Details of the Researcher

PHOTO

Masahiro Saito
Section
Tohoku University Hospital
Job title
Assistant Professor
Degree

  • 博士（医学）（東北大学）

e-Rad No.
90837600

Research Areas 1

  • Life sciences / Gastroenterology /

Papers 142

  1. Usefulness of double-balloon endoscopy-assisted injection sclerotherapy for hemorrhagic varices in the jejunum reconstructed for liver transplantation in a pediatric case.

    Hiroki Kajiura, Kaname Uno, Kiyoshi Kume, Tomoyuki Koike, Masahiro Saito, Yusuke Shimoyama, Masashi Ninomiya, Sota Oguro, Kei Takase, Atsushi Masamune

    Clinical journal of gastroenterology　2025/05/27

    DOI： 10.1007/s12328-025-02150-x 　

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    A 10-year-old girl was admitted to our hospital for treatment of recurrent melena and severe anemia. Her treatment history comprised Kasai's portoenterostomy for biliary atresia as an infant, followed by liver transplantation and partial splenectomy for portal hypertension at 1 year old. Her medications comprised steroids, immunosuppressive agents, a β-blocker, and a potassium-competitive acid blocker. Since the age of 5 years, she had repeatedly visited a local hospital for melena, but the bleeding source had not been identified. She was referred to our hospital, and laboratory data revealed severe anemia. An enhanced computed tomography showed post-liver transplantation status, splenomegaly, and gastric varices, without extravasation. Esophagogastroduodenoscopy and colonoscopy did not identify the bleeding source. Double-balloon endoscopy (DBE) revealed variceal bleeding and serosanguinous fluid accumulated at the choledochojejunostomy site in the jejunum. After obtaining informed consent, our team and the radiologists cooperatively performed DBE-assisted endoscopic injection sclerotherapy with 75% n-butyl-2-cyanoacrylate through a 23- gage needle according to high-resolution varicerography in a hybrid emergency room. Subsequently, the patient was discharged and regularly monitored without any complications. We demonstrated the first pediatric case of successful DBE-assisted endoscopic injection for hemorrhagic jejunal varices after liver transplantation for biliary atresia and partial splenectomy.

  2. Associations between excessive supragastric belching and esophageal reflux factors in patients with PPI-refractory GERD in Japan.

    Yukihiro Shuto, Masahiro Saito, Tomoyuki Koike, Kaoru Koizumi, Yumiko Kaise, Kazuma Yachi, Yutaka Hatayama, Yohei Ogata, Xiaoyi Jin, Takeshi Kanno, Waku Hatta, Kaname Uno, Naoki Asano, Akira Imatani, Atsushi Masamune

    Journal of gastroenterology　2025/05/12

    DOI： 10.1007/s00535-025-02258-4 　

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    BACKGROUND: No studies have evaluated the prevalence of supragastric belching (SGB) in Japanese patients with proton pump inhibitor (PPI)-refractory non-erosive reflux disease (NERD) under off-PPI conditions. This study aimed to clarify the association between excessive SGB and esophageal reflux factors. METHODS: Seventy-nine patients with PPI-refractory NERD under off-PPI treatment were evaluated using 24-h multichannel intraluminal impedance pH monitoring and high-resolution impedance manometry. RESULTS: The prevalence values of excessive SGB overall and in the true NERD, reflux hypersensitivity, and function heartburn subtypes were 19.0%, 35.7%, 5.3%, and 12.5%, respectively. The monitoring results demonstrated that, compared with those without excessive SGB, patients with excessive SGB had a significantly higher total number of reflux events (63 episodes vs. 39 episodes, p = 0.01) and significantly greater acid exposure time (6.1% vs. 1.35%, p = 0.01). However, bolus exposure did not differ significantly between the groups (p = 0.09). The manometry findings showed no significant differences in lower esophageal sphincter pressure, integrated relaxation pressure, and distal contractile integral between the groups. Regarding gastroesophageal reflux, 22% of the SGB episodes were preceded by reflux, 55% occurred independently, and 23% were followed by reflux. CONCLUSIONS: The prevalence of excessive SGB in Japanese patients with PPI-refractory NERD under off-PPI conditions was 19.0% and most commonly observed in patients with true NERD (35.7%). Patients with excessive SGB exhibited increased esophageal acid exposure, and reflux events were sometimes observed before SGB episodes.

  3. Prevalence and Distribution of Gastric Endoscopy Findings in Non-eosinophilic Esophagitis Eosinophilic Gastrointestinal Diseases: Influence of Atrophic Gastritis.

    Naoko Mizumoto, Yasuhiko Abe, Yu Sasaki, Makoto Yagi, Yusuke Onozato, Yasushi Takahashi, Nobuyuki Ara, Eiki Nomura, Masashi Kawamura, So Takahashi, Sho Asonuma, Masakuni Shoji, Yutaka Kondo, Wataru Iwai, Ryosuke Kikuchi, Masahiro Saito, Waku Hatta, Tomoyuki Koike, Tamotsu Matsuhashi, Katsunori Iijima, Atsushi Masamune, Yoshiyuki Ueno

    Internal medicine (Tokyo, Japan)　64　(8)　1161-1170　2025/04/15

    DOI： 10.2169/internalmedicine.4193-24 　

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    Objective The impact of Helicobacter pylori infection on gastric endoscopic findings in non-eosinophilic esophagitis eosinophilic gastrointestinal diseases (non-EoE EGIDs) remains unclear. This study investigated the influence of H. pylori infection on the prevalence and distribution of gastric lesions. Methods The details of 75 patients diagnosed with non-EoE EGIDs were retrospectively reviewed. Of the 56 patients with a definitive diagnosis according to the Japanese criteria (any GI tract; ≥20 eosinophils/high-power field), 25 patients with pathologic gastric eosinophilic infiltration (EI) (gastric EI; ≥30 eosinophils/high power field) were investigated in detail. The prevalence and distribution of gastric endoscopy findings were assessed according to the gastric mucosal atrophy status, an indicator of H. pylori infection. Results Erythema (76%) was the most common finding in the gastric EI-positive group, followed by erosions (36%), ulcers (28%), ulcer scars (28%), and edema (24%). None of these lesions differed significantly in frequency between the patients with and without gastric atrophy. When erosions, ulcers, and ulcer scars were unified, they were slightly more common in the gastric bodies of patients with gastric atrophy than those without gastric atrophy; however, no preferential site was found in those without gastric atrophy. We identified six patients with active gastric ulcers, and half had large, deep ulcers with marginal swelling/irregularity. Conclusion Gastric endoscopy findings in non-EoE EGIDs with gastric EI were evenly observed in the stomach, with no specific trend in frequency or distribution depending on atrophic gastritis, an indicator of H. pylori infection. Gastric ulcers in patients with non-EoE EGIDs should be considered in the differential diagnosis of idiopathic peptic ulcers.

  4. Prevalence and risk factors for lymph node metastasis in duodenal neuroendocrine tumors: a systematic review and meta-analysis

    Yohei Ogata, Waku Hatta, Takeshi Kanno, Yutaka Hatayama, Masahiro Saito, Xiaoyi Jin, Tomoyuki Koike, Akira Imatani, Yuhong Yuan, Atsushi Masamune

    Journal of Gastroenterology　60　(6)　673-682　2025/04/03

    Publisher: Springer Science and Business Media LLC

    DOI： 10.1007/s00535-025-02247-7 　

    ISSN： 0944-1174

    eISSN： 1435-5922

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    Abstract Background Although the status of lymph node metastasis (LNM) is crucial in determining treatment strategy for duodenal neuroendocrine tumors (D-NETs), robust evidence for their potential LNM risk remains lacking. This systematic review aimed to summarize the prevalence and risk factors of LNM in D-NETs. Methods This systematic review of electronic databases identified eligible case–control and cohort studies for D-NET resected either endoscopically or surgically, published from 1990 to 2023. The primary outcome was the pooled prevalence of LNM in D-NETs. Secondary outcomes included the pooled prevalence of LNM according to tumor location and functionality, as well as identifying pathological risk factors for LNM. Meta-analysis was performed. Results We identified 36 studies that involved 1,396 patients with D-NETs, including 326 with LNM. The pooled prevalence of LNM in D-NETs was 22.7% (95% confidence interval [CI] 17.3–29.2%). The prevalence was high in ampullary/peri-ampullary D-NETs and functional D-NETs (46.8 and 53.3%, respectively), whereas it was low in non-functional, non-ampullary D-NETs (NAD-NETs) (9.5%). Pathological risk factors for LNM in NAD-NETs included tumor size > 10 mm (odds ratio [OR] 7.31 [95% CI 3.28–16.31]), tumor invasion into the muscularis propria or deeper (OR 7.79 [3.65–16.61]), lymphovascular invasion (OR 5.67 [2.29–14.06]), and World Health Organization grading of G2 (OR 2.47 [1.03–5.92]). Conclusion Approximately one-fourth of the patients with D-NETs had LNM. Endoscopic resection might be acceptable for non-functional NAD-NETs with diameters of 10 mm or less, but additional surgical resection with lymphadenectomy may be recommended for cases exhibiting pathological risk factors.

  5. Type 2 and type 3 gastric neuroendocrine tumors have high risk of lymph node metastasis: Systematic review and meta‐analysis International-journal

    Yohei Ogata, Waku Hatta, Takeshi Kanno, Masahiro Saito, Xiaoyi Jin, Naoki Asano, Tomoyuki Koike, Akira Imatani, Yuhong Yuan, Atsushi Masamune

    Digestive Endoscopy　2025/04

    Publisher: Wiley

    DOI： 10.1111/den.15026 　

    ISSN： 0915-5635

    eISSN： 1443-1661

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    Objectives Lymph node metastasis (LNM) is crucial in determining treatment strategies for gastric neuroendocrine tumors (gNETs). While type 3 is considered more aggressive than types 1 and 2 within the clinical subtype of gNETs, the supporting data were insufficient, due to their rarity. We aimed to study the prevalence and risk factors associated with LNM in gNETs. Methods We searched electronic databases from 1990 to 2023 to identify case–control and cohort studies regarding gNETs resected either endoscopically or surgically. The primary outcome measured was the pooled prevalence of LNM in gNETs. Secondary outcomes included categorizing the prevalence of LNM by clinical subtypes and identifying pathological risk factors associated with LNM in gNETs. Results We included 28 studies, involving 1742 patients, among whom 240 had LNM (pooled prevalence rate, 11.8%; 95% confidence interval 7.6–17.9%). The pooled prevalence rates of LNM for type 1, type 2, and type 3 gNETs were 6.0%, 38.5%, and 23.2%, respectively. Type 2 (odds ratio [95% confidence interval] 11.53 [3.46–38.49]) and type 3 (6.88 [3.79–12.49]) gNETs exhibited a higher risk for LNM compared to type 1. Pathological risk factors for LNM included tumor size >10 mm (4.18 [1.91–9.17]), tumor invasion into the muscularis propria or deeper (11.21 [3.50–35.92]), grade 2/grade 3 (5.96 [2.65–13.40]), and lymphovascular invasion (34.50 [6.70–177.51]). Conclusion We demonstrated that type 2 gNETs, as well as type 3, had a high risk of LNM. Additionally, four pathological risk factors associated with LNM were identified.

