1.White Opaque Substance, a New Optical Marker on Magnifying Endoscopy: Usefulness in Diagnosing Colorectal Epithelial Neoplasms
Kazutomo YAMASAKI ; Takashi HISABE ; Kenshi YAO ; Hiroshi ISHIHARA ; Kentaro IMAMURA ; Tatsuhisa YASAKA ; Hiroshi TANABE ; Akinori IWASHITA ; Toshiharu UEKI
Clinical Endoscopy 2021;54(4):570-577
Background/Aims:
A white substance that is opaque to endoscopic light is sometimes observed in the epithelium during narrowband imaging with magnifying endoscopy of gastric or colorectal epithelial neoplasms. This prospective observational study aimed to determine whether the morphology of the white opaque substance (WOS) allows differential diagnosis between colorectal adenoma and carcinoma.
Methods:
A consecutive series of patients with colorectal adenomas or early carcinomas who underwent endoscopic resection or surgical excision were studied. The morphology of the WOS was determined based on endoscopic images before the histopathological diagnosis was performed. The primary outcome was the diagnostic performance of an irregular WOS as a marker of colorectal carcinoma.
Results:
The study analyzed 125 lesions. A total of 33 lesions showed an irregular WOS, and 92 lesions showed a regular WOS. Among the 33 lesions found to show an irregular WOS, 30 were carcinomas. Among the 92 lesions showing a regular WOS, 79 were adenomas. With irregular WOS as a marker of carcinoma, the diagnostic accuracy was 87%, sensitivity was 91%, and specificity was 86%.
Conclusions
This study demonstrated the potential usefulness of the morphology of the WOS as a marker for the differential diagnosis between adenoma and carcinoma in cases of colorectal epithelial neoplasms.
2.White Opaque Substance, a New Optical Marker on Magnifying Endoscopy: Usefulness in Diagnosing Colorectal Epithelial Neoplasms
Kazutomo YAMASAKI ; Takashi HISABE ; Kenshi YAO ; Hiroshi ISHIHARA ; Kentaro IMAMURA ; Tatsuhisa YASAKA ; Hiroshi TANABE ; Akinori IWASHITA ; Toshiharu UEKI
Clinical Endoscopy 2021;54(4):570-577
Background/Aims:
A white substance that is opaque to endoscopic light is sometimes observed in the epithelium during narrowband imaging with magnifying endoscopy of gastric or colorectal epithelial neoplasms. This prospective observational study aimed to determine whether the morphology of the white opaque substance (WOS) allows differential diagnosis between colorectal adenoma and carcinoma.
Methods:
A consecutive series of patients with colorectal adenomas or early carcinomas who underwent endoscopic resection or surgical excision were studied. The morphology of the WOS was determined based on endoscopic images before the histopathological diagnosis was performed. The primary outcome was the diagnostic performance of an irregular WOS as a marker of colorectal carcinoma.
Results:
The study analyzed 125 lesions. A total of 33 lesions showed an irregular WOS, and 92 lesions showed a regular WOS. Among the 33 lesions found to show an irregular WOS, 30 were carcinomas. Among the 92 lesions showing a regular WOS, 79 were adenomas. With irregular WOS as a marker of carcinoma, the diagnostic accuracy was 87%, sensitivity was 91%, and specificity was 86%.
Conclusions
This study demonstrated the potential usefulness of the morphology of the WOS as a marker for the differential diagnosis between adenoma and carcinoma in cases of colorectal epithelial neoplasms.
3.Association between occurrence of multiple white and flat elevated gastric lesions and oral proton pump inhibitor intake
Rino HASEGAWA ; Kenshi YAO ; Takao KANEMITSU ; Hisatomi ARIMA ; Takayuki HIRASE ; Yuuya HIRATSUKA ; Kazuhiro TAKEDA ; Kentaro IMAMURA ; Kensei OHTSU ; Yoichiro ONO ; Masaki MIYAOKA ; Takashi HISABE ; Toshiharu UEKI ; Hiroshi TANABE ; Atsuko OHTA ; Satoshi NIMURA
Clinical Endoscopy 2024;57(1):65-72
Background/Aims:
Multiple white and flat elevated lesions (MWFL) that develop from the gastric corpus to the fornix may be strongly associated with oral antacid intake. Therefore, this study aimed to determine the association between the occurrence of MWFL and oral proton pump inhibitor (PPI) intake and clarify the endoscopic and clinicopathological characteristics of MWFL.
