Delayed Perforation after Gastric Endoscopic Submucosal Dissection: Proceed to Prompt Intervention If Acceptable

Abe Seiichiro 거트앤리버 소화기연관학회협의회 2024 Gut and Liver Vol.18 No.1

Metachronous Gastric Cancer Following Curative Endoscopic Resection of Early Gastric Cancer

Seiichiro Abe,Ichiro Oda,Takeyoshi Minagawa,Masau Sekiguchi,Satoru Nonaka,Haruhisa Suzuki,Shigetaka Yoshinaga,Amit Bhatt,Yutaka Saito 대한소화기내시경학회 2018 Clinical Endoscopy Vol.51 No.3

This review article summarizes knowledge about metachronous gastric cancer (MGC) occurring after curative endoscopic resection (ER)of early gastric cancer (EGC), treatment outcomes of patients who developed MGC, and efficacy of Helicobacter pylori eradication toprevent MGC. The incidence of MGC following curative ER increases over time and is higher than in patients undergoing gastrectomy. Increasing age and multifocal EGC are independent risk factors for developing MGC. An MGC following curative ER is usually a small(<20 mm) and differentiated intramucosal cancer. Most MGC lesions are found at an early stage on semiannual or annual surveillanceendoscopy and are successfully treated by further ER, with excellent long-term outcomes. Eradication of H. pylori may reduce the riskof MGC following ER of EGC, but further prospective studies with long-term outcomes are required. Surveillance endoscopy followinggastric ER should be continued indefinitely, due to the risk of MGC even after successful H. pylori eradication. Risk stratification andtailored endoscopic surveillance schedules need to be developed.

Efficacy of Current Traction Techniques for Endoscopic Submucosal Dissection

Seiichiro Abe,Shih Yea Sylvia Wu,Mai Ego,Hiroyuki Takamaru,Masau Sekiguchi,Masayoshi Yamada,Satoru Nonaka,Taku Sakamoto,Haruhisa Suzuki,Shigetaka Yoshinaga,Takahisa Matsuda,Ichiro Oda,Yutaka Saito 거트앤리버 소화기연관학회협의회 2020 Gut and Liver Vol.14 No.6

This systematic review aimed to assess the efficacy of the current approach to tissue traction during the endoscopic submucosal dissection (ESD) of superficial esophageal cancer, early gastric cancer, and colorectal neoplasms. We performed a systematic electronic literature search of articles published in PubMed and selected comparative studies to investigate the treatment outcomes of tractionassisted versus conventional ESD. Using the keywords, we retrieved 381 articles, including five eligible articles on the esophagus, 13 on the stomach, and 12 on the colorectum. A total of seven randomized controlled trials and 23 retrospective studies were identified. Clip line traction and submucosal tunneling were effective in reducing the procedural time during esophageal ESD. The efficacy of traction methods in gastric ESD varied in terms of the devices and strategies used depending on the lesion location and degree of submucosal fibrosis. Several prospective and retrospective studies utilized traction devices without the need to reinsert the colonoscope. When pocket creation is included, the traction devices and methods effectively shorten the procedural time during colorectal ESD. Although the efficacy is dependent on the organ and tumor locations, several traction techniques have been demonstrated to be efficacious in facilitating ESD by maintaining satisfactory traction during dissection.

Endoscopic Resection of Undifferentiated Early Gastric Cancer

Seiichiro Abe,Yuichiro Hirai,Mai Ego Makiguchi,Masau Sekiguchi,Satoru Nonaka,Haruhisa Suzuki,Shigetaka Yoshinaga,Yutaka Saito 대한위암학회 2023 Journal of gastric cancer Vol.23 No.1

Endoscopic resection (ER) is widely performed for early gastric cancer (EGC) with a negligible risk of lymph node metastasis (LNM) in Eastern Asian countries. In particular, endoscopic submucosal dissection (ESD) leads to a high en bloc resection rate, enabling accurate pathological evaluation. As undifferentiated EGC (UD-EGC) is known to result in a higher incidence of LNM and infiltrative growth than differentiated EGC (D-EGC), the indications for ER are limited compared with those for D-EGC. Previously, clinical staging as intramucosal UD-EGC ≤2 cm, without ulceration, was presented as ‘weakly recommended’ or ‘expanded indications’ for ER in the guidelines of the United States, Europe, Korea, and Japan. Based on promising long-term outcomes from a prospective multicenter study by the Japan Clinical Oncology Group (JCOG) 1009/1010, the status of this indication has expanded and is now considered ‘absolute indications’ in the latest Japanese guidelines published in 2021. In this study, which comprised 275 patients with UD-EGC (cT1a, ≤2 cm, without ulceration) treated with ESD, the 5-year overall survival (OS) was 99.3% (95% confidence interval, 97.1%–99.8%), which was higher than the threshold 5-year OS (89.9%). Currently, the levels of evidence grades and recommendations for ER of UD-EGC differ among Japan, Korea, and Western countries. Therefore, a further discussion is warranted to generalize the indications for ER of UD-EGC in countries besides Japan.

