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( Kazuhiko Nakamura ),( Eikichi Ihara ),( Hirotada Akiho ),( Kazuya Akahoshi ),( Naohiko Harada ),( Toshiaki Ochiai ),( Norimoto Nakamura ),( Haruei Ogino ),( Tsutomu Iwasa ),( Akira Aso ),( Yoichiro 대한소화기학회 2016 Gut and Liver Vol.10 No.6
Background/Aims: The ability of endoscopic submucosal dissection (ESD) to resect large early gastric cancers (EGCs) results in the need to treat large artificial gastric ulcers. This study assessed whether the combination therapy of rebamipide plus a proton pump inhibitor (PPI) offered benefits over PPI monotherapy. Methods: In this prospective, randomized, multicenter, open-label, and comparative study, patients who had undergone ESD for EGC or gastric adenoma were randomized into groups receiving either rabeprazole monotherapy (10 mg/day, n=64) or a combination of rabeprazole plus rebamipide (300 mg/day, n=66). The Scar stage (S stage) ratio after treatment was compared, and factors independently associated with ulcer healing were identified by using multivariate analyses. Results: The S stage rates at 4 and 8 weeks were similar in the two groups, even in the subgroups of patients with large amounts of tissue resected and regardless of CYP2C19 genotype. Independent factors for ulcer healing were circumferential location of the tumor and resected tissue size; the type of treatment did not affect ulcer healing. Conclusions: Combination therapy with rebamipide and PPI had limited benefits compared with PPI monotherapy in the treatment of post-ESD gastric ulcer (UMIN Clinical Trials Registry, UMIN000007435). (Gut Liver 2016;10:917-924)
Onigiri Esophagography as a Screening Test for Esophageal Motility Disorders
( Shohei Hamada ),( Eikichi Ihara ),( Kazumasa Muta ),( Masafumi Wada ),( Yoshitaka Hata ),( Hiroko Ikeda ),( Yoshimasa Tanaka ),( Haruei Ogino ),( Takatoshi Chinen ),( Yoshihiro Ogawa ) 대한소화기기능성질환·운동학회 2022 Journal of Neurogastroenterology and Motility (JNM Vol.28 No.1
Background/Aims No screening test for esophageal motility disorder (EMD) has been established, the objective of this study is to examine the potential usefulness of our newly developed “Onigiri esophagography” combined with an obstruction level (OL) classification system in screening for EMD. Methods A total of 102 patients with suspected EMDs who underwent both high-resolution manometry (HRM) and Onigiri esophagography between April 2017 and January 2019 were examined. The EMD diagnosis was performed based on the Chicago classification version 3.0 by HRM. Onigiri esophagography was performed using a liquid medium (barium sulfate) followed by a solid medium, which consisted of an Onigiri (a Japanese rice ball) with barium powder. The extent of medium obstruction was assessed by the OL classification, which was defined in a stepwise fashion from OL0 (no obstruction) to OL4 (severe obstruction). Results The patients with OL0 (32.3%), OL1 (50.0%), OL2 (88.0%), OL3 (100.0%), and OL4 (100.0%) were diagnosed EMDs by HRM. The area under the curve, as determined by a receiver operating characteristic analysis, for the OL classification was 0.86. Using the cutoff value of OL1, the sensitivity and specificity were 87.3% and 61.3%, respectively, while using a cutoff value of OL2, the sensitivity and specificity were 73.2% and 90.3%, respectively. Conclusion In conclusion, Onigiri esophagography combined with the OL classification system can be used as a screening test for EMDs with a cutoff value of OL1. (J Neurogastroenterol Motil 2022;28:43-52)
A Case of Suspicious Allergic Reaction to Peracetic Acid Following Endoscopy
Naohiko Harada,Manami Hirowatari,Eikichi Ihara,Etsuko Ishihara,Mitsuko Inoue,Tomoya Miyamura,Makoto Nakamuta 대한소화기내시경학회 2020 Clinical Endoscopy Vol.53 No.6
A 43-year-old man with rheumatic arthritis was admitted to our hospital for symptoms of cough, left chest pain, and leftelbow pain, and further examination revealed an elevated level of C-reactive protein. On day 2 after admission, he underwentesophagogastroduodenoscopy. On the morning of day 7, he developed a high fever of 39.7°C, several hours after bronchoscopy. Onday 13, he underwent colonoscopy. Five minutes after the colonoscopy, he developed a high fever of 39.9°C, accompanied by stridor,indicating a decrease in arterial oxygen saturation level. An intradermal test for peracetic acid which was used for cleaning flexibleendoscopy was positive. We suspect that he suffered from an allergic reaction to peracetic acid following the flexible endoscopy. This is the first case reported on suspicious allergic reaction to peracetic acid following a flexible endoscopy procedure.
