CASE REPORTS : Repeatedly Recurrent Colon Cancer Involving the Appendiceal Orifice after Endoscopic Piecemeal Mucosal Resection: A Case Report

Masau Sekiguchi,Takahisa Matsuda,Shigeki Sekine,Taku Sakamoto,Takeshi Nakajima,Ryoji Kushima,Takayuki Akasu,Yutaka Saito 대한소화기학회 2013 대한소화기학회지 Vol.61 No.5

Post-polypectomy surveillance: the present and the future

Masau Sekiguchi,Takahisa Matsuda,Kinichi Hotta,Yutaka Saito 대한소화기내시경학회 2022 Clinical Endoscopy Vol.55 No.4

An appropriate post-polypectomy surveillance program requires the effectiveness of reducing colorectal cancer and safety. In addition,the post-polypectomy surveillance program should consider the burden of limited medical resource capacity, cost-effectiveness, andpatient adherence. In this sense, a risk-stratified surveillance program based on baseline colonoscopy results is ideal. Major internationalguidelines for post-polypectomy surveillance, such as those from the European Union and the United States, have recommendedrisk-stratified surveillance programs. Both guidelines have recently been updated to better differentiate between high- and low-risk individuals. In both updated guidelines, more individuals have been downgraded to lower-risk groups that require less frequent or nosurveillance. Furthermore, increased attention has been paid to the surveillance of patients who undergo serrated polyp removal. Previousguidelines in Japan did not clearly outline the risk stratification in post-polypectomy surveillance. However, the new colonoscopyscreening and surveillance guidelines presented by the Japan Gastroenterological Endoscopy Society include a risk-stratifiedpost-polectomy surveillance program. Further discussion and analysis of unresolved issues in this field, such as the optimal follow-upafter the first surveillance, the upper age limit for surveillance, and the ideal method for improving adherence to surveillance guidelines,are warranted.

Estimation of Invasion Depth: The First Key to Successful Colorectal ESD

Bo-In Lee,Takahisa Matsuda 대한소화기내시경학회 2019 Clinical Endoscopy Vol.52 No.2

Colorectal tumors with superficial submucosal invasion, which cannot be removed by snaring, are one of the most optimal indicationsfor colorectal endoscopic submucosal dissection (ESD). Therefore, estimation of the invasion depth is the first key to successfulcolorectal ESD. Although estimation of the invasion depth based on the gross morphology may be useful in selected cases, its diagnosticaccuracy could not reach the clinical requirement. The Japan Narrow-band Imaging (NBI) Expert Team (JNET) classification of NBImagnifying endoscopy findings is a useful method for histologic prediction and invasion depth estimation. However, magnifyingchromoendoscopy is still necessary for JNET type 2B lesions to reach a satisfactory diagnostic accuracy. Endocytoscopy with artificialintelligence is a promising technology in invasion depth estimation; however, more data are needed for its clinical application.

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)

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.

Are Newer Extracorporeal Shock Wave Lithotripsy Models Truly Improving Pancreatolithiasis Lithotripsy Performance? A Japanese Single-Center Study Using Endoscopic Adjunctive Treatment

Ito Ken,Okano Naoki,Takuma Kensuke,Iwasaki Susumu,Watanabe Koji,Kimura Yusuke,Yamada Yuto,Yoshimoto Kensuke,Hara Seiichi,Kishimoto Yui,Matsuda Takahisa,Igarashi Yoshinori 거트앤리버 소화기연관학회협의회 2023 Gut and Liver Vol.17 No.4

Background/Aims: Many Japanese institutions use electromagnetic extracorporeal shock wave lithotripsy (ESWL) systems for treating pancreatic duct stones. However, there are no reports on direct comparisons between recent electromagnetic lithotripters. This study aimed to verify whether the new electromagnetic lithotripter can improve the efficiency of pancreatic stone fragmentation, and to clarify the role of combined endoscopic treatment on the clearance of pancreatic duct stones. Methods: We retrospectively identified 208 patients with pancreatolithiasis who underwent endoscopic adjunctive treatment after pancreatic ESWL at a single Japanese center over a 17-year period. We evaluated the outcome data of this procedure performed with SLX-F2 (last 2 years; group A) and Lithostar/Lithoskop (first 15 years; group B), as well as additional endoscopic treatments for pancreatolithiasis. We also performed logistic regression analysis to detect various factors associated with the procedure. Results: For pancreatic head stones, ESWL disintegration was achieved in 93.7% of group A patients and 69.0% of group B patients (p=0.004), and adjunctive endoscopic treatment removed stones in 96.8% of group A patients and 73.0% of group B patients (p=0.003). Multivariate analysis revealed that lithotripter type (odds ratio, 6.99; 95% confidence interval, 1.56 to 31.33; p<0.01) and main pancreatic duct stricture (odds ratio, 2.87; 95% confidence interval, 1.27 to 6.45; p<0.01) were significant factors for ESWL fragmentation. Conclusions: The SLX F2 showed high performance in fragmenting the pancreatic duct stones. In addition, endoscopic adjunctive treatment improved the overall success rate of the procedure. The improved ESWL lithotripter has many advantages for patients undergoing pancreatic lithotripsy treatment.