Magnified single-balloon enteroscopy in the diagnosis of intestinal follicular lymphoma: a case series

( Kenichiro Takahashi ),( Shigeki Bamba ),( Masahiro Kawahara ),( Atsushi Nishida ),( Osamu Inatomi ),( Masaya Sasaki ),( Tomoyuki Tsujikawa ),( Ryoji Kushima ),( Mitsushige Sugimoto ),( Katsuyuki Kit 대한장연구학회 2018 Intestinal Research Vol.16 No.4

The objective of this study was to evaluate the magnified endoscopic findings in the diagnosis of follicular lymphoma in the small intestine in comparison with those of intestinal follicular lymphoma and lymphangiectasia. Four patients with follicular lymphoma and 3 with lymphangiectasia in the small intestine were retrospectively analyzed. A prototype magnifying single-balloon enteroscope was used. The findings of the intestinal follicular lymphoma and lymphangiectasia were retrospectively analyzed to determine the magnified endoscopic findings of follicular lymphoma in the small intestine. Opaque white granules were observed in 3 of the 4 patients with follicular lymphoma. Magnified narrow-band imaging (NBI) of the opaque white granules showed stretched microvessels, which had a diminutive tree-like appearance. The remaining patient had no opaque white granules and only displayed whitish villi. Magnified NBI observation of the whitish villi revealed the absence of marginal villus epithelium, which was confirmed by histology. The magnified NBI enteroscopy revealed the diminutive tree-like appearance on the opaque white granules and the absence of marginal villus epithelium of the whitish villi in intestinal follicular lymphoma. These findings may be useful in diagnosing follicular lymphoma. (Intest Res 2018;16:628-634)

Efficacy and safety of cold forceps polypectomy utilizing the jumbo cup: a prospective study

( Hiroshi Hasegawa ),( Shigeki Bamba ),( Kenichiro Takahashi ),( Masaki Murata ),( Taketo Otsuka ),( Hiroshi Matsumoto ),( Takehide Fujimoto ),( Rie Osaki ),( Hirotsugu Imaeda ),( Atsushi Nishida ),( 대한장연구학회 2019 Intestinal Research Vol.17 No.2

Background/Aims: There are few prospective studies on cold forceps polypectomy (CFP) using jumbo cup forceps. Therefore, we examined patients with diminutive polyps (5 mm or smaller) treated with CFP using jumbo cup forceps to achieve an ade-noma-free colon and also assessed the safety of the procedure and the recurrence rate of missed or residual polyp after CFP by performing follow-up colo-noscopy 1 year later. Methods: We included patients with up to 5 adenomas removed at initial colonoscopy and analyzed data from a total of 361 patients with 573 adenomas. One-year follow-up colonoscopy was performed in 165 patients, at which 251 lesions were confirmed. Results: The one-bite resection rate with CFP was highest for lesions 3 mm or smaller and decreased significantly with increasing lesion size. Post-procedural hemorrhage was observed in 1 of 573 lesions (0.17%). No perforation was noted. The definite recurrence rate was 0.8% (2/251 lesions). The probable recurrence rate, which was defined as recurrence in the same colorectal segment, was 17%. Adenoma-free colon was achieved in 55% of patients at initial resection. Multivariate analysis revealed that achievement of an adenoma-free colon was significantly associated with number of adenomas and years of endoscopic experience. Conclusions: CFP using jumbo biopsy forceps was safe and showed a high one-bite resection rate for diminutive lesions of 3 mm or smaller. The low definite recurrence rate confirms the reliability of CFP using jumbo biopsy forceps. Number of adenomas and years of endoscopic experience were key factors in achieving an adenoma-free colon. (Intest Res 2019;17:265-272.)

