ESCC who underwent ER between January 2006 and December 2015, with pT1a-muscularis mucosa (MM) with LVI or pT1b, with negative vertical margins, cN0M0, and who underwent surgery or CRT. A 1:1 propensity score-matched analysis was performed between two groups. The primary and secondary end points were overall survival (OS) and relapse-free survival (RFS). OS and RFS were also compared between two subgroups: low risk (pT1a-MM with LVI and pT1b without LVI) and high risk (pT1b with LVI) for metastatic recurrence. RESULTS: Among 472 patients, 160 patients were selected from each group. The OS and RFS did not differ between surgery and CRT groups (hazard ratio, 0.887; P = .635 and hazard ratio, 1.036; P = .876, respectively). Subgroup analysis showed that CRT had a better prognosis in the low-risk group, and conversely, surgery had a better prognosis in the high-risk group. But these were not significant. The high-risk CRT group had a significant worse prognosis than the low-risk CRT group. CONCLUSIONS: In patients with noncurative ER for ESCC, surgery and CRT showed no difference in long-term outcomes. Indications for CRT in the high-risk group need further investigation because of poor prognosis.2025年01月, Journal of gastroenterology, 60(1) (1), 43 - 54, 英語, 国内誌研究論文（学術雑誌）
- To clarify the current status of endoscopy-related musculoskeletal disorders (E-MSDs) in Japan, we conducted a multicenter questionnaire survey targeting gastroenterologists. Responses were obtained from 114 participants across 44 facilities and analyzed accordingly. Among the respondents, 68.4% experienced E-MSDs and 42.3% of them believed that the symptoms affected their daily routine. Age and years of endoscopic experience were significantly associated with symptom occurrence. Additionally, the number of colonoscopies performed was identified as a factor associated with the presence of left-hand symptoms. Notably, gastroenterologists who performed ≥10 endoscopic submucosal dissection procedures per month reported significantly higher symptom scores and a greater incidence of cervical and shoulder symptoms. These findings highlight the urgent need for increased awareness of E-MSDs among gastroenterologists in Japan, along with the development and implementation of effective preventive measures.2025年, Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology, 122(11) (11), 764 - 773, 日本語, 国内誌研究論文（学術雑誌）
- A 64-year-old man was admitted for hematemesis. Esophagogastroduodenoscopy revealed a gastric ulcer with a visible vessel on the posterior wall of the gastric body. After admission, the patient developed multiple episodes of massive hematemesis. During emergent esophagogastroduodenoscopy, he developed hemodynamic instability due to spurting bleeding. On day 18 of hospitalization, hemostasis was achieved using hemostatic forceps; however, contrast-enhanced computed tomography performed on the same day revealed a small splenic artery pseudoaneurysm (SAP) that had not been previously detected. To prevent fatal re-bleeding, interventional radiology was performed, and coil embolization was applied proximal to the pseudoaneurysm. The patient recovered without further hematemesis. One month later, exposed coils were observed from the healing ulcer, and celiac trunk angiography confirmed splenic artery thrombosis. Despite multiple attempts at endoscopic intervention, the patient developed recurrent hematemesis, suggesting that the gastric ulcer had eroded into the splenic artery, forming the SAP and causing significant hemorrhage. Although SAPs secondary to gastric ulcers are extremely rare, early recognition is critical because they carry a high risk of rupture and mortality. Endoscopic procedure alone may be insufficient, and an endovascular approach is a standard treatment to prevent life-threatening re-bleeding.2024年11月, Revista espanola de enfermedades digestivas, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND AND AIM: Sodium picosulfate plus magnesium citrate (SP + MC) is a well-tolerated bowel preparation agent. However, Japan currently approves only two methods of taking SP + MC: the day-before and split-dose preparation, without approval of same-day preparations. This study aimed to evaluate the efficacy and safety of same-day SP + MC preparations. METHODS: This was a multicenter, single-arm, nonrandomized, open-label study. We enrolled 145 Japanese patients between June and December 2023. The patients received two sachets of SP + MC dissolved in 300 ml of water and 1200 mL or more of clear liquid on the day of colonoscopy. Bowel cleansing efficacy, adverse events (AEs), and patient satisfaction were evaluated. RESULTS: Of the enrolled patients, 137 underwent colonoscopy according to our protocol. Bowel preparation was adequate in 133 patients (97.1%). The mean total Boston Bowel Preparation Score was 8.3 ± 1.2. Five patients experienced AEs (3.6%): two (1.5%), abdominal pain; one (0.73%), ischemic enteritis; one (0.73%), vomiting or nausea; and one (0.73%), headache. All AEs were treated conservatively. None of the patients exhibited abnormal blood test results or clinical symptoms after receiving SP + MC. Regarding patient satisfaction, all patients were able to take SP + MC as directed; 136 (99.2%) expressed a preference for this bowel preparation for future colonoscopies. CONCLUSION: The same-day SP + MC preparation showed high bowel-cleansing efficacy and satisfaction in Japanese patients without serious AEs.2024年10月, Journal of gastroenterology and hepatology, 39(10) (10), 2151 - 2157, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Repeat endoscopic submucosal dissection for metachronous recurrence of esophageal squamous cell carcinoma close to previous endoscopic submucosal dissection scars is challenging. Therefore, this study evaluated the efficacy and safety of repeat endoscopic submucosal dissection for recurrent esophageal squamous cell carcinoma. METHODS: The study included 1680 patients. After propensity score matching, esophageal endoscopic submucosal dissection-related outcomes were compared between the post-endoscopic submucosal dissection scar group (n = 91) and first endoscopic submucosal dissection group (n = 910). The Kaplan-Meier method and log-rank tests were used to compare both groups' survival and local recurrence curves. RESULTS: After propensity score matching, the two groups showed no significant difference in en bloc resection rate (97.80% vs. 99.56%, p = 0.096), treatment time (64.75 min vs 61.33 min, p = 0.448), recurrence rate (3.30% vs. 2.20%, p = 0.458), and stricture rate (7.69% vs. 4.07%, p = 0.110). However, the perforation rate was higher in the post-endoscopic submucosal dissection scar group than in the first endoscopic submucosal dissection group (4.40% vs. 1.10%, p = 0.031). The 5-year overall survival rates in the post-endoscopic submucosal dissection scar and first endoscopic submucosal dissection groups were 88.6% and 89.0%, respectively. CONCLUSIONS: Repeated esophageal endoscopic submucosal dissection for recurrent esophageal squamous cell carcinoma yielded satisfactory clinical outcomes and survival rates. Therefore, repeat endoscopic submucosal dissection may effectively treat esophageal squamous cell carcinoma recurrence close to the initial endoscopic submucosal dissection scars.2024年10月, Esophagus : official journal of the Japan Esophageal Society, 21(4) (4), 505 - 513, 英語, 国内誌研究論文（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.2024年05月, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society, 36(5) (5), 554 - 564, 英語, 国際誌研究論文（学術雑誌）