  6. Which of vonoprazan alone or intravenous proton pump inhibitor followed by vonoprazan is optimal for reducing delayed bleeding in gastric endoscopic submucosal dissection? International-journal

    Hiroko Abe, Kunio Tarasawa, Waku Hatta, Naotaro Tanno, Yutaka Hatayama, Yohei Ogata, Masahiro Saito, Xiaoyi Jin, Tomoyuki Koike, Akira Imatani, Shin Hamada, Kenji Fujimori, Kiyohide Fushimi, Atsushi Masamune

    Digestion　1-19　2025/03/25

    DOI： 10.1159/000545253 　

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    BACKGROUND: In gastric endoscopic submucosal dissection (ESD), both vonoprazan alone and intravenous proton pump inhibitor (PPI) followed by vonoprazan have lower delayed bleeding risk than PPI alone. This study aimed to clarify an optimal acid-suppressive method in gastric ESD. METHODS: This population-based cohort study included patients who underwent gastric ESD on only vonoprazan (vonoprazan alone group) or intravenous PPI followed by vonoprazan (intravenous PPI group) using the Diagnosis Procedure Combination database in Japan between 2014 and 2021. The primary outcome was delayed bleeding. To balance the two comparison groups, propensity score matching (PSM), based on 18 variables, was performed; subsequently, to compare the bleeding outcome, logistic regression analysis was performed. RESULTS: Of 63,952 patients, 24,710 pairs were compared following PSM. The delayed bleeding risk in the vonoprazan alone group was similar to that in the intravenous PPI group (odds ratio [OR], 1.00; 95% confidence interval, 0.93-1.08; delayed bleeding rate, 5.9% vs. 5.9%). The results were consistent in some sensitivity and subgroup analyses; however, the result was modified by the status of antithrombotic agents (p for interaction = 0.029). In additional analyses, in patients with antithrombotic agent, the vonoprazan alone group had a higher delayed bleeding risk than the intravenous PPI group (OR, 1.15). CONCLUSION: Both vonoprazan alone and intravenous PPI followed by vonoprazan might be acceptable in gastric ESD when antithrombotic agents were not administered, whereas intravenous PPI followed by vonoprazan might be favorable in patients with antithrombotic agents.

  7. Validation of the Japanese version of the Esophageal Hypervigilance and Anxiety Scale for esophageal symptoms.

    Akinari Sawada, Yoshimasa Hoshikawa, Hiroko Hosaka, Masahiro Saito, Hirotaka Tsuru, Shunsuke Kato, Eikichi Ihara, Tomoyuki Koike, Toshio Uraoka, Kunio Kasugai, Katsuhiko Iwakiri, Daniel Sifrim, John Erik Pandolfino, Tiffany H Taft, Yasuhiro Fujiwara

    Journal of gastroenterology　60　(3)　265-274　2025/03

    DOI： 10.1007/s00535-024-02193-w 　

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    BACKGROUND: The Esophageal Hypervigilance and Anxiety Scale (EHAS) is an English questionnaire created in the USA to assess these factors in all patients with esophageal diseases. The aim of this study was to develop and validate the Japanese version of EHAS and investigate the relationship between EHAS scores and symptoms in untreated disorders of esophagogastric junction (EGJ) outflow. METHODS: This prospective study recruited patients who underwent high-resolution manometry (HRM) at six tertiary centers in Japan. The EHAS was translated to Japanese using standard forward and backward translation methods. Patients completed the following questionnaires: the Japanese EHAS, Eckardt score, Gastroesophageal Reflux Disease Questionnaire, and Hospital Anxiety and Depression Scale for assessment of construct validity. Logistic regression analysis identified factors associated with esophageal symptom severity in untreated disorders of EGJ outflow. RESULTS: Overall, we analyzed 432 patients. Their main symptoms were dysphagia and reflux. The most common HRM diagnosis was normal (35.9%), followed by achalasia (29.4%). The Japanese EHAS demonstrated excellent reliability, and construct validity, with two subscales similar to the original EHAS. Total EHAS score moderately correlated to Eckardt score (r = 0.545, p < 0.001). In 113 patients with untreated disorders of EGJ outflow, multivariable analysis demonstrated that younger age, type II achalasia, and higher EHAS score were independently associated with higher Eckardt score. CONCLUSIONS: The Japanese EHAS is a reliable and valid questionnaire. Its subscale scores can be used as in the original version with some caution. Future studies are warranted to assess the appropriateness of factor loading.

  8. Optimal direct oral anticoagulant for upper gastrointestinal endoscopic submucosal dissection.

    Yoshitaka Ono, Waku Hatta, Kunio Tarasawa, Yohei Ogata, Hiroko Abe, Isao Sato, Yutaka Hatayama, Masahiro Saito, Xiaoyi Jin, Kaname Uno, Tomoyuki Koike, Akira Imatani, Shin Hamada, Kenji Fujimori, Kiyohide Fushimi, Atsushi Masamune

    Journal of gastroenterology　60　(1)　66-76　2025/01

    DOI： 10.1007/s00535-024-02171-2 　

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    BACKGROUND: The patients taking direct oral anticoagulants (DOACs) are at high risk for developing ischemic stroke and delayed bleeding in upper gastrointestinal endoscopic submucosal dissection (ESD). We aimed to identify the optimal DOAC based on both adverse events in upper gastrointestinal ESD. METHODS: A retrospective population-based cohort study was conducted using the Diagnosis Procedure Combination database in Japan. We included patients on a DOAC undergoing upper gastrointestinal ESD between 2012 and 2021. The primary outcomes were ischemic stroke occurring after upper gastrointestinal ESD and delayed bleeding in gastroduodenal and esophageal ESD. Inverse probability weightings were applied to balance the four DOAC groups (dabigatran, rivaroxaban, apixaban, and edoxaban), and logistic regression analyses were performed to compare the outcomes. RESULTS: We analyzed 9729 patients on a DOAC undergoing upper gastrointestinal ESD. Ischemic stroke developed after upper gastrointestinal ESD in 1.4%, 0.7%, 0.6%, and 0.8% of patients taking dabigatran, rivaroxaban, apixaban, and edoxaban, respectively, after weighting. Rivaroxaban and apixaban showed significantly lower risk of ischemic stroke compared with dabigatran (odds ratio, 0.15 and 0.12, respectively) in standard doses. The delayed bleeding developed after gastroduodenal ESD in 7.6%, 14.6%, 19.2%, and 17.3% of patients taking each DOAC, respectively, with the lowest risk in dabigatran, followed by rivaroxaban. A similar pattern was observed in delayed bleeding in esophageal ESD (3.2%, 5.4%, 7.5%, and 5.5% in each DOAC), but with no significant results. CONCLUSIONS: Rivaroxaban might be an optimal DOAC for upper gastrointestinal ESD showing a lower risk for both ischemic stroke and delayed bleeding.

  9. A case of esophagogastric submucosal hematoma with hemorrhagic shock.

    Yumiko Kaise, Kaname Uno, Yohei Ogata, Masahiro Saito, Xiaoyi Jin, Waku Hatta, Tomoyuki Koike, Hideki Ota, Kei Takase, Atsushi Masamune

    Clinical journal of gastroenterology　18　(1)　48-52　2024/11/21

    DOI： 10.1007/s12328-024-02069-9 　

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    A 70-year-old woman had been taking steroids for granulomatosis with polyangiitis since the age of 60 years and warfarin for deep vein thrombosis since the age of 63 years. She was admitted to the emergency unit of our hospital in a shock vital with complaints of sudden onset of epigastralgia, nausea, and melena. Laboratory data revealed anemia, hypoalbuminemia, and coagulation disorders. Enhanced computed tomography demonstrated extravasation in the middle part of the gastric body in an extensive submucosal hematoma extending from the upper esophagus to the entire gastric body. Emergency esophagogastroduodenoscopy depicted a large submucosal hematoma and a large amount of fresh blood in the stomach; however, active bleeding was not identified. Two sessions of interventional radiology treatment in the emergency department, followed by an intensive care, successfully treated the patient without any complications. We report a unique case of a sudden-onset esophagogastric submucosal hematoma with hemorrhagic shock requiring an intensive care and interventional radiology treatment. In this case, the extensive warfarization and the fragility in vascular and connective tissue components in the submucosa due to the long-term steroid therapy and the granulomatosis with polyangiitis-related alteration might comprehensively cause severe esophagogastric submucosal hematoma even without any apparent triggers.

  10. A Case of Superficial Esophageal Neuroendocrine Carcinoma with Marked Morphological Changes in a Short Period.

    Mizuki Tanabe, Masahiro Saito, Kaname Uno, Tomoyuki Koike, Chiaki Sato, Waku Hatta, Naoki Asano, Fumiyoshi Fujishima, Takashi Kamei, Atsushi Masamune

    Internal medicine (Tokyo, Japan)　64　(11)　1666-1672　2024/11/01

    DOI： 10.2169/internalmedicine.4344-24 　

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    A de novo whitish subepithelial lesion (SEL) with irregular vascular hyperplasia was detected in the lower thoracic esophagus during endoscopic surveillance. Special types of esophageal cancer were suspected; however, endoscopic biopsy specimens were inadequate for a diagnosis. Ten days later, endoscopic ultrasound showed a 7-mm homogeneously hypoechoic round mass in the submucosa, and a biopsy confirmed a histological diagnosis of esophageal neuroendocrine carcinoma (eNEC). Based on the clinical diagnosis of cT2N0M0, subtotal esophagectomy followed by adjuvant chemotherapy was performed immediately after endoscopic reexamination revealing a 20-mm reddish SMT. We herein report the marked changes in endoscopic findings of eNEC within 1.5 months.

