Safety of Gastroenterologist-Guided Sedation with Propofol for Upper Gastrointestinal Therapeutic Endoscopy in Elderly Patients Compared with Younger Patients

( Masaya Nonaka ),( Takuji Gotoda ),( Chika Kusano ),( Masakatsu Fukuzawa ),( Takao Itoi ),( Fuminori Moriyasu ) 대한소화기학회 2015 Gut and Liver Vol.9 No.1

Background/Aims: Propofol sedation for elderly patients during time-consuming endoscopic procedures is controversial. Therefore, we investigated the safety of using propofol in elderly patients during upper gastrointestinal therapeutic endoscopy. Methods: The medical records of 160 patients who underwent therapeutic endoscopic procedures under gastroenterologist- guided propofol sedation at a single institution were retrospectively reviewed. The subjects were divided into two groups: a younger group, patients <75 years old; and an elderly group, patients ≥75 years old. The two groups were compared with respect to the therapeutic regimen, circulatory dynamics, and presence/absence of discontinuation of propofol treatment. Results: Although the number of patients with liver dysfunction was higher in the elderly group, there were no other significant differences in the baseline characteristics, including the American Society of Anesthesiologists classification, between the elderly and younger groups. The average maintenance rate of continuous propofol infusion was lower in the elderly patients. No statistically significant differences were found in the occurrence of adverse events between the elderly and younger groups. None of the patients returned to a resedated state after the initial recovery from sedation. Conclusions: Gastroenterologist-guided propofol sedation in elderly patients can be safely achieved in the same manner as that in younger patients, even for timeconsuming upper gastrointestinal therapeutic endoscopic procedures. (Gut Liver 2015;9:38-42)

Non-Curative Resection: Should Clinicians Consider Providing Additional Surgery for All Patients?

Waku Hatta,Takuji Gotoda,Atsushi Masamune 대한소화기내시경학회 2020 Clinical Endoscopy Vol.53 No.2

COMMENTARY

A Recent Argument for the Use of Endoscopic Submucosal Dissection for Early Gastric Cancers

Waku Hatta,Takuji Gotoda,Tomoyuki Koike,Atsushi Masamune 거트앤리버 소화기연관학회협의회 2020 Gut and Liver Vol.14 No.4

Endoscopic submucosal dissection (ESD) has become the standard treatment method for early gastric cancers (EGCs) due to the negligible risk for lymph node metastasis (LNM) in Eastern Asian countries. According to the guidelines, the curability of EGC after endoscopic resection was classified into three groups: curative resection, expanded curative resection, and noncurative resection. In Eastern Asian countries, a structured follow-up schedule is needed for patients undergoing curative resection and expanded curative resection. Conversely, in Western countries, additional surgery may be recommended for some patients undergoing expanded curative resection (ulcerated, undifferentiated, or slight submucosal invasion) due to the potential risk for LNM, even though specimens of ESD and surgery may not be handled with the same methodology as that used in Japan, which may lead to this slightly higher risk. In noncurative resection, additional surgery is the standard method after ESD because of the risk for LNM. However, in elderly patients and/or those with severe underlying diseases, the advantages and disadvantages of additional surgery should be considered when selecting a post-ESD treatment strategy for patients undergoing noncurative resection. Risk-scoring systems for LNM may facilitate clinical decisions for these patients. However, it should be noted that when recurrence was detected in patients who were followed up with no additional treatment after ESD with noncurative resection, most of them had a poor prognosis. To select an appropriate treatment method, especially in elderly patients undergoing ESD with noncurative resection, a new tool for evaluating the condition of patients should be established.

Effect of Ubiquinol Intake on Defecation Frequency and Stool Form: A Prospective, Double-Blinded, Randomized Control Study

Sho Suzuki,Takuji Gotoda,Chika Kusano,Hisatomo Ikehara,Yo Miyakoshi,Kenji Fujii 한국식품영양과학회 2019 Journal of medicinal food Vol.22 No.1