- INTRODUCTION: EndoTrac is a line-attached sheath-type traction device that enables us to control the direction and the force of traction during endoscopic submucosal dissection (ESD). The efficacy of EndoTrac for gastric ESD has not been fully verified. METHODS AND ANALYSIS: The G-Trac study is a multicentre (nine general hospitals and two university hospitals in Japan) collaborative trial assessing the efficacy of EndoTrac for gastric ESDs. Patients with superficial gastric neoplasms will be enrolled and randomly assigned to undergo either conventional ESD or EndoTrac ESD. Allocation will be stratified according to tumour location, operator experience and tumour diameter at an allocation rate of 1:1. The type of endoknife used will be confirmed before randomisation. The primary outcome, procedure time, will be compared between the groups in both intention-to-treat and per-protocol analyses using the Wilcoxon rank sum test. The efficacy-related, safety-related and device-related outcomes will be assessed in the secondary analysis. The planned sample size of the 142 patients in the two groups will enable us to detect a difference with a power of 80% by using the Wilcoxon rank sum test, assuming an effect size of 0.54, asymptotic relative efficiency of 0.864 and a two-sided type 1 error rate of 5%. ETHICS AND DISSEMINATION: This trial was approved by the certified review board of Kobe University (22 December 2022). The results from this trial will be disseminated through peer-review journals, presentations at national and international conferences, and data sharing with other researchers. TRIAL REGISTRATION NUMBER: jRCT1052220166.2024年04月, BMJ open, 14(4) (4), e078974, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND AND AIMS: Perforation during esophageal endoscopic submucosal dissection (ESD) typically results from electrical damage. However, there are cases in which perforation occurs because of segmental absence of intestinal musculature (SAIM) without iatrogenic muscular injury. We investigated the occurrence rate and clinical course of SAIM during esophageal ESD. METHODS: We conducted a retrospective review of esophageal ESDs performed between 2013 and 2019 at 10 centers in Japan. RESULTS: Five of 1708 (0.29%) patients received ESD for esophageal cancer and had SAIM. The median muscular defect size was 20 mm. All lesions were resected without discontinuation. After resection, 3 patients were closed with Endoloop. Four patients had mediastinal emphysema. All patients were managed conservatively. CONCLUSIONS: SAIM is a very rare condition that is usually only diagnosed during ESD. Physicians performing esophageal ESD should be aware of SAIM. When SAIM is detected, the ESD technique should be modified to prevent full-thickness perforation.2024年04月, Gastrointestinal endoscopy, 99(4) (4), 629 - 632, 英語, 国際誌研究論文（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）
- BACKGROUND: Heavy drinking is associated with esophageal cancer and esophageal varices. However, there are limited reports of endoscopic resection for esophageal cancer with esophageal varices. In this multicenter study, we clarified the safety and efficacy of endoscopic submucosal dissection for superficial esophageal cancer with esophageal varices. METHODS: In this multicenter, retrospective, observational study, patients underwent esophageal endoscopic submucosal dissection at 10 referral centers in Japan from January 2013 to December 2019. We analyzed characteristics including backgrounds and varices, treatment outcomes, and adverse events in cases with esophageal varices. RESULTS: A total of 1708 patients were evaluated, 27 (1.6%) of whom had esophageal varices. In patients with esophageal varices, the en bloc resection rate and R0 resection rate were 100% and 77.8%, respectively. Patients with esophageal varices had longer procedure times than patients without esophageal varices (p = 0.015). There was no significant difference in adverse events. There was no significant difference in procedure time and number of adverse events between patients who underwent pretreatment and those who did not. There was no significant difference in these outcomes for patients with lesions on varices compared to those without. Child-Pugh classification and location of the lesions also did not affect these outcomes. CONCLUSIONS: Esophageal cancer with esophageal varices could be treated endoscopically safely and effectively.2023年07月, Esophagus : official journal of the Japan Esophageal Society, 20(3) (3), 515 - 523, 英語, 国内誌研究論文（学術雑誌）
- BACKGROUND: Intraoperative body movements are one of the causes of difficulty in performing esophageal endoscopic submucosal dissection (ESD) under conscious sedation. The use of local anesthetics as local injection materials during ESD may overcome this difficulty. We clinically evaluated the lidocaine injection method (LIM) in the submucosa during esophageal ESD. METHODS: This was a single-center, prospective, double-blind, randomized trial. Patients who underwent esophageal ESD under conscious sedation from June 2018 to May 2021 were included in this study. In the LIM group, lidocaine was used for submucosal injection during ESD; in the control group, ESD was performed without lidocaine. The primary outcome was the presence of body movements. RESULTS: Fifty patients were enrolled and randomized in a 1:1 ratio in two groups. The incidence of body movements was significantly lower in the LIM group (12% [3/25]) than in the control group (48% [12/25]; P = 0.01). The median additional dose of midazolam was 2 mg (interquartile range [IQR]: 0.5-4 mg) in the LIM group and 4 mg (IQR: 3-6 mg) in the control group, which was significantly lower in the LIM group (P < 0.01). The median visual analog scale score for endoscopist satisfaction was 7 (IQR: 5-8) in the LIM group and 5 (IQR: 4-6.5) in the control group, which was significantly higher in the LIM group. CONCLUSIONS: LIM during esophageal ESD reduced body movements while decreasing the level of sedation. Therefore, LIM during esophageal ESD is an option for maintaining good sedation (UMIN000032804).2023年03月, Surgical endoscopy, 37(3) (3), 1962 - 1969, 英語, 国際誌研究論文（学術雑誌）
- Objective We explored the clinicopathological characteristics and disease frequency of oxyntic gland neoplasms (OGNs). Methods We retrospectively evaluated the data of patients pathologically diagnosed with OGN at an internal medicine clinic. Patients A total of 13,240 upper gastrointestinal endoscopies were performed on 7,488 patients between December 1, 2017, and March 31, 2021. Results We identified 27 patients with 30 histopathologically confirmed OGNs, yielding a disease frequency of 0.36% (27/7,488). Furthermore, multiple simultaneous lesions were found in 3 of 27 patients (11%). One (3.3%) of the 30 lesions was present in the antrum, whereas the remaining lesions occurred in the body of the stomach. Nine (33%) of the 27 patients had no history of Helicobacter pylori infection, whereas the remaining 18 (67%) were either currently or had been previously infected. Nevertheless, 27/30 lesions (90%) still occurred in non-atrophied regions. After endoscopic treatment, a histopathological examination of the resected specimens revealed submucosal infiltration in 8 (44%) of the 18 lesions; however, none of the lesions showed submucosal desmoplasia. For all patients with submucosal involvement, only observation was performed. There were no recurrent lesions found on follow-up. Conclusion The period prevalence of OGN was 0.36%, which is much higher than previously reported. The discovery of a small submucosal appearing lesion with a faded yellow or white color and dilated microvasculature, especially in a non-atrophic area of the stomach, should raise suspicion for an OGN, which can be endoscopically managed.2023年02月, Internal medicine (Tokyo, Japan), 62(19) (19), 2763 - 2774, 英語, 国内誌[査読有り]研究論文（学術雑誌）
- 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）
- 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, Digestion, 104(5) (5), 381 - 390, 英語, 国際誌研究論文（学術雑誌）