How should we treat acute kidney injury caused by renal congestion?

( Masanori Abe ),( Seiichiro Hemmi ),( Hiroki Kobayashi ) 대한신장학회 2023 Kidney Research and Clinical Practice Vol.42 No.4

Decreased kidney function is associated with increased risk of cardiovascular events and mortality, and heart failure (HF) is a well-known risk factor for renal dysfunction. Acute kidney injury (AKI) in patients with HF often is attributed to prerenal factors, such as renal hypoperfusion and ischemia as a result of decreased cardiac output. Another such factor is reduction of absolute or relative circulating blood volume, with the decrease in renal blood flow leading to renal hypoxia followed by a decrease in the glomerular filtration rate. However, renal congestion is increasingly being recognized as a potential cause of AKI in patients with HF. Increased central venous pressure and renal venous pressure lead to increased renal interstitial hydrostatic pressure and a reduction of the glomerular filtration rate. Both decreased kidney function and renal congestion have been shown to be important prognostic factors of HF, and adequate control of congestion is important for improving kidney function. Loop and thiazide diuretics are recommended as standard therapies to reduce volume overload. However, these agents are associated with worsening renal function even though they are effective for improving congestive symptoms. There is growing interest in tolvaptan, which can improve renal congestion by increasing excretion of free water and decreasing the required dose of loop diuretic, thereby improving kidney function. This review summarizes renal hemodynamics, the pathogenesis of AKI due to renal ischemia and renal congestion, and diagnosis and treatment options for renal congestion.

Reduced Intravenous Fluorescein Dose for Upper and Lower Gastrointestinal Tract Probe-Based Confocal Laser Endomicroscopy

Kazuya Inoki,Seiichiro Abe,Yusaku Tanaka,Koji Yamamoto,Daisuke Hihara,Ryoji Ichijima,Yukihiro Nakatani,Hsin- Yu Chen,Hiroyuki Takamaru,Masau Sekiguchi,Masayoshi Yamada,Taku Sakamoto,Satoru Nonaka,Haru 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.3

Background/Aims: Probe-based confocal laser endomicroscopy (pCLE) requires the administration of intravenous (IV) fluorescein. This study aimed to determine the optimal dose of IV fluorescein for both upper and lower gastrointestinal (GI) tract pCLE. Methods: Patients 20 to 79 years old with gastric high-grade dysplasia (HGD) or colorectal neoplasms (CRNs) were enrolled in thestudy. The dose de-escalation method was employed with five levels. The primary endpoint of the study was the determination ofthe optimal dose of IV fluorescein for pCLE of the GI tract. The reduced dose was determined based on off-line reviews by threeendoscopists. An insufficient dose of fluorescein was defined as the dose of fluorescein with which the pCLE images were notdeemed to be visible. If all three endoscopists determined that the tissue structure was visible, the doses were de-escalated. Results: A total of 12 patients with gastric HGD and 12 patients with CRNs were enrolled in the study. Doses were de-escalated to0.5 mg/kg of fluorescein for both non-neoplastic duodenal and colorectal mucosa. All gastric HGD or CRNs were visible with pCLEwith IV fluorescein at 0.5 mg/kg. Conclusions: In the present study, pCLE with IV fluorescein 0.5 mg/kg was adequate to visualize the magnified structure of both theupper and lower GI tract.

