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Endoscopic Submucosal Dissection for Early Gastric Cancer  [PDF]
Kouichi Nonaka, Hiroto Kita
Journal of Cancer Therapy (JCT) , 2013, DOI: 10.4236/jct.2013.41A004
Abstract: The field of endoscopy has progressed markedly and become widespread in recent years, and the role of minimally invasive endoscopic treatment has become increasingly more important with the increase in the number of patients in whom gastric cancer is detected at an early stage. In addition, the characteristics of early gastric cancer, which can be curably treated by mucosal resection alone just as by surgical cancer resection, were clarified, and endoscopic submucosal dissection (ESD) was developed as a highly curable, minimally invasive treatment, that is gaining popularity. In this paper, we describe the technical details and complications of ESD for early gastric cancer, including their management.
Endoscopic Diagnosis of Gastric MALT Lymphoma  [PDF]
Kouichi Nonaka, Ken Ohata, Nobuyuki Matsuhashi
Journal of Cancer Therapy (JCT) , 2014, DOI: 10.4236/jct.2014.55051

The endoscopic findings of gastric MALT lymphoma are variable, making its diagnosis very difficult. Although there are many reports on the endoscopic findings of gastric cancer, there are few on those of gastric MALT lymphoma. Herein, we summarize the reports on the endoscopic findings of gastric MALT lymphoma, and report its endoscopic diagnosis.

Fetal Anemia Caused by Prenatal Gastrointestinal Bleeding: A Case Report  [PDF]
Kensuke Matsumoto, Masayuki Yamaguchi, Taro Nonaka, Takayuki Enomoto, Kouichi Takakuwa
Open Journal of Obstetrics and Gynecology (OJOG) , 2016, DOI: 10.4236/ojog.2016.67050
Abstract: A 39-year-old 34-week-pregnant woman was referred to our hospital for preterm labor and fetal dysfunction. Fetal middle cerebral artery systolic maximum blood flow velocity was high, so fetal anemia was suspected. Blood type was O-type Rh (+) and fetal hemoglobin was 0.4%; tests for irregular antibody and human parvovirus B19 IgM were negative. A high brightness echoic mass was observed in fetal stomach bubble, and amniotic fluid appeared bright. Labor suppression was disabled, and emergency cesarean section was performed. Amniotic fluid turbidity was observed, and on suctioning the stomach content of the infant, turbid amniotic fluid containing blood was obtained. On placental pathological examination, the cause of bloody amniotic fluid was not identified. The infant’s hemoglobin level was low at 8.7 g/dL, so the infant received red cell concentrate, with improvement of general condition.
Role of narrow band imaging in endoscopic submucosal dissection
Kouichi Nonaka,Makoto Nishimura,Hiroto Kita
World Journal of Gastrointestinal Endoscopy , 2012, DOI: 10.4253/wjge.v4.i9.387
Abstract: Narrow band imaging (NBI) is a new image enhancement system employing optic digital methods to enhance images of blood vessels on mucosal surfaces, allowing improved visualization of mucosal surface structures. Studies have progressed over the last several years, and the clinical usefulness has been demonstrated. NBI has become frequently applied for preoperative diagnosis before endoscopic submucosal dissection (ESD) of digestive tract cancers, as well as for assessment of the range of ESD for en-bloc resection of large lesions. Consensus has been reached with regard to the usefulness of NBI for detecting micro-lesions of esophageal squamous cell carcinoma indicated for ESD, for the diagnosis of the range and depth. NBI has also been attracting attention for diagnosing gastric cancer based on the observation of micro blood vessels on the mucosal surface and mucosal surface microstructures. The usefulness of NBI has been reported in relation to various aspects of colon cancer, including diagnoses of the presence, quality, range, and depth of lesions. However, as NBI has not surpassed diagnostic methods based on magnifying observation combined with the established and widely employed dye method, its role in ESD is limited at present. Although NBI is very useful for the diagnosis of digestive tract cancers, comprehensive endoscopic diagnosis employing the combination of conventional endoscopy including dye spraying, EUS, and NBI may be important and essential for ESD.