Methods:
The study included 163 patients. The history of oral drug intake was collected, and serum gastrin levels and anti-Helicobacter pylori immunoglobulin G antibody titers were measured. Upper gastrointestinal endoscopy was performed. The primary study endpoint was the association between MWFL and oral PPI intake.
Results:
In the univariate analyses, MWFL were observed in 35 (49.3%) of 71 patients who received oral PPIs and 10 (10.9%) of 92 patients who did not receive oral PPIs. The occurrence of MWFL was significantly higher among patients who received PPIs than in those who did not (p<0.001). Moreover, the occurrence of MWFL was significantly higher in patients with hypergastrinemia (p=0.005). In the multivariate analyses, oral PPI intake was the only significant independent factor associated with the presence of MWFL (p=0.001; odds ratio, 5.78; 95% confidence interval, 2.06–16.2).
Conclusions
Our findings suggest that oral PPI intake is associated with the presence of MWFL (UMINCTR 000030144).
4.Trough level of infliximab is useful for assessing mucosal healing in Crohn's disease: a prospective cohort study.
Akihiro KOGA ; Toshiyuki MATSUI ; Noritaka TAKATSU ; Yasumichi TAKADA ; Masahiro KISHI ; Yutaka YANO ; Takahiro BEPPU ; Yoichiro ONO ; Kazeo NINOMIYA ; Fumihito HIRAI ; Takashi NAGAHAMA ; Takashi HISABE ; Yasuhiro TAKAKI ; Kenshi YAO ; Hirotsugu IMAEDA ; Akira ANDOH
Intestinal Research 2018;16(2):223-232
BACKGROUND/AIMS: Decreased trough levels of infliximab (TLI) and antibodies to infliximab (ATI) are associated with loss of response (LOR) in Crohn's disease. Two prospective studies were conducted to determine whether TLI or ATI better correlates with LOR (Study 1), and whether TLI could become a predictor of mucosal healing (MH) (Study 2). METHODS: Study 1 was conducted in 108 patients, including those with LOR and remission to compare ATI and TLI in discriminating the 2 conditions based on receiver operating characteristic (ROC) curve analyses. Study 2 involved 35 patients who were evaluated endoscopically. RESULTS: In Study 1, there were no differences between the 2 assays in ROC curve analyses; the TLI cutoff value for LOR was 2.6 µg/mL (sensitivity, 70.9%; specificity, 79.2%), and the ATI cutoff value was 4.9 µg/mL (sensitivity, 65.5%; specificity, 67.9%). The AUROC (area under the ROC curve) of TLI was greater than that of ATI. AUROC was useful for discriminating between the 2 conditions. In Study 2, the TLI was significantly higher in the colonic MH group than in the non-MH group (2.7 µg/mL vs. 0.5 µg/mL, P=0.032). CONCLUSIONS: TLI is better than ATI for clinically diagnosing LOR, and a correlation was observed between TLI and colonic MH.
Antibodies
;
Cohort Studies*
;
Colon
;
Crohn Disease*
;
Humans
;
Infliximab*
;
Prospective Studies*
;
ROC Curve
;
Sensitivity and Specificity
5.Risk factors for severity of colonic diverticular hemorrhage.