- Background and study aims Several studies have reported that pathological horizontal margin evaluation cannot be diagnosed in cold snare polypectomy (CSP) specimens. We conducted a prospective randomized controlled trial to determine the efficacy of pasting CSP specimens on paper for pathological horizontal margins. Patients and methods This was a single-center, prospective study conducted at Osaka Saiseikai Nakatsu Hospital. In this study, the indications for CSP were adenomas ≤ 10 mm. Colorectal polyps resected by CSP were randomized to the pasting and non-pasting groups after exclusion of fragmented specimens, and the extended CSP specimens pasted on paper were formalin-fixed in the pasting group. The primary endpoint was rate of unclear horizontal margins after CSP. Results A total of 216 CSP specimens were analyzed. The rate of unclear horizontal margins was significantly lower in the pasting group than in the non-pasting group (15.1 % vs 33.6 %, P = 0.002). CSP specimen pasting significantly reduced the rate of unclear horizontal margins. On multivariate analysis, non-pasting group (odds ratio [OR], 2.69; 95 % confidence interval [CI], 1.38-5.41; P = 0.003) and right colon (OR, 1.98; 95 %CI, 1.01-4.01; P = 0.047) were independent risk factors for unclear horizontal margins in CSP specimens. Conclusions Pasting the extended specimen is important for accurate pathological examination after CSP.2022年05月, Endoscopy international open, 10(5) (5), E572-E579, 英語, 国際誌研究論文（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）
- (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
- 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
- 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. CONCLUSION: 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, 2022年01月, Clinical endoscopy, 55(1) (1), 86 - 94, 英語, 国際誌研究論文（学術雑誌）
- INTRODUCTION: Sodium picosulfate plus magnesium citrate is a bowel preparation agent with high patient acceptability. However, it is unclear which patients are more likely to have inadequate bowel preparation when using this agent. This study aimed to identify the risk factors for inadequate bowel preparation when using sodium picosulfate plus magnesium citrate for colonoscopy and to develop a scoring model to predict which patients will have inadequate bowel preparation. METHODS: A total of 350 Japanese patients were enrolled from June 2021 to April 2022. Data on patient background, details of colonoscopy, and satisfaction assessment questionnaire results were prospectively collected. The scoring model for inadequate bowel preparation was developed based on multiple logistic regression analyses, and its performance was internally validated using bootstrapping. RESULTS: Adequate bowel preparation was obtained in 295 patients (84.3%); 335 (95.7%) were able to ingest the drug without difficulty. The scoring model consisted of five independent risk factors and points of risk scores were assigned to each one as follows: American Society of Anesthesiologists physical status III (1 point), diabetes comorbidities (5 points), use of laxatives (4 points), no defecation once in a day (2 points), and drug use for mental disorder (6 points). The C-statistics of the scoring system for inadequate bowel preparation was 0.75. DISCUSSION: We identified five risk factors for inadequate bowel preparation when using sodium picosulfate plus magnesium citrate regimen and developed a scoring model for inadequate bowel preparation with satisfactory discrimination and calibration.2022年, Digestion, 103(6) (6), 462 - 469, 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, 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
- 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
- (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
- INTRODUCTION: Lubiprostone is an effective treatment of chronic constipation (CC). However, as with other stimulant or osmotic laxatives, adverse events (AEs) can make it difficult to continue treatment. This article investigates AE risk factors associated with lubiprostone. METHODS: We retrospectively analyzed all 1,338 Japanese patients with CC treated at our hospital from October 2013 to July 2017. All patients were diagnosed with constipation as defined by the Roma III criteria. Enrolled patients received lubiprostone orally (24 or 48 μg daily), after which we investigated the incidence of AEs. The causative factors for diarrhea and nausea, the most common AEs, were examined by the backward logistic regression model. RESULTS: Two hundred eight (15.5%) experienced at least 1 AE. No serious AEs were associated with the study drug. The AEs reported by >1% of patients overall were diarrhea (6.1%) and nausea (4.2%). We performed a multivariate logistic regression using a backward variable selection method to investigate AE risk factors. Factors associated with higher incidence of diarrhea were patient age of 65 years or more (odds ratio: [95% confidence interval]; p value) (2.09: [1.05-4.16]; 0.035). Factors associated with greater likelihood of nausea included female gender (1.99: [1.10-3.61]; 0.023), and the chief complaint was a patient complaining of abdominal pain and fullness (2.07: [1.01-4.22]; 0.046). CONCLUSIONS: Understanding AE risk factors can help avoid unnecessary AEs and promote more effective treatment.2021年, Digestive diseases (Basel, Switzerland), 39(1) (1), 10 - 15, 英語, 国際誌研究論文（学術雑誌）
- INTRODUCTION: Elobixibat is a new laxative, but its efficacy and adverse events (AEs) are insufficiently examined compared with those of other laxatives. Hence, by propensity score (PS) matching, we compared the effects and AEs between elobixibat and lubiprostone. METHODS: We retrospectively analyzed 1,887 Japanese patients with chronic constipation (CC) treated at our hospital between October 2013 and April 2020. Enrolled patients were divided into three treatment groups, namely, elobixibat (10 mg daily) (E10 group, n = 293), lubiprostone (24 μg daily) (L24 group, n = 772), and lubiprostone (48 μg daily) (L48 group, n = 822), as their first treatment. We then investigated the changes on the weekly average number of spontaneous bowel movements, stool consistency scores (SCSs), and AEs starting from the baseline until the end of the 2-week treatment. To adjust for patients' background, we performed one-to-one nearest neighbor matching without replacement between elobixibat- and lubiprostone-treated patients according to the individual estimated PSs. RESULTS: After treatment, for SCSs, both the L24 and L48 groups significantly improved compared with the E10 group (p < 0.05), but their stools were soft (Bristol Stool Form Scale: 4.8). Notably, the E10 group had less frequent AEs than the L24 group (26 [9.0%] vs. 43 [14.8%], p = 0.03). Particularly, nausea was significantly less in the E10 group than that in the L48 group (2 [0.7%] vs. 7 [2.4%], p = 0.01). CONCLUSION: Elobixibat is a beneficial drug for patients with mildly symptomatic CC and is safe to use, given its few AEs.2021年, Digestive diseases (Basel, Switzerland), 39(4) (4), 341 - 350, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Vonoprazan, a potassium-competitive acid blocker, is used for acid-related diseases. Occasionally, small white protrusions called "stardust" gastric mucosa have been detected in the stomachs of some patients taking vonoprazan. AIMS: To determine the incidence of, and risk factors for, stardust gastric mucosa potentially induced by vonoprazan METHODS: In this study, we enrolled 19 503 patients who underwent endoscopy at our hospital between 2016 and 2019. Using propensity score matching, we retrospectively compared patients who received and did not receive vonoprazan. The two groups were matched for age, sex, history of proton pump inhibitor use, and atrophic gastritis. RESULTS: After 1:1 propensity score matching, each group comprised 2516 patients. Stardust gastric mucosa was detected significantly more often in the stomachs of patients receiving vonoprazan than those who had not received vonoprazan (4.9% vs 0.2%, P < 0.001). Its location was 70.7% in the upper third of the stomach, 29.3% in the middle third and none in the lower third. Histologically, this lesion had a mucus pool within a dilated duct surrounded by flattened glandular epithelium. The cumulative incidence rate of stardust gastric mucosa at 1, 2 and 3 years was 4.6%, 16.5% and 26.2%, respectively. The factors independently associated with the presence of stardust gastric mucosa were >205 days of vonoprazan oral intake (odds ratio [OR]: 6.99, 95% confidence interval [CI]: 4.60-10.88) and female sex (OR: 1.75, 95% CI: 1.20-2.58). CONCLUSIONS: Stardust gastric mucosa appeared more frequently in the stomachs of patients taking vonoprazan.2021年01月, Alimentary pharmacology & therapeutics, 53(1) (1), 94 - 102, 英語, 国際誌研究論文（学術雑誌）