Usefulness of the DL in ME with NBI for determining the expanded area of early-stage differentiated gastric carcinoma
Kouichi Nonaka,Masaaki Namoto,Hideki Kitada,Michio Shimizu
World Journal of Gastrointestinal Endoscopy , 2012, DOI: 10.4253/wjge.v4.i8.362
Abstract: AIM: To investigate whether magnifying endoscopy with narrow band imaging (ME-NBI) is useful for evaluating the area of superficial, depressed- or flat-type differentiated adenocarcinoma of the stomach. METHODS: This procedure was performed in Saitama Medical University International Medical Center, Japanese Red Cross Kumamoto Hospital and Kitakyushu Municipal Medical Center. The subjects were 31 patients in whom biopsy findings, from superficial, depressed- or flat-type gastric lesion, suggested differentiated adenocarcinoma in the above 3 hospitals between January and December 2009. Biopsy was performed on the lesion and non-lesion sides of a boundary (imaginary boundary) visualized on ME-NBI. The results were pathologically investigated. We evaluated the accuracy of estimating a demarcation line (DL) on ME-NBI in comparison with biopsy findings as a gold standard. RESULTS: The DL that could be recognized at 2 points on the orifice and anal sides of each lesion during ME-NBI was consistent with the pathological findings in 22 patients with 0-IIc lesions, 7 with 0-IIb lesions, and 2 with 0-IIb + IIc lesions, showing an accuracy of 100%. CONCLUSION: The results suggest the usefulness of ME-NBI for evaluating the area of superficial, depressed- and flat-type differentiated adenocarcinoma of the stomach.
Short term results of endoscopic submucosal dissection in superficial esophageal squamous cell neoplasms
Kouichi Nonaka,Shin Arai,Keiko Ishikawa,Masamitsu Nakao
World Journal of Gastrointestinal Endoscopy , 2010,
Abstract: AIM: To evaluate the efficacy of endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms.METHODS: Between July 2007 and March 2009, 27 consecutive superficial esophageal squamous cell neoplasms in 25 enrolled patients were treated by endoscopic submucosal dissection. The therapeutic efficacy, complications, and follow-up results were assessed.RESULTS: The mean size of the lesions was 21 ± 13 mm (range 2-55 mm); the mean size of the resection specimens was 32 ± 12 mm (range 10-70 mm). The en block resection rate was 100% (27/27), and en block resection with tumor-free lateral/basal margins was 88.9% (24/27). Perforation occurred in 1 patient who was managed by conservative medical treatments. None of the patients developed local recurrence or distant metastasis in the follow-up period.CONCLUSION: Endoscopic submucosal dissection is applicable to superficial esophageal squamous cell neoplasms with promising results.
A case of gastric mucosa-associated lymphoid tissue lymphoma in which magnified endoscopy with narrow band imaging was useful in the diagnosis
Kouichi Nonaka,Keiko Ishikawa,Shin Arai,Masamitsu Nakao
World Journal of Gastrointestinal Endoscopy , 2012, DOI: 10.4253/wjge.v4.i4.151
Abstract: Recently, we reported a case of gastric mucosa-associated lymphoid tissue (MALT) lymphoma presenting with unique vascular features. In the report, we defined the tree-like appearance (TLA) on the images of abnormal blood vessels which resembled branches from the trunk of a tree in the shiny mucosa, in which the glandular structure was lost. The 67-year-old female was diagnosed with gastric MALT lymphoma. The patient received eradication therapy for H. pylori. Conventional endoscopy revealed multiple ill-delineated brownish depressions in the stomach and cobblestone-like mucosa was observed at the greater curvature to the posterior wall of the upper gastric body 7 mo after successful eradication. Unsuccessful treatment of gastric MALT lymphoma was suspected on conventional endoscopy. Conventional endoscopic observations found focal depressions and cobblestone-like appearance, and these lesions were subsequently observed using magnified endoscopy combined with narrow band imaging to identify abnormal vessels presenting with a TLA within the lesions. Ten biopsies were taken from the area where abnormal vessels were present within these lesions. Ten biopsies were also taken from the lesions without abnormal vessels as a control. A total of 20 biopsy samples were evaluated to determine whether the diagnosis of MALT lymphoma could be obtained histologically from each sample. A positive diagnosis was obtained in 8/10 TLA (+) sites and in 2/10 TLA(-) sites. Target biopsies of the site with abnormal blood vessels can potentially improve diagnostic accuracy of gastric MALT lymphoma.