  11. 表在型Barrett食道癌の発見契機と特徴に関する検討

    小泉 薫, 齊藤 真弘, 小池 智幸, 谷地 一真, 首藤 千博, 皆瀬 ゆみ子, 畑山 裕, 尾形 洋平, 菅野 武, 金 笑奕, 八田 和久, 宇野 要, 浅野 直喜, 今谷 晃, 正宗 淳

    日本消化器がん検診学会雑誌　62　(Suppl大会)　744-744　2024/10

    Publisher: (一社)日本消化器がん検診学会

    ISSN： 1880-7666

    eISSN： 2185-1190

  12. 【スキルアップ内視鏡診療】口腔・咽頭・食道 観察・診断 好酸球性食道炎のサインを見逃すな 診断と鑑別

    小池 智幸, 齊藤 真弘, 八田 和久, 正宗 淳, 杉山 幸一

    消化器内視鏡　36　(増刊)　75-79　2024/10

    Publisher: (株)東京医学社

    ISSN： 0915-3217

  13. 胃瘻抜去後の瘻孔閉鎖不全に対してOTSCが有用であった一例

    小笠原 光矢, 金 笑奕, 小池 智幸, 畑山 裕, 尾形 洋平, 齊藤 真弘, 菅野 武, 八田 和久, 宇野 要, 正宗 淳

    PEG・在宅医療学会学術集会プログラム抄録集　28回　79-79　2024/09

    Publisher: PEG・在宅医療学会

  14. 大学病院における経皮内視鏡的胃瘻造設術の年次推移と合併症の変化

    小笠原 光矢, 金 笑奕, 小池 智幸, 矢野 翔太, 阿部 寛子, 尾形 洋平, 齊藤 真弘, 八田 和久, 宇野 要, 正宗 淳

    在宅医療と内視鏡治療　27　(1)　21-29　2024/09

    Publisher: PEG・在宅医療学会

    ISSN： 1343-1544

    eISSN： 2758-2299

  15. A Case of Gastric Leiomyosarcoma Completely Resected by Endoscopic Submucosal Dissection after a Precise Preoperative Diagnosis.

    Kazuma Yachi, Waku Hatta, Tomoyuki Koike, Kimiko Kayada, Naotaro Tanno, Yohei Ogata, Masahiro Saito, Xiaoyi Jin, Kaname Uno, Naoki Asano, Akira Imatani, Hirofumi Watanabe, Fumiyoshi Fujishima, Atsushi Masamune

    Internal medicine (Tokyo, Japan)　64　(5)　705-709　2024/08/01

    DOI： 10.2169/internalmedicine.3645-24 　

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    A 68-year-old woman was diagnosed with leiomyosarcoma (LMS) based on preoperative biopsy of the gastric body. As tumor invasion confined to the submucosa with no breaking of the submucosal layer was confirmed on endoscopic ultrasonography (EUS), the patient underwent endoscopic submucosal dissection (ESD) for gastric LMS, resulting in complete tumor resection. No apparent recurrence was observed in the 2.5 years after treatment. This is an extremely rare case of gastric LMS that underwent ESD after a precise preoperative diagnosis, with no signs of recurrence after treatment. ESD may be an acceptable option for gastric LMS when EUS findings allow this treatment method.

  16. The usefulness of gel immersion endoscopy in identifying herald bleeding from an infectious aortoenteric fistula: a case report.

    Suguo Suzuki, Masahiro Saito, Kaname Uno, Naoki Asano, Tomoyuki Koike, Daijirou Akamatsu, Masamichi Mizuma, Takashi Kamei, Michiaki Unno, Atsushi Masamune

    Clinical journal of gastroenterology　17　(5)　871-875　2024/07/23

    DOI： 10.1007/s12328-024-02020-y 　

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    A 62-year-old male with a history of stent graft replacement for an infectious aortic aneurysm, followed by multiple interventions for postoperative complications, was admitted with melena and anemia. Enhanced computed tomography (eCT) demonstrated fluffing and hyperdensities surrounding the graft, despite no evidence of an aortoenteric fistula (AEF). Emergency esophagogastroduodenoscopy (EGD) showed a massive bleeding in the reconstructed tract and the protruding lesion of postoperative granulation tissue with clots at the end of the blind pouch. Thereafter, hemorrhage temporarily reoccurred several times; however, the source could not be identified using eCT or EGD. Finally, on the third attempt, we performed gel immersion endoscopy (GIE) with manual injection of VISCOCLEARⓇ, and it showed purulent blood flowing from one side of the protruding lesion in the pouch. Based on the eCT findings showing exudation of the contrast agent from the graft into the pouch, we made a diagnosis of an AEF. However, radical surgery was not performed because of the patient's poor general condition. During conservative management, he died of uncontrolled bleeding from the AEF on the 5th day of hospitalization. This is the first case in which the GIE might provide tips to identify herald bleeding from a lethal AEF.

  17. The Impact of Tobacco Smoking and Alcohol Consumption on the Development of Gastric Cancers. International-journal

    Waku Hatta, Tomoyuki Koike, Naoki Asano, Yutaka Hatayama, Yohei Ogata, Masahiro Saito, Xiaoyi Jin, Kaname Uno, Akira Imatani, Atsushi Masamune

    International journal of molecular sciences　25　(14)　2024/07/18

    DOI： 10.3390/ijms25147854 　

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    Chronic infection of Helicobacter pylori is considered the principal cause of gastric cancers, but evidence has accumulated regarding the impact of tobacco smoking and alcohol consumption on the development of gastric cancers. Several possible mechanisms, including the activation of nicotinic acetylcholine receptors, have been proposed for smoking-induced gastric carcinogenesis. On the other hand, local acetaldehyde exposure and ethanol-induced mucosal inflammation have been proposed as the mechanisms involved in the development of gastric cancers in heavy alcohol drinkers. In addition, genetic polymorphisms are also considered to play a pivotal role in smoking-related and alcohol-related gastric carcinogenesis. In this review, we will discuss the molecular mechanisms involved in the development of gastric cancers in relation to tobacco smoking and alcohol consumption.

  18. サルコイドーシス関連縦隔リンパ節腫脹により食道通過障害をきたした一例

    大塚 哲也, 宇野 要, 畑山 裕, 尾形 洋平, 齊藤 真弘, 金 笑奕, 菅野 武, 八田 和久, 小池 智幸, 正宗 淳

    日本消化器内視鏡学会東北支部例会　172回　83-83　2024/07

    Publisher: 日本消化器内視鏡学会-東北支部

  19. 出血性ショックをきたし血管内治療を要した食道胃粘膜下血腫の1例

    皆瀬 ゆみ子, 宇野 要, 畑山 裕, 尾形 洋平, 齊藤 真弘, 金 笑奕, 菅野 武, 八田 和久, 今谷 晃, 小池 智幸, 正宗 淳

    日本消化器内視鏡学会東北支部例会　172回　85-85　2024/07

    Publisher: 日本消化器内視鏡学会-東北支部

  20. Barrett食道腺癌の診断と治療 Barrett食道癌における食道内逆流因子及び食道運動機能の特徴

    谷地 一真, 齊藤 真弘, 小池 智幸, 小泉 薫, 皆瀬 ゆみ子, 首藤 千博, 八田 和久, 宇野 要, 浅野 直喜, 正宗 淳

    日本食道学会学術集会プログラム・抄録集　78回　54-54　2024/07

    Publisher: (NPO)日本食道学会

  21. 食道運動障害診療における最新の知見 PPI抵抗性GERD患者におけるexcessive supragastric belchingと食道内逆流因子の検討

    首藤 千博, 齊藤 真弘, 小池 智幸, 小泉 薫, 皆瀬 ゆみ子, 谷地 一真, 八田 和久, 宇野 要, 浅野 直喜, 正宗 淳

    日本食道学会学術集会プログラム・抄録集　78回　72-72　2024/07

    Publisher: (NPO)日本食道学会

  22. 術前確定診断が困難であったEBV関連リンパ球浸潤胃癌の一例

    丹野 尚太郎, 八田 和久, 畑山 裕, 尾形 洋平, 齊藤 真弘, 金 笑奕, 菅野 武, 宇野 要, 小池 智幸, 今谷 晃, 正宗 淳

    日本消化器病学会東北支部例会プログラム・抄録集　217回　91-91　2024/07

    Publisher: 日本消化器病学会-東北支部

  23. H.pylori感染状態とディスペプシアの頻度 成人胃がん検診事業データに基づく疫学的分析

    菅野 武, 鈴木 直生, 小池 智幸, 千葉 隆士, 淺沼 清孝, 加藤 勝章, 畑山 裕, 尾形 洋平, 齊藤 真弘, 金 笑奕, 八田 和久, 宇野 要, 浅野 直喜, 今谷 晃, 正宗 淳

    日本ヘリコバクター学会学術集会プログラム・抄録集　30回　110-110　2024/06

    Publisher: (一社)日本ヘリコバクター学会

  24. 検診で発見されたBarrett食道腺癌の内視鏡的特徴

    小泉 薫, 齊藤 真弘, 小池 智幸, 谷地 一真, 首藤 千博, 皆瀬 ゆみ子, 正宗 淳

    日本消化器がん検診学会雑誌　62　(Suppl総会)　364-364　2024/05

    Publisher: (一社)日本消化器がん検診学会

    ISSN： 1880-7666

    eISSN： 2185-1190

  25. 検診で発見されたBarrett食道腺癌の内視鏡的特徴

    小泉 薫, 齊藤 真弘, 小池 智幸, 谷地 一真, 首藤 千博, 皆瀬 ゆみ子, 正宗 淳

    日本消化器がん検診学会雑誌　62　(Suppl総会)　364-364　2024/05

    Publisher: (一社)日本消化器がん検診学会

    ISSN： 1880-7666

    eISSN： 2185-1190

  26. Is blue light imaging without magnification satisfactory as screening for esophageal squamous cell carcinoma? Post-hoc analysis of multicenter randomized controlled trial. International-journal

    Yohei Ogata, Waku Hatta, Tomoyuki Koike, So Takahashi, Tamotsu Matsuhashi, Wataru Iwai, Sho Asonuma, Hideki Okata, Motoki Ohyauchi, Hirotaka Ito, Yasuhiko Abe, Yu Sasaki, Masashi Kawamura, Masahiro Saito, Kaname Uno, Fumiyoshi Fujishima, Tomohiro Nakamura, Naoki Nakaya, Katsunori Iijima, Atsushi Masamune