- Pyogenic granulomas (PG) are lobular capillary hemangiomas mostly found in the mucous membranes of the skin and oral cavity, and rarely occur in the gastrointestinal tract. Here we describe a case of an 84-year-old patient with alcoholic cirrhosis who presented with persistent melena and progressive anemia. Endoscopy showed esophageal varices and he underwent endoscopic variceal ligation (EVL) with transient resolution of anemia. However, due to worsening anemia, he underwent capsule endoscopy that revealed a bleeding tumor in the small intestine. We performed double-balloon endoscopy and found a 7-mm polyp with a white coat located in the jejunum and resected it at a later date. Histological characteristics led to the diagnosis of PG, and the patient's melena and anemia subsequently improved.Springer Science and Business Media {LLC}, 2020年12月, Clinical journal of gastroenterology, 13(6) (6), 1125 - 1128, 英語, 国内誌研究論文（学術雑誌）
- 日本消化器内視鏡学会-近畿支部, 2020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, 105回, 60 - 60, 日本語PGAシートにて胃ESD後遅発性穿孔を閉鎖し得た一例
- A 67-year-old Japanese man with alcoholic cirrhosis underwent esophagogastroduodenoscopy (EGD), which revealed a 15-mm elevated lesion on the esophagogastric junction (EGJ). Endoscopic findings suggested that the lesion was an intramucosal cancer present on the esophageal varices. The location of the lesion at EGJ caused difficulties in endoscopic injection sclerotherapy and endoscopic variceal ligation for esophageal varices before esophageal endoscopic submucosal dissection (ESD). Direct varices coagulation treatment was therefore selected during ESD. Coagulation of bared varices with hemostatic forceps after mucosal incision enabled performing ESD without serious bleeding. 2 months afterwards, the patient underwent EGD, with no esophageal varices or carcinoma recurrence. Direct varices coagulation was effective for ESD of Barrett adenocarcinoma with esophageal varices.2020年04月, Clinical journal of gastroenterology, 13(2) (2), 178 - 181, 英語, 国内誌研究論文（学術雑誌）
- Elsevier {BV}, 2020年04月, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 18(4) (4), A29, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND AND AIM: Esophageal endoscopic submucosal dissection (ESD) is often technically difficult due to intraoperative body movements. The level of sedation can be increased to suppress body movements, but this may not be successful in all cases. Using local analgesics for submucosal injection during ESD may aid in conscious sedation. This study evaluated the feasibility of the lidocaine injection method (LIM) during esophageal ESD. METHODS: Twenty-nine patients with superficial esophageal cancer were enrolled in this study at Osaka Saiseikai Nakatsu Hospital, and 1% lidocaine + 0.4% hyaluronate sodium was injected into the submucosa underneath the lesion during esophageal ESD. The main outcome was body movements that disturbed the procedure. RESULTS: Most patients were male (90%), with a median age of 70 years (interquartile range [IQR]: 66-75 years old), and the median lesion size was 17 mm (IQR: 12-21 mm). The median injection volume of lidocaine was 70 mg (IQR: 55-79 mg). All lesions were successfully removed en bloc. In all cases, there were no body movements that disturbed the procedure. Regarding adverse events of sedation, five patients (17%) had hypotension, four patients (14%) had bradycardia, and seven patients (24%) had hypoxemia during ESD. Convulsions or arrhythmia as adverse events associated with lidocaine were not observed. CONCLUSIONS: Esophageal ESD with LIM did not cause body movements that disturbed the procedure. LIM may help create a stable conscious sedation method for esophageal ESD.2020年04月, JGH open : an open access journal of gastroenterology and hepatology, 4(2) (2), 251 - 255, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Advances in Endoscopic submucosal dissection (ESD) technology have established ESD for early gastric cancer as a safe and stable technique. However, ESD may induce delayed gastric emptying and the cause of food residue retention in the stomach after ESD is not clear. This study aimed to clarify risk factors for delayed gastric emptying with food retention after gastric ESD. METHODS: We retrospectively examined for food residue in the stomach 1 week after ESD was performed for early gastric carcinoma at Osaka Saiseikai Nakatsu Hospital from February 2008 to November 2016. RESULTS: Food residue was observed in 68 (6.1%) of 1114 patients who underwent gastric ESD. The percentage of lesions located on the lesser curvature of the upper third of the stomach was 45.6% (31/68) in the food residue group and 3.5% (37/1046) in the non-food residue group, which was significantly different (P < 0.01). Multivariate logistic regression analysis revealed that lesions on the lesser curvature of the upper third of the stomach (Odds ratio [OR] 23.31, 95% confidence interval [CI] 12.60-43.61, P < 0.01), post-ESD bleeding (OR 4.25, 95%CI 1.67-9.80, P < 0.01), submucosal invasion (OR 2.80, 95%CI 1.34-5.63, P < 0.01), and age over 80 years (OR 2.34, 95%CI 1.28-4.22, P < 0.01) were independent risk factors for food retention after gastric ESD. Of the 68 patients, 3 had food residue in the stomach on endoscopic examination for follow-up observation after the ESD ulcer had healed. CONCLUSIONS: Delayed gastric emptying with food retention after gastric ESD was associated with lesions located in the lesser curvature of the upper stomach, submucosal invasion of the lesion, age older than 80 years, and post-ESD bleeding, though it was temporary in most cases.Springer Nature, 2018年08月, Surgical endoscopy, 32(8) (8), 3622 - 3629, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND AND STUDY AIMS: Endoscopic submucosal dissection (ESD) is a reliable method that can replace surgery under certain conditions. However, limited information is available on the clinical course of T1b colorectal cancer (CRC) after ESD. The aim of the study was to clarify the feasibility of ESD for T1b CRC. PATIENTS AND METHODS: Three hundred and two patients with 312 T1 CRC were identified in this retrospective cohort study. All patients were treated with ESD, other endoscopic treatments, or surgery. In this study, we (I) investigated the en bloc resection rate of ESD and (II) compared the overall survival (OS) rate for patients who underwent ESD with additional surgery (Group A) and surgery without upfront endoscopic resection (Group B) for T1b CRC. RESULTS: No significant differences were observed in the en bloc resection rates between T1b and T1a CRC (100 vs. 98.7%), but the en bloc R0 resection rate was significantly lower in T1b CRC than in T1a CRC (64.7 vs. 97.4%). Regarding complications, perforations occurred in 2.9% of patients with T1b CRC, which was not significantly different from the rate of 5.3% in patients with T1a CRC. No significant differences were observed in the OS or recurrence-free survival (RFS) curves between Groups A and B (OS rates at 5 years: 92.3 vs. 88.9%, RFS rates at 5 years: 81.4 vs. 85.3%). Similarly, the 5-year disease-specific survival (DSS) rate of Group A was identical to that of Group B (both 100%). CONCLUSIONS: ESD for T1b CRC before surgery is a possible strategy because of the low rate of complications and favorable long-term outcomes.2018年04月, Surgical endoscopy, 32(4) (4), 2123 - 2130, 英語, 国際誌研究論文（学術雑誌）