Perceptions of older adults and generativity among older citizens in Japan: a descriptive cross-sectional study

Yuho Shimizu,Tomoya Takahashi,Kenichiro Sato,Susumu Ogawa,Daisuke Cho,Yoshifumi Takahashi,Daichi Yamashiro,Yan Li,Keigo Hinakura,Ai Iizuka,Tomoki Furuya,Hiroyuki Suzuki 질병관리본부 2023 Osong Public Health and Research Persptectives Vol.14 No.5

Objectives: As the population ages worldwide, including in Japan, there is a growing expectation for older adults to remain active participants in society. The act of sharing one’s experiences and knowledge with younger generations through social engagement not only enriches the lives of older individuals, but also holds significant value for our society. In this study, we examined both positive and negative perceptions of older adults and investigated the correlation between these perceptions and generativity among older citizens. Additionally, we evaluated the impact of life satisfaction on these factors. Methods: We conducted a survey of 100 older adults in Japan (mean age, 71.68 years) and utilized multiple regression analyses, using positive and negative perceptions of older adults, life satisfaction, and demographic factors as independent variables. The sub-categories of generativity—namely, generative action, concern, and accomplishment—were used as dependent variables. Results: Participants who held a more positive perception of older adults demonstrated a higher level of generative actions and concerns. Additionally, participants who reported higher levels of life satisfaction also exhibited more generative actions, concerns, and accomplishments. Conversely, those who held a more negative perception of older adults were found to have higher levels of generative actions. Conclusion: Enhancing positive perceptions of older adults among them can boost the sub-categories of generativity. This study, which was conducted from an exploratory perspective, has several limitations, including a potential sampling bias. A more comprehensive examination of the relationship between perceptions of older adults and generativity is anticipated in future research.

Prototype single-balloon enteroscopy with passive bending and high force transmission improves depth of insertion in the small intestine

( Yasuhiro Morita ),( Shigeki Bamba ),( Osamu Inatomi ),( Kenichiro Takahashi ),( Takayuki Imai ),( Masaki Murata ),( Masashi Ohno ),( Masaya Sasaki ),( Tomoyuki Tsujikawa ),( Akira Andoh ) 대한장연구학회 2020 Intestinal Research Vol.18 No.2

Background/Aims: We retrospectively analyzed Crohn’s disease (CD) patients with small intestinal strictures who underwent single-balloon enteroscopy (SBE) to ascertain whether prototype SBEs with a passive bending mechanism and high force transmission insertion tube had better insertability in the small intestine than a conventional SBE. Methods: Among 253 CD patients who underwent SBE, we identified 94 CD patients who had undergone attempted endoscopic balloon dilatation (EBD) for small intestinal stenosis for inclusion in this study. We analyzed whether the type of scope used for their initial procedure affected the cumulative surgery-free rate. For the insertability analysis, patients who underwent SBE at least twice were divided into 3 groups according to the type of scope used: conventional SBE only, prototype SBE only, and both conventional and prototype SBEs. For each group, depth of insertion, procedure time, and number of EBDs were compared in the same patient at different time points. Results: The success rate of EBD was 88.3%. The 5- and 10-year cumulative surgery-free rate was 75.7% and 72.8%, respectively. Cox regression analysis indicated that the factors contributing to surgery were long stricture (≥2 cm), EBD failure, and elevated Crohn’s Disease Activity Index, but not the type of scope used for EBD. The prototype SBEs significantly improved the depth of insertion (P=0.03, Wilcoxon’s signed-rank test). Conclusions: In CD patients with small intestinal stenosis, the prototype SBEs with a passive bending mechanism and high force transmission insertion tube did not improve long-term EBD outcome but did improve deep insertability. (Clinical Trial Registration No. UMIN000037102) (Intest Res 2020;18:229-237)

Relationship between the gut microbiota and bile acid composition in the ileal mucosa of Crohn’s disease

Shigeki Bamba,Osamu Inatomi,Atsushi Nishida,Masashi Ohno,Takayuki Imai,Kenichiro Takahashi,Yuji Naito,Junichi Iwamoto,Akira Honda,Naohiro Inohara,Akira Andoh 대한장연구학회 2022 Intestinal Research Vol.20 No.3