Endoscopic Submucosal Dissection for Large Colorectal Tumor in a Japanese General Hospital
Ken Ohata,Kouichi Nonaka,Yohei Minato,Yoshitsugu Misumi,Tomoaki Tashima,Meiko Shozushima,Takahiro Mitsui,Nobuyuki Matsuhashi
Journal of Oncology , 2013, DOI: 10.1155/2013/218670
Abstract: Background and Aims. Endoscopic submucosal dissection (ESD) is not widely used in large colorectal lesions because of technical difficulty and possible complications. We aimed to examine the efficacy and safety of ESD for large colorectal neoplasms. Patients and Methods. During the past 5 years, 608 cases of colorectal neoplasm (≧20?mm) were treated by ESD. They were divided into Group A (20–49?mm, 511 cases) and Group B (≧50?mm, 97 cases). Results. The average age, lesion size, and procedure time were 67.4 years, 30.0?mm, and 60.0?min in Group A, and they were 67.1 years, 64.2?mm, and 119.6?min in Group B. En bloc resection rates were 99.2% and 99.0% ( ), and complication rates were 4.1% and 9.9% ( ). Complications in Group A consisted of perforation (2.7%), bleeding (1.2%), and ischemic colitis (0.2%). Those in Group B were perforation (8.2%) and bleeding (1.0%). Two cases in Group A and none in Group B required emergency surgery for perforation. Conclusions. There was no difference in efficacy between Groups A and B. Complications were more frequent in Group B, but all perforations in Group B were successfully managed conservatively. ESD can be effective and safe for large colorectal tumors. 1. Introduction More than 20 years have passed since the introduction of endoscopic mucosal resection (EMR) to the treatment of digestive tract tumors, and the endoscopic treatment is now widely performed for early digestive tract cancers including stomach esophageal, and colon cancers [1–4]. More recently, endoscopic submucosal dissection (ESD) has been developed as a new technique [5], and an en bloc endoscopic resection of large lesions and lesions with ulcer scars has become possible [6]. ESD is a minimally invasive treatment and enables the en bloc resection for early colorectal neoplasm. However, it is not widely used in the large neoplastic lesions because of technical difficulty and complications. It has been reported that the tumor size of 50?mm or large is an independent risk factor for complications [7]. We aimed to examine the safety, efficacy and complications of ESD for large colorectal neoplasms (larger than 20?mm) in a nonacademic hospital in Japan, retrospectively. 2. Patients and Methods We have treated 608 cases of colorectal neoplasm (size ≧20?mm) from July 2007 to December 2012. All cases were carried out with 1 expert and/or 5 novice endoscopists who had performed under expert’s supervision. We have treated 608 cases of colorectal neoplasm (size ≧20?mm) from July 2007 to December 2012. We divided the cases into two groups by size: Group A
Status of the Gastric Mucosa with Endoscopically Diagnosed Gastrointestinal Stromal Tumor
Kouichi Nonaka,Shinichi Ban,Yoshimitsu Hiejima,Rei Narita,Michio Shimizu,Masayasu Aikawa,Ken Ohata,Nobuyuki Matsuhashi,Shin Arai,Hiroto Kita
Diagnostic and Therapeutic Endoscopy , 2014, DOI: 10.1155/2014/429761