- AIM: To investigated the hemostatic ability of the S and F1-10 methods in clinical and ex vivo studies. METHODS: The hemostatic abilities of the two methods were analyzed retrospectively in all six gastric endoscopic submucosal dissection cases. The treated vessel diameter, compressed vessel frequency, and bleeding frequency after cutting the vessels were noted by the recorded videos. The coagulation mechanism of the two power settings was evaluated using the data recording program and histological examination on macro- and microscopic levels in the ex vivo experiments using porcine tissues. RESULTS: F1-10 method showed a significantly better hemostatic ability for vessels ≥ 2 mm in diameter and a trend of overall better coagulation effect, evaluated by the bleeding rate after cutting the vessels. F1-10 method could sustain electrical current longer and effectively coagulate the tissue wider and deeper than the S method in the porcine model. CONCLUSION: F1-10 method is suggested to achieve a stronger hemostatic effect than the S method in clinical procedures and ex vivo models.2017年08月, World journal of gastroenterology, 23(29) (29), 5422 - 5430, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND AND AIM: Currently, endoscopic submucosal dissection (ESD) is a widely accepted standard treatment for early gastric cancer, but one challenging aspect of ESD is hemostasis. We developed a new hemostatic forceps (FD-Y0007) with the aim of achieving more effective hemostasis and investigated the hemostatic ability of the FD-Y0007 during gastric ESD in humans. METHODS: This study was a prospective randomized controlled trial, which was conducted at a cancer referral center. Sixty-six patients who were scheduled to undergo ESD were enrolled and randomly assigned to either the Coagrasper or the FD-Y0007, which was used for hemostasis throughout the case. The primary end point was the time required to obtain hemostasis, which was measured for the first episode of bleeding during each case. RESULTS: Hemostasis time for the first bleeding episode during ESD was 73.0 s for the Coagrasper and 21.5 s for the FD-Y0007 (P < 0.001). When all episodes of bleeding were included, hemostasis time was 56.8 s in the Coagrasper group and 25.5 s in FD-Y0007group (P < 0.0001). The frequency of adverse events (perforation: 3.4% vs 7.1%; delayed bleeding: 0% vs 0%) was not significantly different between the two groups. CONCLUSIONS: Compared with the Coagrasper, the FD-Y0007 efficiently reduces the hemostatic time during gastric ESD with no increase in adverse events.2017年04月, Journal of gastroenterology and hepatology, 32(4) (4), 846 - 851, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND/AIM: The effects of vonoprazan and proton pump inhibitors (PPIs) in patients with reflux esophagitis (RE) have not yet been compared using multichannel intraluminal impedance-pH (MII-pH). METHODS: A total of 8 patients with persistent gastric mucosal injury, despite completing an 8-week standard PPI therapy, were enrolled in the study. While they were on standard PPI therapy, the baseline values of reflux parameters, holding time ratio (HTR) of gastric pH >4, and esophageal pH <4 were obtained by using 24 h MII-pH monitoring. They were re-evaluated after discontinuation of the therapy and 4 weeks of subsequent treatment with vonoprazan 20 mg/day. RESULTS: The patients were found to be CYP2C19 extensive metabolizers and negative for Helicobacter pylori infection. In 7 patients (87.5%), the mucosal lesions had healed completely after vonoprazan therapy. A significant increase in gastric pH >4 HTR was observed, from 26.5 to 78.0% (p = 0.029). A reduction in esophageal pH <4 HTR was also observed but it was not statistically significant. Furthermore, acid clearance time and the total number of reflux events, including acid and proximal reflux events, were significantly reduced. CONCLUSION: Vonoprazan may be a better therapy for the treatment of patients with PPI-refractory RE.2017年, Digestion, 96(1) (1), 52 - 59, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND AND STUDY AIMS: Endoscopic submucosal dissection (ESD) is performed for treatment of various gastrointestinal lesions; however, the cecum in proximity to the appendiceal orifice remains a challenging area. We reviewed our experience with cecal ESD near the appendiceal orifice in order to clarify whether this procedure is a safe and effective therapeutic option. PATIENTS AND METHODS: We retrospectively reviewed ESD for lesions within approximately 12 mm of the appendiceal orifice at Kobe University Hospital and an affiliated hospital between January 2003 and December 2014. Lesions were classified as: Type 0, proximity to the appendiceal orifice but does not reach it; Type 1, reaches border of the appendix, but does not enter orifice; Type 2, enters orifice, and transition to normal appendiceal mucosa is discernible on inspection of the appendiceal lumen; and Type 3, enters orifice deeply and tumor edge cannot be observed. ESD was not performed for Type 3 lesions unless appendectomy was performed prior to ESD. RESULTS: A total of 76 lesions satisfied the inclusion criteria (47 Type 0 lesions, 20 Type 1, 6 Type 2, and 3 Type 3). En bloc resection was achieved in 72 lesions (94.7 %). Median specimen size was 49 mm (range 15 - 114 mm), and median tumor size was 35.5 mm (10 - 110 mm). One patient experienced postoperative bleeding, which was treated by endoscopic hemostasis. Another patient who experienced intraoperative perforation and was treated by clip closure later developed appendicitis; he underwent emergency ileocecal surgical resection. Another patient experienced postoperative appendicitis and recovered with antibiotic treatment. CONCLUSIONS: ESD in close proximity to the appendiceal orifice seems safe and effective.2016年09月, Endoscopy, 48(9) (9), 829 - 36, 英語, 国際誌研究論文（学術雑誌）
- AIM: To evaluate the feasibility and safety of endoscopic submucosal dissection (ESD) for lower rectal lesions with hemorrhoids. METHODS: The outcome of ESD for 23 lesions with hemorrhoids (hemorrhoid group) was compared with that of 48 lesions without hemorrhoids extending to the dentate line (non-hemorrhoid group) during the same study period. RESULTS: Median operation times (ranges) in the hemorrhoid and non-hemorrhoid groups were 121 (51-390) and 130 (28-540) min. The en bloc resection rate and the curative resection rate in the hemorrhoid group were 96% and 83%, and they were 100% and 90% in the non-hemorrhoid group, respectively. In terms of adverse events, perforation and postoperative bleeding did not occur in both groups. In terms of the clinical course of hemorrhoids after ESD, the rate of complete recovery of hemorrhoids after ESD in lesions with resection of more than 90% was significantly higher than that in lesions with resection of less than 90%. CONCLUSION: ESD on lower rectal lesions with hemorrhoids could be performed safely, similarly to that on rectal lesions extending to the dentate line without hemorrhoids. In addition, all hemorrhoids after ESD improved to various degrees, depending on the resection range.2016年07月, World journal of gastroenterology, 22(27) (27), 6268 - 75, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND AND STUDY AIM: Endoscopic submucosal dissection (ESD) has been applied to treat early colorectal cancers. The aim of this study was to clarify the clinical course of ESD for lesions involving the ileocecal valve (ICV) by evaluating the successful resection rates, and the risk and frequency of adverse events. PATIENTS AND METHODS: The outcome of ESD on 38 ICV lesions was compared with the outcome of 132 cecal lesions that did not involve the ICV or appendiceal orifice during the same study period. The factors related to longer procedure time, postoperative stricture development, and tumor recurrence were investigated for ESD of ICV lesions. RESULTS: There was no significant difference between the ICV and non-ICV groups in the en block resection rates. The median procedure time was significantly longer in the ICV group than in the non-ICV group, with a point estimate of the difference of 37 minutes (95 % confidence interval [CI] 20.00 to 56.00; P < 0.01). None