Background/Aims: Crosstalk between the gut microbiota and bile acid plays an important role in the pathogenesis of gastrointestinal disorders. We investigated the relationship between microbial structure and bile acid metabolism in the ileal mucosa of Crohn’s disease (CD).Methods: Twelve non-CD controls and 38 CD patients in clinical remission were enrolled. Samples were collected from the distal ileum under balloon-assisted enteroscopy. Bile acid composition was analyzed by liquid chromatography-mass spectrometry. The gut microbiota was analyzed by 16S rRNA gene sequencing.Results: The Shannon evenness index was significantly lower in endoscopically active lesions than in non-CD controls. β-Diversity, evaluated by the UniFrac metric, revealed a significant difference between the active lesions and non-CD controls (<i>P</i>=0.039). The relative abundance of <i>Escherichia</i> was significantly higher and that of <i>Faecalibacterium</i> and <i>Roseburia</i> was significantly lower in CD samples than in non-CD controls. The increased abundance of <i>Escherichia</i> was more prominent in active lesions than in inactive lesions. The proportion of conjugated bile acids was significantly higher in CD patients than in non-CD controls, but there was no difference in the proportion of primary or secondary bile acids. The genera <i>Escherichia</i> and <i>Lactobacillus</i> were positively correlated with the proportion of conjugated bile acids. On the other hand, <i>Roseburia</i>, <i>Intestinibacter</i>, and <i>Faecalibacterium</i> were negatively correlated with the proportion of conjugated bile acids.Conclusions: Mucosa-associated dysbiosis and the alteration of bile acid composition were identified in the ileum of CD patients. These may play a role in the pathophysiology of ileal lesions in CD patients.

Contraindication of Minimally Invasive Lateral Interbody Fusion for Percutaneous Reduction of Degenerative Spondylolisthesis: A New Radiographic Indicator of Bony Lateral Recess Stenosis Using I Line

Ishii Ken,Isogai Norihiro,Shiono Yuta,Yoshida Kodai,Takahashi Yoshiyuki,Takeshima Kenichiro,Nakayama Masanori,Funao Haruki 대한척추외과학회 2021 Asian Spine Journal Vol.15 No.4

Study DesignRetrospective cohort study.PurposeThis study aimed to evaluate aggravated lateral recess stenosis and clarify the indirect decompression threshold by combined lateral interbody fusion and percutaneous pedicle screw fixation (LIF/PPS).Overview of LiteratureNo previous reports have described an effective radiographic indicator for determining the surgical indication for LIF/PPS.MethodsA retrospective review of 185 consecutive patients, who underwent 1- or 2-level lumbar fusion surgery for degenerative spondylolisthesis (DS). According to their symptomatic improvement, they were placed into either the “recovery” or “no-recovery” group. Preoperative computed tomography (CT) images were evaluated for the position of the superior articular processes at the slipping level, followed by a graded classification (grades 0–3) using the impingement line (I line), a new radiographic indicator. All 432 superior articular facets in 216 slipped levels were classified, and both groups’ characteristics were compared.ResultsThere were 171 patients (92.4%) in the recovery group and 14 patients in the no-recovery group (7.6%). All patients in the no-recovery group were diagnosed with symptoms associated with deteriorated bony lateral recess stenosis. All superior articular processes of the lower vertebral body in affected levels reached and exceeded the I line (I line-; grade 2 and 3) on preoperative sagittal CT images. In the recovery group, most superior articular processes did not reach the I line (I line+; grade 0 and 1; p=0.0233).ConclusionsIn DS cases that are classified as grade 2 or greater, the risk of aggravated bony lateral recess stenosis due to corrective surgery is high; therefore, indirect decompression by LIF/PPS is, in principle, contraindicated.