Abstract: Background. Since gastrointestinal stromal tumor (GIST) is a mesenchymal submucosal tumor, the endosonographic, CT, and MRI features of gastric GISTs have been widely investigated. However, the GIST-bearing gastric mucosa status has not been reported. Objective. To characterize the GIST-bearing gastric mucosa status in terms of the degree of inflammation and atrophy, assessed endoscopically. Subjects and Methods. The subjects were 46 patients with submucosal tumors (histologically proven gastric GISTs) who had undergone upper gastrointestinal endoscopy in our hospital between April 2007 and September 2012. They were retrospectively evaluated regarding clinicopathological features, the endoscopically determined status of the entire gastric mucosa (presence or absence and degree of atrophy), presence or absence and severity of endoscopic gastritis/atrophy (A-B classification) at the GIST site, and presence or absence of H. pylori infection. Results. Twenty-three patients had no mucosal atrophy, but 17 and 6 had closed- and open-type atrophy, respectively. Twenty-six, 5, 12, 1, 1, and 1 patients had grades B0, B1, B2, B3, A0, and A1 gastritis/atrophy at the lesion site, respectively, with no grade A2 gastritis/atrophy. Conclusion. The results suggest that gastric GISTs tend to arise in the stomach wall with H. pylori-negative, nonatrophic mucosa or H. pylori-positive, mildly atrophic mucosa. 1. Introduction Gastric gastrointestinal stromal tumor (GIST) is a mesenchymal tumor arising from the muscularis propria of the gastric wall and is covered with normal mucosa, giving the endoscopic appearance of a submucosal tumor with bridging folds. Since gastric GIST is a submucosal tumor, its endosonographic, CT, and MRI features have been widely investigated [1–4]. However, the status of the GIST-bearing gastric mucosa itself has not been reported. Based on our experience, many GIST patients often show no evidence of H. pylori infection, gastritis, or mucosal atrophy on upper gastrointestinal endoscopy, and even H. pylori-infected patients may show mild gastritis in the background gastric mucosa. We consider that it is necessary to evaluate the GIST-bearing gastric mucosa using available data before testing the validity of this empirical rule and investigate the reason for it, if it is valid. In this study, we retrospectively evaluated patients with submucosal tumors (histologically proven gastric GISTs) regarding the age, gender, site and size of the lesion, risk classification of GISTs, presence or absence and degree of endoscopic atrophy in the entire gastric
Risperidone Versus Yokukansan in the Treatment of Severe Alzheimer’s Disease  [PDF]
Yuko Furuhashi, Kouichi Shin
International Journal of Clinical Medicine (IJCM) , 2011, DOI: 10.4236/ijcm.2011.22028
Abstract: PURPOSE: Patients with AD commonly exhibit behavioral and psychological symptoms of dementia (BPSD). This study is aimed to compare the efficacy of yokukansan (YKS) and risperidone (RIS) on BPSD in patients with severe Alzheimer’s disease (AD). METHODS: Thirty eight inpatients with AD were investigated. Patients were randomly as-signed to the YKS group (N = 18) or the RIS group (N = 20) and treated for 4 weeks. The primary outcomes were changes in the scores on the Neuropsychiatric Inventory (NPI), the Mini-Mental State Examination (MMSE), the Bar-thel Index, and the Cohen-Mansfield Agitation Inventory (CMAI). The frequency of extrapyramidal symptoms (EPS) and other adverse events were recorded at every visit. RESULTS: All participants in both groups completed the trial. The Barthel Index did not significantly change either in the RIS group or the YKS group. The MMSE scores did not change either in the RIS group or the YKS group. Significant improvements in mean total NPI and CMAI scores showed in both groups. Between the YKS and the RIS groups, there were no significant differences in the NPI or the CMAI scores. EPS and other serious adverse effects were not observed in either group. CONCLUSIONS: In this 4-week trial, YKS treatment significantly improved BPSD in the patients with severe AD. The present study suggests that YKS is as effective as RIS on BPSD with severe AD.
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