of the patients developed symptomatic post-ESD stricture or tumor recurrence. ESD procedure duration was ≥ 120 minutes in 16 lesions and < 120 minutes in 22 lesions of the ICV group. A specimen diameter of ≥ 40 mm and tumor extension into terminal ileum were factors related to a longer procedure time (odds ratio [OR] 8.40, 95 %CI 1.53 to 46.10, P = 0.01; OR 10.60, 95 %CI 2.17 to 51.40, P < 0.01, respectively). CONCLUSIONS: ICV lesions can be resected by ESD without major adverse events or causing symptomatic stricture development. However, ESD for ICV lesions should be performed only by expert endoscopists, as the procedure requires accomplished endoscopic skill and experience.2016年07月, Endoscopy, 48(7) (7), 639 - 45, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND AND STUDY AIMS: Improvements in the endoscopic submucosal dissection (ESD) technique have made circumferential ESD in the rectum possible. However, little is known about the clinical course after extensive ESD in the rectum. The aim of this study was to determine the stricture risk in the rectum after total or subtotal circumferential ESD. PATIENTS AND METHODS: A total of 69 patients with 69 rectal tumors that required ≥ 75 % circumferential resection were identified at Kobe University Hospital and an affiliated hospital between April 2005 and May 2014. Among the patients, 61 were available for evaluation of stricture development, either by follow-up colonoscopy or by surgical specimens. The rate and possible risk factors of post-ESD strictures were investigated. RESULTS: Post-ESD rectal strictures developed in 12 patients (19.7 %). Patients who underwent total circumferential ESD developed a stricture (5/7, 71.4 %) more frequently than those with subtotal (≥ 90 %) ESD (7/16, 43.8 %). Patients undergoing an ESD procedure that involved < 90 % of the circumference did not develop strictures. The strictures were membranous or < 10 mm long in all cases. Of the patients with stricture, 11 received endoscopic balloon dilation and one received bougie with short-caliber-tip transparent hood; all strictures improved following dilation therapy. Statistical analysis revealed that ≥ 90 % circumferential resection was an independent risk factor for stricture, whereas morphology and size were not. CONCLUSIONS: Patients who underwent total or subtotal circumferential ESD of a rectal tumor had a high risk of stricture formation. Dilation helped to alleviate the stenosis.Study registered at University Hospital Medical Information Network (UMIN 000016559).2016年01月, Endoscopy, 48(1) (1), 62 - 70, 英語, 国際誌研究論文（学術雑誌）
- A 66-year-old woman presented to us with malaise, anorexia and rectal mucous discharge, and her laboratory data showed severe hyponatremia, hypokalemia, hypochloremia and renal failure. Computed tomography revealed massive occupation of the rectum by a large tumor. Colonoscopy revealed a mucus-rich villous tumor in the rectum. As there were no other factors that could cause an electrolyte disorder, she was diagnosed with McKittrick-Wheelock syndrome (MWS). The current standard treatment for MWS is partial surgical colectomy. However, surgeries are invasive and postoperative complications sometimes become an issue. After confirming no signs of submucosal invasion of the tumor by magnifying chromoendoscopic examination, endoscopic submucosal dissection (ESD) was indicated. The tumor was completely removed en bloc without adverse events. The histology showed a mucosal adenocarcinoma containing a villous component, 24.5 x 17.0 cm in size. This removal dramatically improved the patient's symptoms and the electrolyte abnormalities without medication. Although several sessions of endoscopic balloon dilation were required to treat postoperative stricture, she has been symptom-free and had no recurrence for 4 years after treatment. We experienced a case of MWS treated by ESD instead of surgery. ESD should be feasible and beneficial for the treatment of MWS.2015年10月, Clinical journal of gastroenterology, 8(5) (5), 280 - 4, 英語, 国内誌研究論文（学術雑誌）
- PURPOSE: Recently, endoscopic submucosal dissection (ESD) has been applied for superficial colorectal neoplasms and the number of publications about it has been increasing, but little is known about the outcomes of colorectal ESD for the lesions > 50 mm. In this study, we evaluated the feasibility and safety of colorectal ESD for the lesions > 50 mm compared with the lesions < 50 mm. METHODS: A total of 674 superficial colorectal neoplasms in 629 patients treated by ESD at Kobe University Hospital from July 2008 to July 2013 were included in the analysis. RESULTS: The median operation time (range) in the large lesion group (≥ 5 cm) was 109 (37 to 596) minutes, and it was 55 (6 to 248) minutes in the small lesion group (< 5 cm). Median procedure speed (range) in the large lesion group was 0.28 (0.06 to 0.83) cm2/min, and it was 0.19 (0.04 to 0.83) cm2/min in the small lesion group. The en bloc resection rate and the curative resection rate in the small lesion group was 98.7% and 96.0%, and those were 95.7% and 91.4% in the large lesion group, respectively. In terms of adverse events, perforation, muscle damage, and postoperative bleeding occurred at similar frequency in both groups. CONCLUSIONS: ESD on colorectal lesions > 50 mm takes longer operation time; however, it is resected time effectively without increasing the risk of adverse events compared with smaller lesions by ESD.2015年06月, Surgical laparoscopy, endoscopy & percutaneous techniques, 25(3) (3), 223 - 8, 英語, 国際誌研究論文（学術雑誌）
- Endoscopic submucosal dissection (ESD) is now widely accepted as a strategy to treat superficial esophageal neoplasms. The rate of adverse events, such as perforation, has been decreasing with the improvement of devices and techniques. In this paper, we report a case of esophageal cancer that had a diverticulum under cancerous epithelium. The diverticulum was not detected during preoperative examination, and led to perforation during the ESD procedure. Our case shows that, although rare, some diverticula can exist underneath the mucosal surface without obvious depression. If there is any sign of hidden diverticula during ESD, surgeons should proceed with caution or, depending on the case, the procedure should be discontinued to avoid adverse events.2015年03月, World journal of gastroenterology, 21(10) (10), 3121 - 6, 英語, 国際誌研究論文（学術雑誌）
- An 85-year-old man underwent endoscopic submucosal dissection for a large superficial esophageal epithelial neoplasm, which required removal of 95% of the circumference of the esophageal mucosa. Steroids were given orally to prevent esophageal stricture starting on day 3 postoperatively. In the 6th week of steroid treatment, he developed high fever without other symptoms. Chest computed tomography revealed a nodular lesion in the lung. Sputum sample showed Gram-positive, branching, filamentous bacteria, and a diagnosis of nocardiosis was suspected. Brain magnetic resonance imaging revealed multiple focal lesions which indicated dissemination of nocardiosis. Trimethoprim-sulfamethoxazole was immediately started, which led to the disappearance of pulmonary and cerebral nocardiosis with alleviation of fever. Recently, oral steroid treatment has been widely used for the prevention of esophageal stricture. However, the present case indicates the risk of life-threatening infection and the importance of close monitoring of this treatment.2015年03月, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society, 27(3) (3), 388 - 91, 英語, 国際誌研究論文（学術雑誌）