    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society　36　(10)　1118-1126　2024/03/17

    DOI： 10.1111/den.14788 　

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    OBJECTIVES: Narrow light observation is currently recommended as an alternative to Lugol chromoendoscopy (LCE) to detect esophageal squamous cell carcinoma (ESCC). Studies revealed little difference in sensitivity between the two modalities in expert settings; however, these included small numbers of cases. We aimed to determine whether blue light imaging (BLI) without magnification is satisfactory for preventing misses of ESCC. METHODS: This was a post-hoc analysis of a multicenter randomized controlled trial targeting patients at high risk of ESCC in expert settings. In this study, BLI without magnification followed by LCE was performed. The evaluation parameters included: (i) the diagnostic abilities of ESCC; (ii) the endoscopic characteristics of lesions with diagnostic differences between the two modalities; and (iii) the color difference between cancerous and noncancerous areas in BLI and LCE. RESULTS: This study identified ESCC in 49 of 699 cases. Of these cases, nine (18.4%) were missed by BLI but detected by LCE. In per-patient analysis, the sensitivity of BLI was lower than that of LCE following BLI (83.7% vs. 100.0%; P = 0.013), whereas the specificity and accuracy of BLI were higher (88.2% vs. 81.2%; P < 0.001 and 87.8% vs. 82.5%; P < 0.001, respectively). No significant endoscopic characteristics were identified, but the color difference was lower in BLI than in LCE (21.4 vs. 25.1; P = 0.003). CONCLUSION: LCE following BLI outperformed BLI in terms of sensitivity in patients with high-risk ESCC. Therefore, LCE, in addition to BLI, would still be required in screening esophagogastroduodenoscopy even by expert endoscopists.

  27. 機能性消化器疾患の病態解明と臨床展開 PPI抵抗性GERD患者におけるexcessive supragastric belching(excessive SGB)の食道内逆流因子と有病率の検討

    首藤 千博, 齊藤 真弘, 小池 智幸, 小泉 薫, 皆瀬 ゆみ子, 谷地 一真, 八田 和久, 宇野 要, 浅野 直喜, 正宗 淳

    日本消化器病学会雑誌　121　(臨増総会)　A130-A130　2024/03

    Publisher: (一財)日本消化器病学会

    ISSN： 0446-6586

    eISSN： 1349-7693

  28. 食道胃接合部腺癌の病態,診断,治療の最前線 Barrett食道の発癌に対する食道内逆流因子と食道運動機能の影響

    谷地 一真, 齊藤 真弘, 小池 智幸, 小泉 薫, 皆瀬 ゆみ子, 首藤 千博, 八田 和久, 宇野 要, 浅野 直喜, 正宗 淳

    日本消化器病学会雑誌　121　(臨増総会)　A198-A198　2024/03

    Publisher: (一財)日本消化器病学会

    ISSN： 0446-6586

    eISSN： 1349-7693

  29. 一般成人におけるディスペプシアの疫学と内視鏡所見 がん検診事業のデータから

    鈴木 直生, 菅野 武, 小池 智幸, 千葉 隆士, 淺沼 清孝, 加藤 勝章, 尾形 洋平, 齊藤 真弘, 金 笑奕, 八田 和久, 宇野 要, 浅野 直喜, 今谷 晃, 正宗 淳

    日本消化器病学会雑誌　121　(臨増総会)　A350-A350　2024/03

    Publisher: (一財)日本消化器病学会

    ISSN： 0446-6586

    eISSN： 1349-7693

  30. Linked Color Imaging of Barrett’s Esophageal Adenocarcinoma: Effects on Visibility

    Masahiro Saito, Tomoyuki Koike, Yuki Ohara, Yohei Ogata, Takeshi Kanno, Xiaoyi Jin, Waku Hatta, Kaname Uno, Naoki Asano, Akira Imatani, Atsushi Masamune

    Gastroenterology Insights　2024/02/05

    DOI： 10.3390/gastroent15010010 　

  31. 【基本が大切 胃内視鏡診断】食道胃接合部癌は今後増える?

    小池 智幸, 齊藤 真弘, 谷地 一真, 皆瀬 ゆみ子, 首藤 千博, 八田 和久, 宇野 要, 浅野 直喜, 正宗 淳

    消化器内視鏡　36　(2)　282-287　2024/02

    Publisher: (株)東京医学社

    ISSN： 0915-3217

  32. ボノプラザン投与により軽快したHypercontractile esophagusの一例

    小泉 薫, 齊藤 真弘, 小池 智幸, 谷地 一真, 首藤 千博, 皆瀬 ゆみ子, 尾形 洋平, 菅野 武, 金 笑奕, 八田 和久, 宇野 要, 浅野 直喜, 今谷 晃, 正宗 淳

    日本消化器内視鏡学会東北支部例会　171回　95-95　2024/02

    Publisher: 日本消化器内視鏡学会-東北支部

  33. 内視鏡的粘膜下層剥離術を施行した粘膜内限局リンパ球浸潤胃癌の一例

    丹野 尚太郎, 尾形 洋平, 八田 和久, 小池 智幸, 齊藤 真弘, 金 笑奕, 菅野 武, 宇野 要, 浅野 直喜, 今谷 晃, 正宗 淳, 山崎 有人, 藤島 史喜

    日本消化器内視鏡学会東北支部例会　171回　97-97　2024/02

    Publisher: 日本消化器内視鏡学会-東北支部

  34. 【基本が大切 胃内視鏡診断】食道胃接合部癌は今後増える?

    小池 智幸, 齊藤 真弘, 谷地 一真, 皆瀬 ゆみ子, 首藤 千博, 八田 和久, 宇野 要, 浅野 直喜, 正宗 淳

    消化器内視鏡　36　(2)　282-287　2024/02

    Publisher: (株)東京医学社

    ISSN： 0915-3217

  35. Interactive training with a novel simulation model for upper gastrointestinal endoscopic hemostasis improves trainees’ technique and confidence International-journal

    Takeshi Kanno, Yutaro Arata, Eric Greenwald, Paul Moayyedi, Suguo Suzuki, Yutaka Hatayama, Masahiro Saito, Xiaoyi Jin, Waku Hatta, Kaname Uno, Naoki Asano, Akira Imatani, Yutaka Kagaya, Tomoyuki Koike, Atsushi Masamune

    Endoscopy International Open　12　(2)　E245-E252　2024/01/17

    Publisher: Georg Thieme Verlag KG

    DOI： 10.1055/a-2248-5110 　

    ISSN： 2364-3722

    eISSN： 2196-9736

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    Background and study aims: Endoscopic hemostasis is a life-saving procedure for gastrointestinal bleeding; however, its training is often performed on real patients and during urgent situations that put patients at risk. Reports of simulation-based training models for endoscopic hemostasis are scarce. Herein, we developed a novel simulator called “Medical Rising STAR-Ulcer type” to practice endoscopic hemostasis with hemoclips and coagulation graspers. This study aimed to evaluate the reproducibility of the clinical difficulty of this model and the effectiveness of simulation-based training for clipping hemostasis.Patients and methods: This was a prospective educational study. Fifty gastroenterology resident doctors from Japan and Canada were recruited to participate in a simulation-based training program. The primary outcome was the success rate of clipping hemostasis. We measured differences in trainees’ subjective assessment scores and evaluated the co-occurrence network based on comments after training.Results: The hemostasis success rate of the trainees significantly increased after instruction (64% vs. 86%, p&lt;0.05). The success rate for ulcers in the upper body of the stomach (59%), a high-difficulty site, was significantly lower than that for ulcers in the antrum, even after feedback and instruction. Trainees’ self-perceived proficiency and confidence significantly improved after simulation-based training (p&lt;0.05). Co-occurrence network analysis showed that trainees valued a structured learning approach, acknowledged the simulator’s limitations, and recognized the need for continuous skill refinement. Conclusions: Our study demonstrates the potential of our simulation-based training model as a valuable tool for improving technical skills and confidence in trainees learning to perform endoscopic hemostasis.

  36. A Novel Dry Simulator Model for Learning Comprehensive Endoscopic Retrograde Cholangiopancreatography/Endoscopic Sphincterotomy Procedures while Minimizing Adverse Bleeding Events (with Video) International-journal

    Yutaka Hatayama, Takeshi Kanno, Tetsuya Takikawa, Ryotaro Matsumoto, Yutaro Arata, Suguo Suzuki, Yohei Ogata, Masahiro Saito, Xiaoyi Jin, Shin Miura, Waku Hatta, Shin Hamada, Kaname Uno, Kiyoshi Kume, Kazuhiro Kikuta, Naoki Asano, Akira Imatani, Tomoyuki Koike, Atsushi Masamune

    Digestion　105　(2)　149-156　2024/01/10

    Publisher: S. Karger AG

    DOI： 10.1159/000536217 　

    ISSN： 0012-2823

    eISSN： 1421-9867

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    &lt;b&gt;&lt;i&gt;Introduction:&lt;/i&gt;&lt;/b&gt; Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST) are essential skills for performing endoscopic cholangiopancreatic procedures. However, these procedures have a high incidence of adverse events, and current training predominantly relies on patient-based approaches. Herein, we aimed to develop an ERCP/EST simulator model to address the need for safer training alternatives, especially for learners with limited ERCP experience. &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; The model was designed to facilitate the use of actual endoscopic devices, supporting learning objectives that align with the components of the validated Bethesda ERCP Skill Assessment Tool (BESAT). BESAT focuses on skills, such as papillary alignment, maintenance of duodenoscope position, gentle and efficient cannulation, controlled sphincterotomy in the correct trajectory, and guidewire manipulation. Thirty gastroenterology trainees used the simulator between May 2022 and March 2023, and their satisfaction was assessed using a visual analog scale (VAS) and pre- and post-training questionnaires. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; The novel simulator model comprised a disposable duodenal papillary section, suitable for incision with an electrosurgical knife, alongside washable upper gastrointestinal tract and bile duct sections for repeated use. The duodenal papillary section enabled reproduction of a realistic endoscope position and the adverse bleeding events due to improper incisions. The bile duct section allowed for the reproduction of fluoroscopic-like images, enabling learners to practice guidewire guidance and insertion of other devices. Following training, the median VAS score reflecting the expectation for model learning significantly increased from 69.5 (interquartile range [IQR]: 55.5–76.5) to 85.5 (IQR: 78.0–92.0) (&lt;i&gt;p&lt;/i&gt; &amp;lt; 0.01). All participants expressed a desire for repeated simulator training sessions. &lt;b&gt;&lt;i&gt;Conclusions:&lt;/i&gt;&lt;/b&gt; This innovative simulator could serve as a practical educational tool, particularly beneficial for novices in ERCP. It could facilitate hands-on practice with actual devices, enhancing procedural fluency and understanding of precise incisions to minimize the risk of bleeding complications during EST.