Azusa Kawasaki,Kunihiro Tsuji,Noriya Uedo,Takashi Kanesaka,Hideaki Miyamoto,Ryosuke Gushima,Yosuke Minoda,Eikichi Ihara,Ryosuke Amano,Kenshi Yao,Yoshihide Naito,Hiroyuki Aoyagi,Takehiro Iwasaki,Kunihi 대한소화기내시경학회 2023 Clinical Endoscopy Vol.56 No.1
Background/Aims: The etiology of superficial non-ampullary duodenal epithelial tumors (SNADETs) remains unclear. Recent studieshave reported conflicting associations between duodenal tumor development and Helicobacter pylori infection or endoscopic gastricmucosal atrophy. As such, the present study aimed to clarify the relationship between SNADETs and H. pylori infection and/or endoscopicgastric mucosal atrophy. Methods: This retrospective case-control study reviewed data from 177 consecutive patients with SNADETs who underwent endoscopicor surgical resection at seven institutions in Japan over a three-year period. The prevalence of endoscopic gastric mucosal atrophyand the status of H. pylori infection were compared in 531 sex- and age-matched controls selected from screening endoscopies attwo of the seven participating institutions. Results: For H. pylori infection, 85 of 177 (48.0%) patients exhibited SNADETs and 112 of 531 (21.1%) control patients were non-infected(p<0.001). Non-atrophic mucosa (C0 to C1) was observed in 96 of 177 (54.2%) patients with SNADETs and 112 of 531 (21.1%)control patients (p<0.001). Conditional logistic regression analysis revealed that non-atrophic gastric mucosa was an independent riskfactor for SNADETs (odds ratio, 5.10; 95% confidence interval, 2.44–8.40; p<0.001). Conclusions: Non-atrophic gastric mucosa, regardless of H. pylori infection status, was a factor independently associated with SNADETs.
Hiroki Fukuya,Yoichiro Iboshi,Masafumi Wada,Yorinobu Sumida,Naohiko Harada,Makoto Nakamuta,Hiroyuki Fujii,Eikichi Ihara 대한소화기내시경학회 2023 Clinical Endoscopy Vol.56 No.6
We report a rare case of gastric cancer presenting with a gastrocolic fistula during ramucirumab and paclitaxel combination therapythat was successfully managed with colonic stenting. A 75-year-old man was admitted to our hospital with the chief complaint of mele-na. Esophagogastroduodenoscopy revealed a large ulcerated tumor in the lower stomach, judged by laparoscopy as unresectable (sT4b-N1M0). After four cycles of first-line chemotherapy with S-1 plus oxaliplatin, the patient showed disease progression, and second-linetherapy with ramucirumab and paclitaxel was started. At the end of the third cycle, the patient had gastric antral stenosis, which neces-sitated the placement of a gastroduodenal stent. When the patient complained of diarrhea 10 days later, esophagogastroduodenoscopyrevealed a fistula between the greater curvature of the stomach and the transverse colon. The fistula was covered by double colonicstenting, with a covered metal stent placed within an uncovered metal stent, after which leakage from the stomach to the colon stopped.