Bowel habits affect the quality of life (QOL) of patients with functional gastrointestinal disorders. This study evaluated the effects of reduced form coenzyme Q 10 (ubiquinol) intake on defecation frequency and stool form in patients with daily abdominal symptoms. This was a single-center, prospective, double-blind, randomized control study. Forty-one patients who had the daily symptom of constipation or diarrhea were randomly assigned at a 1:1 ratio to receive either ubiquinol (150 mg/day) or placebo for 12 weeks. Patients completed a daily diary to collect information regarding their numbers of defecations and stool forms according to the Bristol Stool Form (BSF) Scale for 7 days at baseline and 12 weeks. QOL was assessed using the 36-item short-form (SF-36) at baseline and 12 weeks. Twenty-one patients were assigned to the ubiquinol group, and 20 were assigned to the placebo group. At 12 weeks, the mean defecation frequency, compared to baseline, significantly decreased in the ubiquinol group (−0.1 times/day, P = .034) and increased in the placebo group (+0.3 times/day, P = .004). There was no significant change in the 12-week BSF Scale score of the ubiquinol group (+0.2, P = .123), whereas that of the placebo group was increased (+0.5, P < .001). The 12-week general health perception SF-36 score was significantly increased in the ubiquinol group (+3.5, P = .045), whereas there was no significant difference in that score in the placebo group (+1.2, P = .178). In conclusion, taking ubiquinol for 12 weeks decreased defecation frequencies and increased the QOL score, suggesting that ubiquinol may change the bowel habits and improve QOL in patients with abdominal distress.

Histopathological examination following side-by-side placement of metal stents for malignant hilar biliary obstruction

Hiroshi Nakagawara,Kenji Yamao,Takuji Gotoda,Daiichiro Kikuta,Akinori Takei,Kunio Iwatsuka,Toshimi Takahashi,Masahiro Ogawa,Akihiro Henmi,Makio Kobayashi,Mitsuhiko Moriyama 소화기인터벤션의학회 2019 International journal of gastrointestinal interven Vol.8 No.2

Background: Endoscopic-guided placement of metal stents for unresectable malignant hilar biliary obstruction (UMHBO) is performed using partial stent-in-stent or side-by-side (SBS) techniques. The latter involves placing sequential stents within the bile duct. Excessive dilation of the bile duct during stent placement can have serious effects on the surrounding organs.Methods: This study details seven cases of SBS placement of 8.0 mm metal stents for UMHBO. Histopathological examinations were performed to identify the effects on the bile duct and surrounding tissues.Results: The mean post-placement diameter of the bile ducts was 13.86 mm, and no compression necrosis or thrombi were observed in surrounding tissues. Cholangitis occurred in five cases, and death occurred as a result of cholecystitis in one case. Conclusion: The use of 8.0-mm stents for SBS is unlikely to have major negative effects on peribiliary tissues and blood vessels. However, post-placement cholecystitis can result in increased mortality; thus, gallbladder drainage should be considered.

Histopathological examination following side-by-side placement of metal stents for malignant hilar biliary obstruction

Hiroshi Nakagawara,Kenji Yamao,Takuji Gotoda,Daiichiro Kikuta,Akinori Takei,Kunio Iwatsuka,Toshimi Takahashi,Masahiro Ogawa,Akihiro Henmi,Makio Kobayashi,Mitsuhiko Moriyama 소화기인터벤션의학회 2019 Gastrointestinal Intervention Vol.8 No.2

Background: Endoscopic-guided placement of metal stents for unresectable malignant hilar biliary obstruction (UMHBO) is performed using partial stent-in-stent or side-by-side (SBS) techniques. The latter involves placing sequential stents within the bile duct. Excessive dilation of the bile duct during stent placement can have serious effects on the surrounding organs.Methods: This study details seven cases of SBS placement of 8.0 mm metal stents for UMHBO. Histopathological examinations were performed to identify the effects on the bile duct and surrounding tissues.Results: The mean post-placement diameter of the bile ducts was 13.86 mm, and no compression necrosis or thrombi were observed in surrounding tissues. Cholangitis occurred in five cases, and death occurred as a result of cholecystitis in one case. Conclusion: The use of 8.0-mm stents for SBS is unlikely to have major negative effects on peribiliary tissues and blood vessels. However, post-placement cholecystitis can result in increased mortality; thus, gallbladder drainage should be considered.