  37. 機能性消化管疾患～最新の診断と治療～さらなる進歩を目指して PPI抵抗性GERD患者におけるexcessive supragastric belching(SGB)のPPI内服下・非内服下の症状と食道内逆流因子に関する検討

    首藤 千博, 齊藤 真弘, 小泉 薫, 皆瀬 ゆみ子, 谷地 一真, 小池 智幸, 正宗 淳

    日本消化管学会雑誌　8　(Suppl.)　163-163　2024/01

    Publisher: (一社)日本消化管学会

    ISSN： 2433-3840

    eISSN： 2435-8967

  38. 機能性消化管疾患～最新の診断と治療～さらなる進歩を目指して PPI抵抗性GERD患者におけるexcessive supragastric belching(SGB)のPPI内服下・非内服下の症状と食道内逆流因子に関する検討

    首藤 千博, 齊藤 真弘, 小泉 薫, 皆瀬 ゆみ子, 谷地 一真, 小池 智幸, 正宗 淳

    日本消化管学会雑誌　8　(Suppl.)　163-163　2024/01

    Publisher: (一社)日本消化管学会

    ISSN： 2433-3840

    eISSN： 2435-8967

  39. シミュレータ学習プログラムは安全なESTの達成および自覚的習熟度の向上に寄与する 前向き教育介入研究

    畑山 裕, 菅野 武, 滝川 哲也, 松本 諒太郎, 齊藤 真弘, 金 笑奕, 三浦 晋, 八田 和久, 濱田 晋, 宇野 要, 粂 潔, 菊田 和宏, 浅野 直喜, 今谷 晃, 小池 智幸, 正宗 淳

    Gastroenterological Endoscopy　65　(Suppl.2)　2026-2026　2023/10

    Publisher: (一社)日本消化器内視鏡学会

    ISSN： 0387-1207

    eISSN： 1884-5738

  40. 東北大学病院における経皮内視鏡的胃瘻造設術の動向及び合併症の検討

    矢野 翔太, 金 笑奕, 小笠原 光矢, 阿部 寛子, 齊藤 真弘, 小池 智幸, 正宗 淳

    PEG・在宅医療学会学術集会プログラム抄録集　27回　77-77　2023/09

    Publisher: PEG・在宅医療学会

  41. 【消化管出血のマネジメントが変わっている?-最新情報と診療の実際】総論 消化管出血の診断手順

    小池 智幸, 八田 和久, 尾形 洋平, 齊藤 真弘, 菅野 武, 正宗 淳

    臨床消化器内科　38　(11)　1360-1367　2023/09

    Publisher: (株)日本メディカルセンター

    ISSN： 0911-601X

    eISSN： 2433-2488

  42. 【上部消化管疾患の残された課題】食道胃接合部がんの病態と内視鏡治療

    小池 智幸, 齊藤 真弘, 正宗 淳

    Progress in Medicine　43　(9)　767-773　2023/09

    Publisher: (株)ライフ・サイエンス

    ISSN： 0287-3648

  43. 【胃良性疾患の近未来】[薬剤関連疾患]酸分泌抑制薬(PPI/PCAB)関連胃病変

    小池 智幸, 齊藤 真弘, 谷地 一真, 首藤 千博, 尾形 洋平, 八田 和久, 宇野 要, 浅野 直喜, 正宗 淳

    消化器内視鏡　35　(8)　1065-1071　2023/08

    Publisher: (株)東京医学社

    ISSN： 0915-3217

  44. ステロイド嚥下療法により食道運動機能障害の改善を認めた好酸球性食道炎の一例

    谷地 一真, 齊藤 真弘, 小池 智幸, 首藤 千博, 尾形 洋平, 菅野 武, 金 笑奕, 八田 和久, 宇野 要, 浅野 直喜, 今谷 晃, 正宗 淳

    日本消化器病学会東北支部例会・日本消化器内視鏡学会東北支部例会プログラム・抄録集　215回・170回　151-151　2023/07

    Publisher: 日本消化器病学会-東北支部

  45. 肝様腺癌を伴った胃腺癌の一例

    加宅田 公子, 菅野 武, 宇野 要, 藤島 史喜, 尾形 洋平, 齊藤 真弘, 金 笑奕, 八田 和久, 浅野 直喜, 今谷 晃, 小池 智幸, 正宗 淳

    日本消化器病学会東北支部例会・日本消化器内視鏡学会東北支部例会プログラム・抄録集　215回・170回　158-158　2023/07

    Publisher: 日本消化器病学会-東北支部

  46. 感染性大動脈-十二指腸瘻の診断にビスコクリアを用いた内視鏡観察が有用であった一例

    鈴木 直生, 齊藤 真弘, 宇野 要, 金 笑奕, 小池 智幸, 正宗 淳, 赤松 大二朗, 水間 正道, 亀井 尚, 海野 倫明

    日本消化器病学会東北支部例会・日本消化器内視鏡学会東北支部例会プログラム・抄録集　215回・170回　162-162　2023/07

    Publisher: 日本消化器病学会-東北支部

  47. 検診で発見されたBarrett食道腺癌の臨床病理学的特徴

    谷地 一真, 齊藤 真弘, 小池 智幸, 菅野 武, 金 笑奕, 八田 和久, 宇野 要, 浅野 直喜, 今谷 晃, 正宗 淳

    日本消化器がん検診学会雑誌　61　(Suppl総会)　475-475　2023/06

    Publisher: (一社)日本消化器がん検診学会

    ISSN： 1880-7666

    eISSN： 2185-1190

  48. 検診にて発見された非機能性十二指腸NETに対してEMROにて断端陰性切除となった一例

    鈴木 直生, 八田 和久, 小池 智幸, 齊藤 真弘, 金 笑奕, 菅野 武, 宇野 要, 浅野 直喜, 今谷 晃, 正宗 淳

    日本消化器がん検診学会雑誌　61　(Suppl総会)　476-476　2023/06

    Publisher: (一社)日本消化器がん検診学会

    ISSN： 1880-7666

    eISSN： 2185-1190

  49. A case of refractory bleeding from duodenal angioectasia with acquired hemophilia A.

    Hiroko Abe, Masahiro Saito, Kaname Uno, Tomoyuki Koike, Satoshi Ichikawa, Masashi Saito, Takeshi Kanno, Waku Hatta, Naoki Asano, Atsushi Masamune

    Clinical journal of gastroenterology　16　(3)　355-360　2023/06

    DOI： 10.1007/s12328-023-01790-1 　

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    Acquired hemophilia A (AHA) is a coagulation disorder related to the factor VIII inhibitors, which might cause intractable bleeding of gastrointestinal tracts. However, its scarcity makes it difficult to recognize AHA as a pitfall of endoscopic hemostasis failure. An 81-year-old female with a history of endoscopic treatment for colon polyps visited a local hospital with chief compliments of bloody stool and severe anemia. During several examinations for the bleeding origin, esophagogastroduodenoscopy depicted a 5 mm-sized hemorrhagic angioectasia of the duodenum, followed by treatment with argon plasma coagulation. However, hemostasis was not achieved by multiple sessions of endoscopic hemostasis and transcatheter arterial embolization, so blood transfusion was repeatedly done and she was transferred to our hospital. Laboratory data showed severe anemia with coagulation disorder. Based on the results of von Willebrand factor activity, factor VIII activity and factor VIII inhibitor, we diagnosed AHA as a comorbidity. Endoscopic hemostasis was confirmed only after improvement of APTT level and negative for the factor VIII inhibitor by hemostatic bypass treatment with recombinant active factor VII and immunosuppressive therapy with prednisolone and cyclophosphamide. In case of refractory bleeding of gastrointestinal tract, we should suspect of a comorbidity of coagulation disorder like AHA.

  50. 【GERDを極める】病態と診断 食道胃接合部の病理診断 GERDを中心に

    藤島 史喜, 根本 哲生, 小池 智幸, 首藤 千博, 谷地 一真, 齊藤 真弘, 名久井 実, 正宗 淳, 鈴木 貴

    消化器内視鏡　35　(5)　637-643　2023/05

    Publisher: (株)東京医学社

    ISSN： 0915-3217

  51. 【GERDを極める】治療 逆流性食道炎の薬物治療

    小池 智幸, 齊藤 真弘, 首藤 千博, 谷地 一真, 菅原 英之, 八田 和久, 宇野 要, 浅野 直喜, 正宗 淳

    消化器内視鏡　35　(5)　651-656　2023/05

    Publisher: (株)東京医学社

    ISSN： 0915-3217

  52. 【GERDを極める】病態と診断 食道胃接合部の病理診断 GERDを中心に

    藤島 史喜, 根本 哲生, 小池 智幸, 首藤 千博, 谷地 一真, 齊藤 真弘, 名久井 実, 正宗 淳, 鈴木 貴

    消化器内視鏡　35　(5)　637-643　2023/05

    Publisher: (株)東京医学社

    ISSN： 0915-3217

  53. 【GERDを極める】治療 逆流性食道炎の薬物治療

    小池 智幸, 齊藤 真弘, 首藤 千博, 谷地 一真, 菅原 英之, 八田 和久, 宇野 要, 浅野 直喜, 正宗 淳

    消化器内視鏡　35　(5)　651-656　2023/05

    Publisher: (株)東京医学社

    ISSN： 0915-3217

  54. 食道胃接合部癌の治療戦略 食道胃接合部癌における腺癌と扁平上皮癌の治療後経過に関する検討

    齊藤 真弘, 小池 智幸, 正宗 淳

    日本消化器病学会雑誌　120　(臨増総会)　A108-A108　2023/03

    Publisher: (一財)日本消化器病学会

    ISSN： 0446-6586

    eISSN： 1349-7693

  55. DOAC服用患者における上部消化管ESD後出血と脳梗塞

    小野 義高, 八田 和久, たら澤 邦男, 阿部 寛子, 尾形 洋平, 齊藤 真弘, 菅野 武, 金 笑奕, 宇野 要, 浅野 直喜, 小池 智幸, 藤森 研司, 伏見 清秀, 正宗 淳