Ken KINJO ; Toshiyuki MATSUI ; Takashi HISABE ; Hiroshi ISHIHARA ; Toshiki KOJIMA ; Kenta CHUMAN ; Shigeyoshi YASUKAWA ; Tsuyoshi BEPPU ; Akihiro KOGA ; Satoshi ISHIKAWA ; Masahiro KISHI ; Noritaka TAKATSU ; Fumihito HIRAI ; Kenshi YAO ; Toshiharu UEKI ; Masakazu WASHIO
Intestinal Research 2018;16(3):458-466
BACKGROUND/AIMS: Colonic diverticular hemorrhage (DH) was a rare disease until the 1990s, and its incidence has increased rapidly since 2000 in Japan. In recent years, colonic DH has been the most frequent cause of lower gastrointestinal bleeding (LGIB). Nearly all cases of DH are mild, with the bleeding often stopping spontaneously. Some cases, however, require surgery or arterial embolization. In this study, using a cohort at Fukuoka University Chikushi Hospital, we investigated factors associated with severe colonic DH. METHODS: Among patients with LGIB who underwent colonoscopy at our hospital between 1995 and 2013, DH was identified in 273 patients. Among them, 62 patients (22.7%) were defined as having severe colonic DH according to recurrence of bleeding in a short period, and/or the necessity of transfusion, arterial embolization, or surgery. We then evaluated risk factors for severe DH among DH patients in this retrospective cohort. RESULTS: Among the 273 patients with DH, use of non-steroidal anti-inflammatory drugs (NSAIDs) (odds ratio [OR], 2.801; 95% confidence interval [CI], 1.164–6.742), Charlson Risk Index (CRI) ≥2 (OR, 3.336; 95% CI, 1.154–7.353), right-sided colonic DH (OR, 3.873; 95% CI, 1.554–9.653), and symptoms of cerebral hypoperfusion (such as light-headedness, dizziness, or syncope) (OR, 2.926; 95% CI, 1.310–6.535) showed an increased risk of severe DH even after controlling for other factors. CONCLUSIONS: Severe DH occurred in 23% of DH patients, and NSAID use, CRI ≥2, right-sided colonic DH, and symptoms of cerebral hypoperfusion are suggested to be predictors of severe DH.
Anti-Inflammatory Agents, Non-Steroidal
;
Cohort Studies
;
Colon*
;
Colonoscopy
;
Dizziness
;
Hemorrhage*
;
Humans
;
Incidence
;
Japan
;
Rare Diseases
;
Recurrence
;
Retrospective Studies
;
Risk Factors*
6.Efficacy of endoscopy under general anesthesia for the detection of synchronous lesions in oro-hypopharyngeal cancer
Yoichiro ONO ; Kenshi YAO ; Yasuhiro TAKAKI ; Satoshi ISHIKAWA ; Kentaro IMAMURA ; Akihiro KOGA ; Kensei OHTSU ; Takao KANEMITSU ; Masaki MIYAOKA ; Takashi HISABE ; Toshiharu UEKI ; Atsuko OTA ; Hiroshi TANABE ; Seiji HARAOKA ; Satoshi NIMURA ; Akinori IWASHITA ; Susumu SATO ; Rumie WAKASAKI
Clinical Endoscopy 2023;56(3):315-324
Background/Aims:
Image-enhanced endoscopy can detect superficial oro-hypopharyngeal squamous cell carcinoma; however, reliable endoscopy of the pharyngeal region is challenging. Endoscopy under general anesthesia during transoral surgery occasionally reveals multiple synchronous lesions that remained undetected on preoperative endoscopy. Therefore, we aimed to determine the lesion detection capability of endoscopy under general anesthesia for superficial oro-hypopharyngeal squamous cell carcinoma.
Methods:
This retrospective study included 63 patients who underwent transoral surgery for superficial oropharyngeal squamous cell carcinoma between April 2005 and December 2020. The primary endpoint was to compare the lesion detection capabilities of preoperative endoscopy and endoscopy under general anesthesia. Other endpoints included the comparison of clinicopathological findings between lesions detected using preoperative endoscopy and those newly detected using endoscopy under general anesthesia.
Results:
Fifty-eight patients (85 lesions) were analyzed. The mean number of lesions per patient detected was 1.17 for preoperative endoscopy and 1.47 for endoscopy under general anesthesia. Endoscopy under general anesthesia helped detect more lesions than preoperative endoscopy did (p<0.001). The lesions that were newly detected on endoscopy under general anesthesia were small and characterized by few changes in color and surface ruggedness.
Conclusions
Endoscopy under general anesthesia for superficial squamous cell carcinoma is helpful for detecting multiple synchronous lesions.