Review : Endoscopic Mucosal Resection and Endoscopic Submucosal Dissection as Treatments for Early Gastrointestinal Cancers in Western Countries

( Sergio Coda ),( Sun Young Lee ),( Takuji Gotoda ) The Editorial Office of Gut and Liver 2007 Gut and Liver Vol.1 No.1

Early gastrointestinal cancers are defined as lesions limited to the mucosa or submucosa without invading the muscularis propria, regardless of the presence of lymph node metastases. Although the natural history of these diseases is basically alike worldwide, its management is quite different between the East and West; aggressive surgery is frequently adopted by Western surgeons, while less invasive techniques are adopted by Asian colleagues. These techniques include endoscopic mucosal resection and endoscopic submucosal dissection which are now accepted as treatments for early gastrointestinal cancers in selected cases. Recent advances in endoscopic detection and treatment techniques, especially in Japan and Korea, have prompted Western endoscopists to learn these techniques. This review addresses recent advances regarding endoscopic resections of early gastrointestinal cancers, which promoted its use in Western countries. In addition, prospective studies on endoscopic resection in Western countries are also described. (Gut and Liver 2007;1:12-21)

Diagnostic Ability of High-definition Imaging Using Ultraslim Endoscopes in Early Gastric Cancer

Sugita, Tomomi,Suzuki, Sho,Ichijima, Ryoji,Ogura, Kanako,Kusano, Chika,Ikehara, Hisatomo,Gotoda, Takuji,Moriyama, Mitsuhiko The Korean Gastric Cancer Association 2021 Journal of gastric cancer Vol.21 No.3

Purpose: It is unclear whether high-definition (HD) imaging improves visibility and diagnostic ability in early gastric cancer (EGC) compared with standard-definition (SD) imaging. We aimed to compare the diagnostic performance and visibility scores of HD and SD ultraslim endoscopes in EGC. Materials and Methods: We used HD and SD ultraslim endoscopes to obtain 60 images with similar compositions of gastric environments. Of the 60 images, 30 showed EGC (15 images for each modality) and 30 showed no EGC (15 images for each modality). Seventeen endoscopists evaluated the presence and location of the lesions in each image. Diagnostic ability was compared between modalities. The color difference between a lesion and the surrounding mucosa (ΔE) was measured and compared between the modalities. Results: The ability of HD to detect EGC was significantly higher than that of SD (accuracy: 80.8% vs. 71.6%, P=0.017; sensitivity: 94.9% vs. 76.5%, P<0.001; positive predictive value, 76.2% vs. 55.3%, P<0.001; and negative predictive value (NPV), 94.1% vs. 73.5%, P<0.001). The ability of HD to determine the horizontal extent of EGC was significantly higher than that of SD (accuracy: 71.0% vs. 57.8%, P=0.004; sensitivity: 75.3% vs. 49.0%, P<0.001; NPV, 72.9% vs. 55.9%, P<0.001; and area under the curve: 0.891 vs. 0.631, P=0.038). The mean ΔE was significantly higher for HD than for SD (10.3 vs. 5.9, P=0.011). Conclusions: The HD ultraslim endoscope showed a higher diagnostic performance in EGC than the SD endoscope because it provided good color contrast.

Growth Patterns of Signet Ring Cell Carcinoma of the Stomach for Endoscopic Resection

( Hyunki Kim ),( Jie-hyun Kim ),( Yong Chan Lee ),( Hoguen Kim ),( Young Hoon Youn ),( Hyojin Park ),( Seung Ho Choi ),( Sung Hoon Noh ),( Takuji Gotoda ) 대한소화기학회 2015 Gut and Liver Vol.9 No.6

Background/Aims: It is difficult to precisely detect the lateral margin during endoscopic submucosal dissection (ESD) for signet ring cell carcinoma (SRC) because SRC often expands to lateral direction through the lamina propria. Thus, the aim of this study was to classify the intramucosal spreading patterns of SRC and to analyze the patients’ clinicopathological findings according to the spreading patterns. Methods: The intramucosal spreading patterns of SRC were classified as expansive or infiltrative types. A total of 100 surgical and 42 ESD specimens were reviewed. Results: In the surgical specimens, the proportions of expansive and infiltrative types were 44% and 56%, respectively. The infiltrative type was more commonly associated with old age, atrophy, and intestinal metaplasia in surrounding mucosa and the absence of Helicobacter pylori compared with the expansive type. In ESD specimens, the proportions of expansive and infiltrative types were each 50%. When lateral margin-positive lesions were compared with -negative lesions, larger size, residual lesion, and the lack of a neutrophil infiltration were more significantly associated with lateral margin-positive lesions.All cases with residual tumors in lateral margin-positive lesions were classified as the infiltrative type. Conclusions: SRC surrounded with atrophy and/or intestinal metaplasia often spreads subepithelially in the margin. This finding may suggest that a larger safety margin is necessary in this type during ESD. (Gut Liver 2015,9:720-726)