    日本消化器病学会雑誌　120　(臨増総会)　A307-A307　2023/03

    Publisher: (一財)日本消化器病学会

    ISSN： 0446-6586

    eISSN： 1349-7693

  56. Blue light imaging and linked color imaging as a screening mode for esophageal squamous cell carcinoma in high-risk patients: A multicenter randomized trial. International-journal

    Yohei Ogata, Waku Hatta, Tomoyuki Koike, So Takahashi, Tamotsu Matsuhashi, Tomoyuki Oikawa, Wataru Iwai, Sho Asonuma, Hideki Okata, Motoki Ohyauchi, Hirotaka Ito, Yasuhiko Abe, Yu Sasaki, Masashi Kawamura, Masahiro Saito, Kaname Uno, Fumiyoshi Fujishima, Tomohiro Nakamura, Naoki Nakaya, Katsunori Iijima, Atsushi Masamune

    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society　35　(7)　835-844　2023/02/18

    DOI： 10.1111/den.14538 　

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    OBJECTIVES: Blue light imaging (BLI) and linked color imaging (LCI) are superior to conventional white light imaging for detecting esophageal squamous cell carcinoma (ESCC). Hence, we compared their diagnostic performances in ESCC screening. METHODS: This open-labeled, randomized controlled trial was performed at seven hospitals. Patients with a high risk of ESCC were randomly assigned to the BLI group (BLI followed by LCI) and LCI group (LCI followed by BLI). The primary endpoint was the detection rate of ESCC in the primary mode. The main secondary endpoint was its miss rate in the primary mode. RESULTS: In total, 699 patients were enrolled. The detection rate of ESCC did not significantly differ between the BLI and LCI groups [4.0% (14/351) vs. 4.9% (17/348); p = 0.565]; however, the number of patients with ESCC tended to be smaller in the BLI group (19 vs. 30). Notably, the miss rate of ESCC was lower in the BLI group [26.3% (5/19) vs. 63.3% (19/30); p = 0.012] and LCI detected no ESCCs missed by BLI. The sensitivity was higher in BLI (75.0% vs. 47.6%; p = 0.042); on the other hand, the positive predictive value in BLI tended to be lower (28.8% vs. 45.5%; p = 0.092). CONCLUSIONS: The detection rates of ESCC did not significantly differ between BLI and LCI. Although BLI may have a potential to be advantageous over LCI for the diagnosis of ESCC, it is still unclear whether BLI is superior to LCI, and a further large-scale study is needed.

  57. 胃瘻造設後腹膜炎を含む多彩な合併症を経てLCIG療法の長期継続に至った1例

    小笠原 光矢, 金 笑奕, 小池 智幸, 矢野 翔太, 齊藤 真弘, 菅野 直人, 正宗 淳

    日本消化器内視鏡学会東北支部例会　169回　107-107　2023/02

    Publisher: 日本消化器内視鏡学会-東北支部

  58. 十二指腸血管拡張症からの難治性出血を契機に後天性血友病を診断・治療しえた1例

    阿部 寛子, 齊藤 真弘, 宇野 要, 金 笑奕, 菅野 武, 八田 和久, 浅野 直喜, 小池 智幸, 今谷 晃, 正宗 淳, 市川 聡

    日本消化器内視鏡学会東北支部例会　169回　108-108　2023/02

    Publisher: 日本消化器内視鏡学会-東北支部

  59. Excessive supragastric belchingの1例

    首藤 千博, 小池 智幸, 伊丹 英昭, 谷地 一真, 大原 祐樹, 齊藤 真弘, 中川 健一郎, 金 笑奕, 菅野 武, 八田 和久, 宇野 要, 浅野 直喜, 今谷 晃, 正宗 淳

    日本消化器病学会東北支部例会プログラム・抄録集　214回　75-75　2023/02

    Publisher: 日本消化器病学会-東北支部

  60. 食道胃接合部癌診療の最前線 食道胃接合部癌の内視鏡的特徴と内視鏡治療後予後に関する検討 腺癌と扁平上皮癌の比較

    齊藤 真弘, 小池 智幸, 正宗 淳

    日本消化管学会雑誌　7　(Suppl.)　159-159　2023/01

    Publisher: (一社)日本消化管学会

    ISSN： 2433-3840

    eISSN： 2435-8967

  61. Similar Effect of Vonoprazan and Oral Proton Pump Inhibitors for Preventing Rebleeding in Cases of Upper Gastrointestinal Bleeding

    Hiroko Abe, Kunio Tarasawa, Waku Hatta, Tomoyuki Koike, Isao Sato, Yoshitaka Ono, Yohei Ogata, Masahiro Saito, Xiaoyi Jin, Takeshi Kanno, Kaname Uno, Naoki Asano, Akira Imatani, Kenji Fujimori, Kiyohide Fushimi, Atsushi Masamune

    Internal Medicine　63　(7)　911-918　2023

    Publisher: Japanese Society of Internal Medicine

    DOI： 10.2169/internalmedicine.2211-23 　

    ISSN： 0918-2918

    eISSN： 1349-7235

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    Objective The use of a proton pump inhibitor (PPI) reduces rebleeding and mortality in patients with upper gastrointestinal bleeding (UGIB). Vonoprazan is a novel oral agent with strong and sustained acid-inhibitory activity. We clarified the effect of vonoprazan compared with oral PPIs in such patients. Methods We analyzed the Diagnosis Procedure Combination database. The primary outcome was rebleeding, and secondary outcomes were in-hospital mortality and in-hospital mortality after rebleeding. Propensity score matching was performed to balance the comparison groups, and logistic regression analyses were used to compare the outcomes between vonoprazan and oral PPIs. Patients Patients on vonoprazan or oral PPIs who underwent endoscopic hemostasis for UGIB between 2014 and 2019 were included. Results We enrolled 78,964 patients, of whom 27,101 and 51,863 were prescribed vonoprazan and a PPI, respectively. After propensity score matching, the rebleeding rate of vonoprazan did not significantly differ from that of oral PPIs [6.4% vs. 6.1%; odds ratio (OR), 1.05; 95% confidence interval (CI), 0.98-1.13]; similarly, the in-hospital mortality rate (1.4% vs. 1.5%; OR, 0.91; 95% CI, 0.79-1.05) and in-hospital mortality after rebleeding (0.3% vs. 0.2%; OR, 1.09; 95% CI, 0.78-1.54) also did not significantly differ between the groups. The acquired findings were robust across dose-restricted analyses and several sensitivity analyses. Conclusion Rebleeding and in-hospital mortality risks in patients on vonoprazan were similar to those in patients on oral PPIs. Considering the higher cost of vonoprazan, oral PPIs might be an optimal oral agent as an acid-suppressive therapy in such patients.

  62. 食道胃接合部癌診療の最前線 食道胃接合部癌の内視鏡的特徴と内視鏡治療後予後に関する検討 腺癌と扁平上皮癌の比較

    齊藤 真弘, 小池 智幸, 正宗 淳

    日本消化管学会雑誌　7　(Suppl.)　159-159　2023/01

    Publisher: (一社)日本消化管学会

    ISSN： 2433-3840

    eISSN： 2435-8967

  63. PREDICTORS OF EARLY AND LATE MORTALITY AFTER THE TREATMENT FOR EARLY GASTRIC CANCERS

    OGATA Yohei, HATTA Waku, OHARA Yuki, KOIKE Tomoyuki, ABE Hiroko, SAITO Masahiro, JIN Xiaoyi, KANNO Takeshi, UNO Kaname, ASANO Naoki, IMATANI Akira, YAMAMURA Akihiro, TANAKA Naoki, KAMEI Takashi, UNNO Michiaki, NAKAMURA Tomohiro, NAKAYA Naoki, MASAMUNE Atsushi

    GASTROENTEROLOGICAL ENDOSCOPY　65　(2)　162-172　2023

    Publisher: Japan Gastroenterological Endoscopy Society

    DOI： 10.11280/gee.65.162 　

    ISSN： 0387-1207

    eISSN： 1884-5738

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    Objectives: Although many patients with early gastric cancers (EGCs) die of non-gastric cancer-related causes, the association of the risk categories of lymph node metastasis (LNM) with all-cause mortality remains unclear. We aimed to clarify the predictors of early and late mortality, separately. Methods: Patients with endoscopic resection or gastrectomy for EGCs between 2003 and 2017 were retrospectively enrolled. We analyzed predictors for early and late mortality, including risk categories of LNM, treatment method, and nine non-cancer-related indices, separately, with a cut-off value of 3 years. Results: We enrolled 1439 patients with a median follow-up period of 79 months. The 5-year overall survival rate was 86.8%. In the multivariate Cox analysis, the most important predictors for early and late mortality were age ≥85 years (hazard ratio [HR] 2.88 and 4.54, respectively) and Eastern Cooperative Oncology Group Performance Status ≥2 (HR 3.00 and 4.19, respectively). Charlson comorbidity index ≥2 (HR 2.76 and 1.99, respectively), American Society of Anesthesiologists Physical Status ≥3 (HR 2.35 and 1.79, respectively), and C-reactive protein/albumin ratio ≥0.028 (HR 2.30 and 1.58, respectively) were also predictors for both early and late mortality. Male (HR 2.26), intermediate- (HR 2.12)/high-risk (HR 1.85) of LNM in eCura system, and sarcopenia evaluated by the psoas muscle mass index (HR 1.70) were predictors for early mortality. Conclusion: The combined assessment of multiple predictors might help to predict early and/or late mortality in patients with EGCs. The eCura system was associated with early mortality

  64. Discrepancy between Abdominal Symptoms and Endoscopic Findings in Patients with Gastro-duodenal Eosinophilia: A Case Series

    Hideyuki Sugawara, Takeshi Kanno, Masahiro Saito, Xiaoyi Jin, Waku Hatta, Kaname Uno, Naoki Asano, Akira Imatani, Fumiyoshi Fujishima, Tomoyuki Koike, Atsushi Masamune

    Internal Medicine　62　(18)　2661-2665　2023

    Publisher: Japanese Society of Internal Medicine

    DOI： 10.2169/internalmedicine.1137-22 　

    ISSN： 0918-2918

    eISSN： 1349-7235

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    Some patients present gastro-duodenal eosinophilia without abdominal symptoms. Nine cases with gastro-duodenal eosinophilia were seen at the Tohoku University Hospital between January 2011 and June 2022. Seven (78%) patients had a background of allergic or hyper-eosinophilic disease. Esophagogastroduodenoscopy showed erosions (n=6), discoloration (n=4), ulcers (n=3), erythema (n=3), muskmelon-like appearance (n=2), and cracks (n=1). Two cases were asymptomatic with eosinophilic gastroenteritis (EGE)-like endoscopic findings, and two were symptomatic with normal endoscopic findings. The discrepancy between the abdominal symptoms and esophagogastroduodenoscopy findings suggests that clinicians should assess patients for background allergic disease, regardless of abdominal symptoms.