Complications of endoscopic resection in the upper gastrointestinal tract

Takeshi Uozumi,Seiichiro Abe,Mai Ego Makiguchi,Satoru Nonaka,Haruhisa Suzuki,Shigetaka Yoshinaga,Yutaka Saito 대한소화기내시경학회 2023 Clinical Endoscopy Vol.56 No.4

Endoscopic resection (ER) is widely utilized as a minimally invasive treatment for upper gastrointestinal tumors; however, complications could occur during and after the procedure. Post-ER mucosal defect leads to delayed perforation and bleeding; therefore, endoscopic closure methods (endoscopic hand-suturing, the endoloop and endoclip closure method, and over-the-scope clip method) and tissue shielding methods (polyglycolic acid sheets and fibrin glue) are developed to prevent these complications. During duodenal ER, complete closure of the mucosal defect significantly reduces delayed bleeding and should be performed. An extensive mucosal defect that comprises three-quarters of the circumference in the esophagus, gastric antrum, or cardia is a significant risk factor for post-ER stricture. Steroid therapy is considered the first-line option for the prevention of esophageal stricture, but its efficacy for gastric stricture remains unclear. Methods for the prevention and management of ER-related complications in the esophagus, stomach, and duodenum differ according to the organ; therefore, endoscopists should be familiar with ways of preventing and managing organ-specific complications.

Preclinical Efficacy and Clinical Feasibility of a Novel Aerosol- Exposure Protection Mask for Esophagogastroduodenoscopy

Mai Ego Makiguchi,Seiichiro Abe,Yutaka Okagawa,Satoru Nonaka,Haruhisa Suzuki,Shigetaka Yoshinaga,Ichiro Oda,Okamoto Ryuta,Yutaka Saito 대한소화기내시경학회 2022 Clinical Endoscopy Vol.55 No.2

Background/Aims: This study aimed to assess the efficacy of a novel aerosol-exposure protection (AP) mask in preventingcoronavirus disease in healthcare professionals during upper gastrointestinal endoscopy and to evaluate its clinical feasibility. Methods: In Study 1, three healthy volunteers volitionally coughed with and without the AP mask in a cleanroom. Microparticleswere visualized and counted with a specific measurement system and compared with and without the AP mask. In Study 2,30 patients underwent endoscopic resection with the AP mask covering the face, and the SpO2 was measured throughout theprocedure. Results: In Study 1, the median number of microparticles in volunteers 1, 2, and 3 with and without the AP mask was 8.5 and 110.0,7.0 and 51.5, and 8.0 and 95.0, respectively (p<0.01). Using the AP mask, microparticles were reduced by approximately 92%. Themedian distances of microparticle scattering without the AP mask were 60, 0, and 68 in volunteers 1, 2, and 3, respectively. In Study 2,the mean SpO2 was 96.3%, and desaturation occurred in three patients. Conclusion: The AP mask could provide protection from aerosol exposure and can be safely used for endoscopy in clinical practice.

Review : Indications for and Technical Aspects of Colorectal Endoscopic Submucosal Dissection

( Yutaka Saito ),( Yosuke Otake ),( Taku Sakamoto ),( Takeshi Nakajima ),( Masayoshi Yamada ),( Shin Haruyama ),( Eriko So ),( Seiichiro Abe ),( Takahisa Matsuda ) The Editorial Office of Gut and Liver 2013 Gut and Liver Vol.7 No.3

Due to the widespread acceptance of gastric and esophageal endoscopic submucosal dissections (ESDs), the number of medical facilities that perform colorectal ESDs has grown and the effectiveness of colorectal ESD has been increasingly reported in recent years. The clinical indications for colorectal ESD at the National Cancer Center Hospital, Tokyo, Japan include laterally spreading tumor (LST) nongranular type lesions >20 mm and LST granular type lesions >30 mm. In addition, 0-IIc lesions >20 mm, intramucosal tumors with nonlifting signs and large sessile lesions, all of which are difficult to resect en bloc by conventional endoscopic mucosal resection (EMR), represent potential candidates for colorectal ESD. Rectal carcinoid tumors less than 1 cm in diameter can be treated simply, safely, and effectively by endoscopic submucosal resection using a ligation device and are therefore not indications for ESD. The en bloc resection rate was 90%, and the curative resection rate was 87% for 806 ESDs. The median procedure time was 60 minutes, and the mean size for resected specimens was 40 mm (range, 15 to 150 mm). Perforations occurred in 23 (2.8%) cases, and postoperative bleeding occurred in 15 (1.9%) cases, but only two perforation cases required emergency surgery (0.25%). ESD was an effective procedure for treating colorectal tumors that are difficult to resect en bloc by conventional EMR. ESD resulted in a higher en bloc resection rate as well as decreased invasiveness in comparison to surgery. Based on the excellent clinical results of colorectal ESDs in Japan, the Japanese healthcare insurance system has approved colorectal ESD for coverage. (Gut Liver 2013; 7:263-269)