- OBJECTIVE: Superficial colorectal tumors can be treated effectively by endoscopic submucosal dissection (ESD). Few data are available on using ESD for residual or recurrent tumors after the first endoscopic resection. This study aimed to evaluate the efficacy of ESD for these lesions. METHODS: In all, 28 patients with residual or recurrent superficial colorectal tumors were referred to the Kobe University Hospital for ESD. The therapeutic outcomes and the possible factors predictive of procedure difficulties for ESD were analyzed. RESULTS: In total, 27 (96.4%) patients were successfully treated using ESD. There was no related immediate complication. One patient had a delayed perforation which was then treated surgically. En bloc R0 resection was possible in all the patients and curative resection in 26 patients (92.9%). One invasive cancer was treated surgically. More than one previous endoscopic resection was the only significant predictive factor for the difficulty in performing ESD. None of the patients experienced recurrence during a follow-up of 22 months (range 3-41 months). CONCLUSIONS: The use of ESD allowed a high rate of en bloc resection for residual or locally recurrent colorectal tumors. Furthermore, these lesions should be treated by ESD as a first-line treatment.2015年01月, Journal of digestive diseases, 16(1) (1), 14 - 21, 英語, 国際誌研究論文（学術雑誌）
- OBJECTIVE: The standard treatment for submucosal esophageal cancer is esophagectomy or chemoradiotherapy (CRT). However, these treatment modalities could deteriorate the general condition and quality of life of the patients who are intolerant to invasive therapy. It is therefore important and beneficial to develop less invasive treatment protocols for these patients. METHODS: The study included 43 patients who were clinically suspected of mucosa or submucosal esophageal cancer but underwent endoscopic submucosal dissection (ESD) as a primary treatment, due to the patients' poor performance statuses and/or preferences for less invasive therapy. According to the pathological findings and patient's general condition, whether the patient underwent additional treatments or remained hospitalized without additional treatments was thereafter decided for each patient. We retrospectively analyzed the outcomes of these patients. RESULTS: Fifteen patients underwent additional surgery, 11 patients underwent CRT/radiation therapy (RT) and 17 patients were followed without additional treatments. During the 3-year follow-up period, the relapse-free survival rates in the patients who received or did not receive additional treatments were 88% and 64%, respectively (95% confidence interval, 0.45-0.76, p=0.04). The relapse-free and overall survival rates in the patients with additional treatments were equivalent or superior to those described in previous reports of the standard treatments. Preceding ESD contributed to reduce the local relapse significantly to approximately 3.5% and additional CRT-related toxicities. CONCLUSION: Preceding ESD is very effective for the local control of cancer, and useful for histologically confirming the high-risk factors of relapse, such as ≥submucosal layer 2 (SM2) invasion and lymphovascular involvements. ESD with additional therapy may be a promising strategy for optimizing the selection of therapy depending on the patient's general condition.2015年, Internal medicine (Tokyo, Japan), 54(22) (22), 2803 - 13, 英語, 国内誌研究論文（学術雑誌）
- BACKGROUND: Detection of early gastric cancer (EGC) in the remnant stomach is increasing because of follow-up endoscopic surveillance programs. Endoscopic treatment appears to be desirable for EGC in the remnant stomach because it is less invasive than surgical resection. METHODS: In this retrospective study, to evaluate the feasibility of endoscopic submucosal dissection (ESD) for EGC in an anastomotic site, treatment results of ESD for EGC in an anastomotic site and in remnant stomach not involving an anastomotic site were compared. In total, 11 EGC lesions of anastomotic sites in 11 patients and 22 EGC lesions of remnant stomach not involving an anastomotic site in 21 patients were treated by ESD. RESULTS: All lesions were successfully treated by en bloc resection. There were three patients with perforations in the anastomotic site group. Although resected specimen size and tumor size were larger in the anastomotic site group than in the non-anastomotic site group (P < 0.01), the procedure duration was far longer in the anastomotic site group than in the non-anastomotic site group (P < 0.01). The speed of the procedure was faster in the non-anastomotic site group than in the anastomotic site group (P < 0.05). CONCLUSIONS: Although ESD for EGC in an anastomotic site is a time-consuming procedure and requires advanced techniques compared with ESD for EGC not involving an anastomotic site, a high en bloc resection rate was achieved. ESD by endoscopists with sufficient experience appears to be a feasible treatment for EGC in an anastomotic site.2014年04月, Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association, 17(2) (2), 371 - 6, 英語, 国内誌研究論文（学術雑誌）
- (株)東京医学社, 2025年09月, 消化器内視鏡, 37(9) (9), 1147 - 1150, 日本語
- (株)東京医学社, 2025年08月, 消化器内視鏡, 37(8) (8), 1017 - 1020, 日本語
- 日本消化器内視鏡学会-近畿支部, 2025年06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, 114回, 60 - 60, 日本語何でものみこむ消化器内視鏡学～下部消化管腫瘍診療の進歩～ 大腸ESD後粘膜欠損部に対するUpdated double-layered suturingの有効性の検討
- 日本消化器内視鏡学会-近畿支部, 2025年06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, 114回, 79 - 79, 日本語何でものみこむ消化器内視鏡学:コラボレーション内視鏡～内科・外科の共同診療の進歩～ 表在型非乳頭部十二指腸上皮性腫瘍に対するLECSの治療成績や合併症についての検討
- (NPO)日本食道学会, 2025年06月, 日本食道学会学術集会プログラム・抄録集, 79回, 358 - 358, 日本語食道運動機能障害に合併した表在型食道癌の12症例
- (一社)日本消化器内視鏡学会, 2025年04月, Gastroenterological Endoscopy, 67(Suppl.1) (Suppl.1), 768 - 768, 日本語6～20mm大の十二指腸非乳頭部上皮性腫瘍に対するUnderwater EMRとEMRCの比較
- (一社)日本消化器内視鏡学会, 2025年04月, Gastroenterological Endoscopy, 67(Suppl.1) (Suppl.1), 784 - 784, 日本語表在型食道扁平表皮癌ESDの治療困難性に関わる因子についての多施設共同後ろ向き研究
- (一社)日本消化器内視鏡学会, 2025年04月, Gastroenterological Endoscopy, 67(Suppl.1) (Suppl.1), 789 - 789, 日本語胃底腺型胃癌に対する内視鏡治療法の選択
- (一財)日本消化器病学会, 2025年03月, 日本消化器病学会雑誌, 122(臨増総会) (臨増総会), A118 - A118, 日本語
- 日本消化器内視鏡学会-近畿支部, 2024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, 113回, 61 - 61, 日本語消化管腫瘍に対する内視鏡診療の進歩と課題 6～20mm大の十二指腸非乳頭部上皮性腫瘍に対するUnderwater EMRとEMRCの比較
- 日本消化器内視鏡学会-近畿支部, 2024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, 113回, 85 - 85, 日本語回腸導管内に発生した非浸潤性乳頭状尿路上皮癌に対して、underwater EMRを施行した1例
- (一社)日本消化器内視鏡学会, 2024年10月, Gastroenterological Endoscopy, 66(Suppl.2) (Suppl.2), 2250 - 2250, 日本語内科クリニックで発見された胃底腺型腫瘍の臨床病理学的特徴 85名106病変の検討
- (一財)日本消化器病学会, 2024年10月, 日本消化器病学会雑誌, 121(臨増大会) (臨増大会), A746 - A746, 日本語
- 日本消化器病学会-近畿支部, 2024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, 121回, 53 - 53, 日本語
- (NPO)日本食道学会, 2024年07月, 日本食道学会学術集会プログラム・抄録集, 78回, 73 - 73, 日本語食道運動障害診療における最新の知見 経口内視鏡的筋層切開術後に発生する入院特異的治療介入に関わる因子の検討
- 日本消化器内視鏡学会-近畿支部, 2024年06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, 112回, 52 - 52, 日本語上部消化管腫瘍内視鏡治療(EMR、ESD、EFTR、ステント、その他) 十二指腸非乳頭部上皮性腫瘍に対する術前生検がEMRに与えるへの影響について
- (株)日本メディカルセンター, 2024年05月, 臨床消化器内科, 39(6) (6), 692 - 697, 日本語
- (一社)日本消化器内視鏡学会, 2024年04月, Gastroenterological Endoscopy, 66(Suppl.1) (Suppl.1), 1124 - 1124, 日本語内視鏡関連MSDsの現状に関する考察 多施設アンケート調査の結果から
- 日本消化器病学会-近畿支部, 2024年01月, 日本消化器病学会近畿支部例会プログラム・抄録集, 120回, 54 - 54, 日本語
- 日本消化器病学会-近畿支部, 2024年01月, 日本消化器病学会近畿支部例会プログラム・抄録集, 120回, 80 - 80, 日本語
- 日本消化器病学会-近畿支部, 2024年01月, 日本消化器病学会近畿支部例会プログラム・抄録集, 120回, 105 - 105, 日本語
- (一社)日本消化器内視鏡学会, 2023年10月, Gastroenterological Endoscopy, 65(Suppl.2) (Suppl.2), 1825 - 1825, 日本語高齢者の食道表在癌・早期胃癌に対する内視鏡治療の適応と問題点 高齢者における食道内視鏡治療後の異時性病変に対する内視鏡治療困難症例の検討
- (一財)日本消化器病学会, 2023年10月, 日本消化器病学会雑誌, 120(臨増大会) (臨増大会), A761 - A761, 日本語
- 日本消化器病学会-近畿支部, 2023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, 119回, 63 - 63, 日本語
- 日本消化器病学会-近畿支部, 2023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, 119回, 82 - 82, 日本語
- 日本消化器内視鏡学会-近畿支部, 2023年06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, 110回, 76 - 76, 日本語消化管腫瘍に対する内視鏡診療の現況と展望 食道内視鏡治療後の多発病変に対する再内視鏡治療困難症例の臨床的特徴
- (株)日本臨床社, 2023年05月, 日本臨床, 81(増刊5 最新臨床大腸癌学2023) (増刊5 最新臨床大腸癌学2023), 198 - 204, 日本語
- (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
- (株)医学書院, 2023年03月, 胃と腸, 58(3) (3), 308 - 317, 日本語
- (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
- 日本消化器病学会-近畿支部, 2023年01月, 日本消化器病学会近畿支部例会プログラム・抄録集, 118回, 55 - 55, 日本語
- 日本重症心身障害学会, 2022年11月, 日本重症心身障害学会誌, 47(2) (2), 265 - 265, 日本語
- 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