  65. 特集 消化管内視鏡治療のリスク克服に向けて 1.待機的内視鏡治療に潜むリスクとそのマネジメント(4)胃EMR/ESD

    八田 和久, 小池 智幸, 齊藤 真弘, 宇野 要, 浅野 直喜, 正宗 淳

    臨床消化器内科　38　(1)　29-35　2022/12/20

    Publisher: 日本メディカルセンター

    DOI： 10.19020/cg.0000002476 　

    ISSN： 0911-601X

    eISSN： 2433-2488

  66. 今月の主題 食道癌診療トピックス2022 主題 食道病理をめぐるトピックス 低異型度のBarrett食道腫瘍性病変の臨床病理学的検討

    藤島 史喜, 佐藤 聡子, 國吉 真平, 谷地 一真, 大原 祐樹, 齊藤 真弘, 角掛 純一, 國光 敦, 谷山 裕亮, 田中 一平, 平澤 大, 小池 智幸, 正宗 淳, 亀井 尚, 鈴木 貴

    胃と腸　57　(11)　1373-1379　2022/10/25

    Publisher: 株式会社医学書院

    DOI： 10.11477/mf.1403203019 　

    ISSN： 0536-2180

    eISSN： 1882-1219

  67. Development of Advanced Imaging and Molecular Imaging for Barrett's Neoplasia. International-journal

    Kaname Uno, Tomoyuki Koike, Waku Hatta, Masahiro Saito, Mizuki Tanabe, Atsushi Masamune

    Diagnostics (Basel, Switzerland)　12　(10)　2022/10/08

    DOI： 10.3390/diagnostics12102437 　

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    Barrett esophagus (BE) is a precursor to a life-threatening esophageal adenocarcinoma (EAC). Surveillance endoscopy with random biopsies is recommended for early intervention against EAC, but its adherence in the clinical setting is poor. Dysplastic lesions with flat architecture and patchy distribution in BE are hardly detected by high-resolution endoscopy, and the surveillance protocol entails issues of time and labor and suboptimal interobserver agreement for diagnosing dysplasia. Therefore, the development of advanced imaging technologies is necessary for Barrett's surveillance. Recently, non-endoscopic or endoscopic technologies, such as cytosponge, endocytoscopy, confocal laser endomicroscopy, autofluorescence imaging, and optical coherence tomography/volumetric laser endomicroscopy, were developed, but most of them are not clinically available due to the limited view field, expense of the equipment, and significant time for the learning curve. Another strategy is focused on the development of molecular biomarkers, which are also not ready to use. However, a combination of advanced imaging techniques together with specific biomarkers is expected to identify morphological abnormalities and biological disorders at an early stage in the surveillance. Here, we review recent developments in advanced imaging and molecular imaging for Barrett's neoplasia. Further developments in multiple biomarker panels specific for Barrett's HGD/EAC include wide-field imaging systems for targeting 'red flags', a high-resolution imaging system for optical biopsy, and a computer-aided diagnosis system with artificial intelligence, all of which enable a real-time and accurate diagnosis of dysplastic BE in Barrett's surveillance and provide information for precision medicine.

  68. 上部消化管内視鏡治療におけるP-CABの後出血予防効果 propensity scoreを用いたデータベース解析

    阿部 寛子, 八田 和久, たら澤 邦男, 尾形 洋平, 齊藤 真弘, 菅野 武, 金 笑奕, 宇野 要, 小池 智幸, 今谷 晃, 藤森 研司, 伏見 清秀, 正宗 淳

    潰瘍　49　55-55　2022/10

    Publisher: (一社)日本潰瘍学会

    ISSN： 2189-7956

  69. 上部消化管出血患者における,ボノプラザンのPPI内服に対する再出血・死亡リスクの検討 傾向スコアを用いたDPCデータベースの解析

    阿部 寛子, 八田 和久, たら澤 邦男, 小野 義高, 尾形 洋平, 齊藤 真弘, 菅野 武, 金 笑奕, 宇野 要, 小池 智幸, 今谷 晃, 藤森 研司, 伏見 清秀, 正宗 淳

    Gastroenterological Endoscopy　64　(Suppl.2)　2069-2069　2022/10

    Publisher: (一社)日本消化器内視鏡学会

    ISSN： 0387-1207

    eISSN： 1884-5738

  70. 出血を再現した十二指腸ESTシミュレータモデルの開発

    畑山 裕, 菅野 武, 滝川 哲也, 齊藤 真弘, 金 笑奕, 三浦 晋, 八田 和久, 濱田 晋, 宇野 要, 粂 潔, 浅野 直喜, 今谷 晃, 小池 智幸, 正宗 淳

    Gastroenterological Endoscopy　64　(Suppl.2)　2138-2138　2022/10

    Publisher: (一社)日本消化器内視鏡学会

    ISSN： 0387-1207

    eISSN： 1884-5738

  71. 上部消化管内視鏡治療におけるP-CABの後出血予防効果 propensity scoreを用いたデータベース解析

    阿部 寛子, 八田 和久, たら澤 邦男, 尾形 洋平, 齊藤 真弘, 菅野 武, 金 笑奕, 宇野 要, 小池 智幸, 今谷 晃, 藤森 研司, 伏見 清秀, 正宗 淳

    潰瘍　49　55-55　2022/10

    Publisher: (一社)日本潰瘍学会

    ISSN： 2189-7956

  72. 食道発がん(腺癌、扁平上皮癌)に関する新知見と臨床へのインパクト Barrett食道腺癌の局在に関するMII-pHによる食道内逆流因子と,MNBIを用いた粘膜傷害に関する検討

    齊藤 真弘, 小池 智幸, 大原 祐樹, 谷地 一真, 首藤 千博, 伊丹 英昭, 八田 和久, 宇野 要, 今谷 晃, 正宗 淳

    日本食道学会学術集会プログラム・抄録集　76回　33-33　2022/09

    Publisher: (NPO)日本食道学会

  73. 食道疾患の診療 Ⅱ 胃食道逆流症の診療 4 胃食道逆流症の薬物療法

    小池 智幸, 伊丹 英昭, 大原 祐樹, 齊藤 真弘, 正宗 淳

    臨床消化器内科　37　(9)　1029-1038　2022/08/10

    Publisher: 日本メディカルセンター

    DOI： 10.19020/cg.0000002302 　

    ISSN： 0911-601X

    eISSN： 2433-2488

  74. Suppressed cellular senescence mediated by T-box3 in aged gastric epithelial cells may contribute to aging-related carcinogenesis International-journal

    Akio Takeuchi, Naoki Asano, Akira Imatani, Masashi Saito, Xiaoyi Jin, Masahiro Saito, Takeshi Kanno, Waku Hatta, Kaname Uno, Tomoyuki Koike, Atsushi Masamune

    Cancer Research Communications　2　(8)　772-783　2022/07/14

    Publisher: American Association for Cancer Research (AACR)

    DOI： 10.1158/2767-9764.crc-22-0084 　

    eISSN： 2767-9764

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    Abstract Aging is a risk factor for cancers in various organs. Recent advances in the organoid culturing system have made it viable to investigate the influence of aging utilizing these mini organs. In this study, we aimed to examine the implications of aging for gastric carcinogenesis. Gastric organoids established from aged mice grew larger, proliferated vigorously, and survived longer than that from young mice. Since Wnt/b-catenin signaling was intensified in the aged organoids and since removal of Wnt-related factors diminished their proliferation, we investigated for Wnt target gene that contributed to enhanced proliferation and discovered that the aged organoids expressed the transcription factor T-box3 (Tbx3), which has been reported to suppress cellular senescence. Indeed, cellular senescence was suppressed in the aged organoids, and this resulted from enhanced G2/M transition. As for the mechanism involved in the intensified Wnt/b-catenin signaling, we identified that Dickkopf3 (Dkk3) expression was reduced in the aged organoids due to methylation of the Dkk3 gene. Finally, the expression of TBX3 was enhanced in human atrophic gastritis and even more enhanced in human gastric cancers. In addition, its expression correlated positively with patients' age. These results indicated that the emergence of anti-senescent property in aged gastric organoids due to enhanced Tbx3 expression led to accelerated cellular proliferation and organoid formation. Since the enhanced Tbx3 expression seen in aged gastric organoids was also observed in human gastric cancer tissues, this Dkk3-Wnt-Tbx3 pathway may be involved in aging-related gastric carcinogenesis.

  75. A Case of Gastric Cancer With a Rare Spreading Pattern Into the Submucosal Layer International-journal

    Yutaka Hatayama, Takeshi Kanno, Masahiro Saito, Xiaoyi Jin, Waku Hatta, Kaname Uno, Naoki Asano, Akira Imatani, Fumiyoshi Fujishima, Tomoyuki Koike, Atsushi Masamune

    Journal of the Canadian Association of Gastroenterology　6　(4)　135-136　2022/04/08

    Publisher: Oxford University Press (OUP)

    DOI： 10.1093/jcag/gwac012 　

    ISSN： 2515-2084

    eISSN： 2515-2092

  76. Current status of surveillance for Barrett's esophagus in Japan and the West. International-journal

    Tomoyuki Koike, Masahiro Saito, Yuki Ohara, Waku Hatta, Atsushi Masamune

    DEN open　2　(1)　e94　2022/04

    DOI： 10.1002/deo2.94 　

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    Prospective studies in western countries have shown that the obvious risk factors for Barrett's esophageal cancer are male sex, smoking habit, a longer length of Barrett's esophagus, and low-grade dysplasia. However, few reports have prospectively examined risk factors for adenocarcinoma development from Barrett's esophagus in Japan. In the West, where adenocarcinoma is common among esophageal cancer, endoscopic surveillance of Barrett's esophagus every 2-5 years is recommended for early detection of adenocarcinoma. However, there is no established surveillance method in Japan. In recent years, the incidence of adenocarcinoma from long-segment Barrett's esophagus and short-segment Barrett's esophagus longer than 2 cm in Japan has been reported to be similar to the West. For surveillance of adenocarcinoma arising from Barrett's esophagus, recognizing the characteristics of superficial adenocarcinoma and carefully observing the entire Barrett's esophagus are needed. It has been reported that representative characteristics of Barrett's adenocarcinoma are a reddish area or a lesion located on the anterior to the right sidewall. It is necessary to establish surveillance methods for Barrett's esophagus sooner in Japan.