- (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)日本消化管学会, 2022年01月, 日本消化管学会雑誌, 6(Suppl.) (Suppl.), 156 - 156, 日本語消化管狭窄に対する治療の工夫 胃幽門領域における内視鏡的粘膜下層剥離術後の狭窄タイミングとバルーン拡張術の効果
- (一社)日本消化器内視鏡技師会, 2021年09月, 日本消化器内視鏡技師会会報, (67) (67), 116 - 120, 日本語安全で質の高い内視鏡医療のために私たちができること cold snare polypectomy検体の適切な検体処理を目指す取り組み 濾紙貼付けの有用性についての前向きランダム化比較試験
- 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, 53 - 53, 日本語
- (一社)日本消化器内視鏡学会, 2021年04月, Gastroenterological Endoscopy, 63(Suppl.1) (Suppl.1), 811 - 811, 日本語上部消化管ESDの限界を探る 幽門側胃切除後残胃に発生した早期胃癌に対するESDの技術的困難性を予測するリスクスコアリングシステム 多施設共同研究
- (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
- (一財)日本消化器病学会, 2021年03月, 日本消化器病学会雑誌, 118(臨増総会) (臨増総会), A182 - A182, 日本語薬剤性の消化管傷害の現状と課題 ボノプラザン内服との関連が疑われる胃内白点について傾向スコアマッチングによる検討
- (NPO)日本食道学会, 2020年12月, 日本食道学会学術集会プログラム・抄録集, 74回, 285 - 285, 日本語食道ESD術後疼痛の関連因子の検討
- 日本消化器内視鏡学会-近畿支部, 2020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, 105回, 60 - 60, 日本語PGAシートにて胃ESD後遅発性穿孔を閉鎖し得た一例
- (一社)日本消化器内視鏡学会, 2020年10月, Gastroenterological Endoscopy, 62(Suppl.2) (Suppl.2), 2094 - 2094, 日本語同時多発胃癌と京都分類の関連性について
- (一社)日本消化器内視鏡学会, 2020年10月, Gastroenterological Endoscopy, 62(Suppl.2) (Suppl.2), 2129 - 2129, 日本語食道粘膜下層剥離術(ESD)におけるリドカイン局所注射(LIM)の蠕動抑制効果
- (一社)日本消化器内視鏡学会, 2020年08月, Gastroenterological Endoscopy, 62(Suppl.1) (Suppl.1), 1276 - 1276, 日本語高齢者における胃ESD後の胃運動障害の検討
- (一社)日本消化器内視鏡学会, 2020年08月, Gastroenterological Endoscopy, 62(Suppl.1) (Suppl.1), 1295 - 1295, 日本語多発低分化型胃癌と鑑別を要した乳癌胃転移の1例
- (一財)日本消化器病学会, 2020年07月, 日本消化器病学会雑誌, 117(臨増総会) (臨増総会), A278 - A278, 日本語
- 日本消化器内視鏡学会-近畿支部, 2020年06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, 104回, 39 - 39, 日本語全身疾患/薬物副作用と消化器内視鏡 ボノプラザン内服との関連が疑われる胃内白点についての検討
- 日本消化器内視鏡学会-近畿支部, 2020年06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, 104回, 51 - 51, 日本語上部消化管のESD治療における現状と課題 食道粘膜下層剥離術(ESD)におけるリドカイン局所注射(LIM)の蠕動抑制効果
- (一社)日本臨床衛生検査技師会, 2020年01月, 医学検査, 69(1) (1), 25 - 29, 日本語
- (一社)日本消化管学会, 2020年01月, 日本消化管学会雑誌, 4(Suppl.) (Suppl.), 270 - 270, 日本語当院における大腸ステント留置後の術前全結腸観察の有用性について
- (一財)日本消化器病学会, 2019年11月, 日本消化器病学会雑誌, 116(臨増大会) (臨増大会), A857 - A857, 日本語
- 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, 56 - 56, 日本語
- 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, 59 - 59, 日本語
- 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, 101 - 101, 日本語
- (一社)日本消化器内視鏡学会, 2019年10月, Gastroenterological Endoscopy, 61(Suppl.2) (Suppl.2), 2153 - 2153, 日本語高齢者に対する胃ESD後の異時性多発胃癌の検討
- (一社)日本消化器内視鏡学会, 2019年10月, Gastroenterological Endoscopy, 61(Suppl.2) (Suppl.2), 2175 - 2175, 日本語大腸憩室出血再発症例における抗血栓薬の関与について
- (一社)日本消化器内視鏡技師会, 2019年09月, 日本消化器内視鏡技師会会報, (63) (63), 89 - 91, 日本語cold snare polypectomyで切除した検体に対する濾紙貼付けの有用性 検体提出の仕方で病理診断が変わる
- (一社)日本消化器内視鏡学会, 2019年05月, Gastroenterological Endoscopy, 61(Suppl.1) (Suppl.1), 869 - 869, 日本語当院における悪性大腸狭窄に対する大腸ステント留置術の現状について
- (一社)日本消化器内視鏡学会, 2019年05月, Gastroenterological Endoscopy, 61(Suppl.1) (Suppl.1), 933 - 933, 日本語食道ESDにおけるリドカイン粘膜下局注の有効性
- (一社)日本消化器内視鏡学会, 2019年05月, Gastroenterological Endoscopy, 61(Suppl.1) (Suppl.1), 991 - 991, 日本語当院における悪性胃十二指腸狭窄に対する内視鏡的十二指腸ステント留置術の検討
- (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), A425 - A425, 日本語
- 日本消化器病学会-近畿支部, 2019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, 110回, 73 - 73, 日本語
- (一社)日本消化器内視鏡学会, 2018年10月, Gastroenterological Endoscopy, 60(Suppl.2) (Suppl.2), 2066 - 2066, 日本語胃ESDにおける水平断端陽性症例に対する治療戦略
- (一財)日本消化器病学会, 2018年10月, 日本消化器病学会雑誌, 115(臨増大会) (臨増大会), A695 - A695, 日本語当院における胃ESD後出血リスク因子についての検討
- (一社)日本膵臓学会, 2018年05月, 膵臓, 33(3) (3), 319 - 319, 日本語
- (一社)日本膵臓学会, 2018年05月, 膵臓, 33(3) (3), 590 - 590, 日本語
- (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), A42 - A42, 日本語慢性便秘症診療ガイドラインを踏まえた便秘症診療の現状 一般病院における便秘症診療の現状とガイドライン分類による治療検討
- (一社)日本消化管学会, 2018年02月, 日本消化管学会雑誌, 2(Suppl.) (Suppl.), 111 - 111, 日本語胃癌の低侵襲治療の現状と将来 早期胃癌ESD後7日目の胃内残渣物量評価による間接的胃排出障害関連因子についての検討
- (一財)日本消化器病学会, 2017年09月, 日本消化器病学会雑誌, 114(臨増大会) (臨増大会), A749 - A749, 日本語DIC合併重症急性膵炎へのThrombomodulin α投与に対するPerfusion CTの検討
- (一財)日本消化器病学会, 2017年09月, 日本消化器病学会雑誌, 114(臨増大会) (臨増大会), A833 - A833, 日本語終末期癌患者の腹水へのtriamcinolone acetonide腹腔内投与及びKM-CARTの臨床的検討
- (一社)日本消化器内視鏡学会, 2017年09月, Gastroenterological Endoscopy, 59(Suppl.2) (Suppl.2), 2222 - 2222, 日本語びらん性食道炎におけるボノプラザンとエソメプラゾールの症状改善効果の比較
- (一社)日本消化器内視鏡学会, 2017年09月, Gastroenterological Endoscopy, 59(Suppl.2) (Suppl.2), 2232 - 2232, 日本語胃ESD後の残渣量評価による胃運動機能障害の検討
- (一社)日本胆道学会, 2017年08月, 胆道, 31(3) (3), 485 - 485, 日本語
- (一財)日本消化器病学会, 2017年03月, 日本消化器病学会雑誌, 114(臨増総会) (臨増総会), A288 - A288, 日本語胃ESD後潰瘍におけるプロトンポンプ阻害剤とボノプラザンの術後合併症と潰瘍治癒過程の比較検討
- (一社)日本消化器内視鏡学会, 2016年10月, Gastroenterological Endoscopy, 58(Suppl.2) (Suppl.2), 2003 - 2003, 日本語胃瘻造設における透明シースを使用した腹壁確認法
- (一社)日本消化器内視鏡学会, 2016年04月, Gastroenterological Endoscopy, 58(Suppl.1) (Suppl.1), 634 - 634, 日本語CO2レーザーを用いたESD新規デバイスの安全性、有用性の検討
- (一社)日本消化器内視鏡学会, 2016年04月, Gastroenterological Endoscopy, 58(Suppl.1) (Suppl.1), 671 - 671, 日本語虫垂近傍の腫瘍性病変に対する内視鏡的粘膜下層剥離術の安全性および有用性
- (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
- (一社)日本消化器内視鏡学会, 2015年09月, Gastroenterological Endoscopy, 57(Suppl.2) (Suppl.2), 2099 - 2099, 日本語ESDにおけるForced凝固超低出力設定を用いた新vessel sealing法
- 京都消化器医会, 2015年06月, 京都消化器医会会報, (31) (31), 25 - 28, 日本語ESDにて診断し得たgastric carcinoma with lymphoid stromaの一例
- (株)メディカルレビュー社, 2015年05月, 大腸がんperspective, 2(2) (2), 92 - 95, 日本語
- (一社)日本消化器内視鏡学会, 2015年04月, Gastroenterological Endoscopy, 57(Suppl.1) (Suppl.1), 641 - 641, 日本語臨床応用に向けた次世代消化器内視鏡とその周辺機器開発の現況 CO2レーザーによる新しいESD技術の開発
- (NPO)日本レーザー医学会, 2014年10月, 日本レーザー医学会誌, 35(3) (3), 326 - 326, 日本語
- (一社)日本消化器内視鏡学会, 2014年09月, Gastroenterological Endoscopy, 56(Suppl.2) (Suppl.2), 3099 - 3099, 日本語胃粘膜下腫瘍に対する粘膜切開生検症例15例の検討
- (NPO)日本食道学会, 2014年07月, 日本食道学会学術集会プログラム・抄録集, 68回, 84 - 84, 日本語cT1b食道表在癌の治療 内視鏡治療先行の妥当性について
- (NPO)日本食道学会, 2014年07月, 日本食道学会学術集会プログラム・抄録集, 68回, 170 - 170, 日本語食道ESDによる食道穿孔に伴い意識障害で発症したSIADHの1例
- (NPO)日本食道学会, 2014年07月, 日本食道学会学術集会プログラム・抄録集, 68回, 177 - 177, 日本語当院での表在型バレット食道癌の治療成績
- (一社)日本消化器内視鏡学会, 2014年04月, Gastroenterological Endoscopy, 56(Suppl.1) (Suppl.1), 1123 - 1123, 日本語回盲弁を含む切除が必要な大腸腫瘍に対するESD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), 1181 - 1181, 日本語表在性大腸腫瘍の内視鏡治療後遺残再発に対する内視鏡的粘膜下層剥離術の検討
- (一社)日本消化器内視鏡学会, 2014年04月, Gastroenterological Endoscopy, 56(Suppl.1) (Suppl.1), 1210 - 1210, 日本語当院でのバレット食道表在癌の治療成績
- (株)日本メディカルセンター, 2014年01月, Intestine, 18(1) (1), 79 - 88, 日本語
- (株)東京医学社, 2013年09月, 消化器内視鏡, 25(9) (9), 1487 - 1490, 日本語
- (一社)日本消化器内視鏡学会, 2013年09月, Gastroenterological Endoscopy, 55(Suppl.2) (Suppl.2), 2824 - 2824, 日本語内視鏡的に切除した胃型粘液形質を発現する十二指腸高分化型管状腺癌の1例
- (一社)日本消化器内視鏡学会, 2013年09月, Gastroenterological Endoscopy, 55(Suppl.2) (Suppl.2), 2888 - 2888, 日本語食道癌の深達度診断における食道学会分類の有用性の検討
- (株)東京医学社, 2013年08月, 消化器内視鏡, 25(8) (8), 1107 - 1113, 日本語
- 医学図書出版(株), 2013年06月, 胆と膵, 34(6) (6), 509 - 513, 日本語
- (一社)日本消化器内視鏡学会, 2013年04月, Gastroenterological Endoscopy, 55(Suppl.1) (Suppl.1), 1050 - 1050, 日本語食道静脈瘤を合併した表在型食道癌に対するESDの検討
- (一社)日本消化器内視鏡学会, 2013年04月, Gastroenterological Endoscopy, 55(Suppl.1) (Suppl.1), 1124 - 1124, 日本語内視鏡切除後遠隔転移を来たしたLST-NG(偽陥凹型)の一例
- (一社)日本消化器内視鏡学会, 2013年04月, Gastroenterological Endoscopy, 55(Suppl.1) (Suppl.1), 1194 - 1194, 日本語膜性腎症合併早期胃がんに対するESD後、狭窄を来たし、外科的バイパス術を要した1例
- (株)東京医学社, 2013年03月, 消化器内視鏡, 25(3) (3), 433 - 443, 日本語
- (株)医学書院, 2013年02月, 胃と腸, 48(2) (2), 145 - 154, 日本語
- (一社)日本糖尿病学会, 2011年03月, 糖尿病, 54(3) (3), 221 - 221, 日本語2型糖尿病の治療中に、抗GAD抗体陽転化を伴ってインスリン分泌能の低下を来たした一例
- 日本学術振興会, 科学研究費助成事業, 若手研究, 神戸大学, 2023年04月01日 - 2026年03月31日RNA網羅的解析に基づいた食道癌に対する内視鏡治療後狭窄の病態解明内視鏡的粘膜下層剥離術 (ESD) は早期食道癌の標準治療の一つであり、既にその治療は確立されている。しかし、病変が巨大な場合、術後に食道狭窄が生じることがあり、その狭窄は、患者のQOLを著しく低下させることから、臨床現場で課題となっている。しかし、ESD後の狭窄が発症する機構は不明であり、さらに、術前に腸管狭窄の発症を予測することは困難である。一般的に、狭窄は創傷治癒の修復不全によって生じる線維化が原因となることが知られており、腸管や、その他の臓器である皮膚・肝・肺などの線維化の基礎研究の結果から、関連する細胞や多くの分子機構が明らかとなっている。 その中で、線維芽細胞は大量の細胞外マトリックス (ECM) を産生することから、線維化における最も重要なエフェクター細胞の一つとしてよく知られている。しかし、その活性化の機構は複雑で一元的な理解が難しく、食道では、他臓器とその活性化機構が異なる可能性がある。また、ESDでは、電気による熱変性といった人為的な侵襲が加わることからも、他の疾患で生じる線維化の機構と異なる可能性が高い。 本課題では、広範囲切除が必要な食道ESD後に発生する食道狭窄の発生機構を明らかにするために、患者から検体を採取し、シークエンス解析によるmRNA発現の網羅的解析を行い、食道ESD後狭窄に関わる因子の同定を試みる。さらに同定された因子と線維化の関連を、線維芽細胞株を用いた in vitro 実験で検証する。本課題の完遂は、食道ESD後の食道狭窄の病態解明に繋がることから、治療にも応用できる可能性がある。