  77. Recent approach for preventing complications in upper gastrointestinal endoscopic submucosal dissection International-journal

    Waku Hatta, Tomoyuki Koike, Hiroko Abe, Yohei Ogata, Masahiro Saito, Xiaoyi Jin, Takeshi Kanno, Kaname Uno, Naoki Asano, Akira Imatani, Atsushi Masamune

    DEN Open　2　(1)　e60　2022/04

    Publisher: Wiley

    DOI： 10.1002/deo2.60 　

    ISSN： 2692-4609

    eISSN： 2692-4609

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    Although endoscopic submucosal dissection (ESD) is a minimally invasive treatment method for upper gastrointestinal (GI) tumors, patients undergoing upper GI ESD sometimes fall into a serious condition from complications. Thus, it is important to fully understand how to prevent complications when performing upper GI ESD. One of the major complications in esophageal and gastric ESD is intraoperative perforation. To prevent this complication, blind dissection should be avoided. Traction-assisted ESD is a useful technique for maintaining good endoscopic view. This method was proven to reduce the incidence of intraoperative perforation, which would become a standard technique in esophageal and gastric ESD. In gastric ESD, delayed bleeding is the most common complication. Recently, a novel prediction model (BEST-J score) consisting of 10 factors with four risk categories for delayed bleeding in gastric ESD was established, and a free mobile application is now available. For reducing delayed bleeding in gastric ESD, vonoprazan ≥20 mg/day is the sole reliable method in the current status. Duodenal ESD is still challenging with a much higher frequency of complications, such as perforation and delayed bleeding, than ESD in other organs. However, with the development of improved devices and techniques, the frequency of complications in duodenal ESD has been decreasing. To prevent intraoperative perforation, some ESD techniques, such as using the distal tips of the Clutch Cutter, were developed. An endoscopic mucosal defect closure technique would be mandatory for preventing delayed complications. However, several unresolved issues, including standardization of duodenal ESD, remain and further studies are demanded.

  78. 今月の主題 食道上皮内腫瘍の診断と取り扱い 主題 食道上皮内腫瘍の病理学的検討

    藤島 史喜, 國吉 真平, 佐藤 聡子, 尾形 洋平, 齊藤 真弘, 菅野 武, 八田 和久, 小池 智幸, 正宗 淳, 笹野 公伸

    胃と腸　57　(3)　243-249　2022/03/25

    Publisher: 株式会社医学書院

    DOI： 10.11477/mf.1403202673 　

    ISSN： 0536-2180

    eISSN： 1882-1219

  79. 特集 明日の診療に役立つ 消化器内視鏡これ1冊 上部消化管 咽喉頭･食道 逆流性食道炎の診断と治療

    小池 智幸, 齊藤 真弘, 正宗 淳

    診断と治療　110　(13)　58-66　2022/03/25

    Publisher: (株)診断と治療社

    DOI： 10.34433/j00697.2022140965 　

    ISSN： 0370-999X

  80. Parietal Cell Dysfunction: A Rare Cause of Gastric Neuroendocrine Neoplasm with Achlorhydria and Extreme Hypergastrinemia.

    Yasuaki Abe, Waku Hatta, Sho Asonuma, Tomoyuki Koike, Hiroko Abe, Yohei Ogata, Masahiro Saito, Xiaoyi Jin, Takeshi Kanno, Kaname Uno, Naoki Asano, Akira Imatani, Fumiyoshi Fujishima, Hironobu Sasano, Atsushi Masamune

    Internal medicine (Tokyo, Japan)　61　(16)　2441-2448　2022/02/01

    DOI： 10.2169/internalmedicine.8253-21 　

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    A 69-year-old woman with multiple neuroendocrine neoplasms (NENs) was referred to our hospital. Although she had extreme hypergastrinemia (11,675 pg/mL), no findings that indicated types I to III gastric NENs were found. Although gastric corpus atrophy was suspected on conventional white-light imaging, findings on magnifying endoscopy with narrow-band imaging indicated no severe atrophy. A biopsy from the background fundic gland mucosa revealed no atrophic changes, parietal cells with vacuolated cytoplasm and negative findings for H+K+-ATPase [please check this carefully]. Thus, this case was diagnosed as multiple NENs with parietal cell dysfunction. Neither progression nor metastasis has been confirmed during two-year follow-up.

  81. Visceral obesity is associated with an increased risk of developing esophago-gastric junctional adenocarcinoma in Japan: a population-based case-control study in Akita Prefecture.

    Kenta Watanabe, Shigeto Koizumi, Kenji Shirane, Hidehiko Tsuda, Hiroyuki Watanabe, Tsuyotoshi Tsuji, Kengo Onochi, Kiyonori Yamai, Chika Kusano, Takahiro Dohmen, Yohei Horikawa, Takuma Ajimine, Masahiro Saito, Tomoyuki Koike, Atsushi Masamune, Yosuke Shimodaira, Tamotsu Matsuhashi, Katsunori Iijima

    Esophagus : official journal of the Japan Esophageal Society　19　(3)　477-485　2022/01/06

    DOI： 10.1007/s10388-021-00906-1 　

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    BACKGROUND: While an association between esophago-gastric junctional adenocarcinomas (EGJACs) and obesity, especially visceral obesity, has been suggested in Western countries, the association remains unclear in Asia, including Japan. In this population-based case-control study, we investigated the association between EGJACs and obesity. METHODS: To perform near-population-based data collection for all early-stage EGJACs occurring in Akita Prefecture from 2014 to 2019, clinical data, including endoscopic and computed tomography (CT) findings, were collected from 11 cancer treatment base hospitals in the area. Age- and gender-matched controls were extracted at a case-to-control ratio of 1:2 from healthy subjects who received health checkups in the same area. The visceral fat area (VFA) was calculated using CT images. Logistic regression analyses were performed to investigate the associations between EGJACs and obesity-related parameters. RESULTS: In total, 74 EGJAC cases (62 males, median age of 70 years old) and 148 controls were extracted. Multivariable analyses showed a significantly negative association between the BMI and EGJACs and a significantly positive association between the VFA and EGJACs with odds ratios (ORs) (95% confidence intervals [CIs]) of 0.65 (0.53-0.80) and 1.01 (1.01-1.02), respectively. These findings were confirmed in another dataset (40 EGJACs and 80 controls). In addition, as a categorical variable, VFA ≥ 100 cm2 showed a significantly positive association with EGJACs (OR [95% CI] 1.96 [1.02-3.76]). CONCLUSIONS: We found paradoxical associations between EGJACs and obesity-related parameters (BMI vs. VFA) in a Japanese population, suggesting a potentially pivotal role of the VFA rather than the BMI as a risk factor for EGJACs.

  82. Decreased Expression of NRF2 Target Genes after Alcohol Exposure in the Background Esophageal Mucosa of Patients with Esophageal Squamous Cell Carcinoma

    Shusuke Toda, Waku Hatta, Kiyotaka Asanuma, Naoki Asano, Yoshitaka Ono, Hiroko Abe, Yohei Ogata, Masahiro Saito, Takeshi Kanno, Xiaoyi Jin, Kaname Uno, Tomoyuki Koike, Akira Imatani, Shin Hamada, Tomohiro Nakamura, Naoki Nakaya, Atsushi Masamune

    The Tohoku Journal of Experimental Medicine　258　(3)　195-206　2022

    Publisher: Tohoku University Medical Press

    DOI： 10.1620/tjem.2022.j077 　

    ISSN： 0040-8727

    eISSN： 1349-3329

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    Patients with esophageal squamous cell carcinoma (ESCC) might have a specific mechanism for the carcinogenesis by alcohol consumption in the background esophageal mucosa, and nuclear factor erythroid 2-related factor 2 (NRF2), which plays a protective role against esophageal carcinogenesis, and barrier dysfunction might be associated with this phenomenon. This study aimed to confirm this hypothesis. Twenty patients with superficial ESCCs (ESCC patients) and 20 age- and sex-matched patients without ESCC (non-ESCC patients) were enrolled. Biopsy samples were obtained from non-neoplastic esophageal mucosa: one for histological evaluation, one for quantitative real-time polymerase chain reaction (PCR), and two for the mini-Ussing chamber system to measure transepithelial electrical resistance (TEER) and, thereafter, for PCR. The TEER after acetaldehyde or both acetaldehyde and ethanol exposure did not differ significantly between ESCC and non-ESCC patients. Unlike non-ESCC patients, mRNA levels of NRF2 target genes and claudin4 in ESCC patients tended to decrease after the exposure, with a significant difference between no exposure and both acetaldehyde and ethanol exposure in NRF2 target genes (p < 0.05). Furthermore, in ESCC patients, the decreased tendency of mRNA levels of NRF2 target genes after the exposure was more pronounced in high-risk states, such as aldehyde dehydrogenase 2 (ALDH2) Lys alleles (Glu/Lys + Lys/Lys), Lugol-voiding lesion grade C, and drinking history. In conclusion, the protective role of NRF2 against carcinogenesis from alcohol exposure might be disrupted in the background esophageal mucosa of ESCC patients, which might lead to a high incidence of metachronous ESCC.

  83. Nitric oxide could promote development of Barrett's esophagus by S-nitrosylation-induced inhibition of Rho-ROCK signaling in esophageal fibroblasts. International-journal

    Taku Fujiya, Kiyotaka Asanuma, Tomoyuki Koike, Tomoki Okata, Masahiro Saito, Naoki Asano, Akira Imatani, Atsushi Masamune

    American journal of physiology. Gastrointestinal and liver physiology　322　(1)　G107-G116　2022/01/01

    DOI： 10.1152/ajpgi.00124.2021 　

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    Barrett's esophagus arises in the process of wound healing in distal esophageal epithelium damaged by gastroesophageal reflux disease. Differentiation of fibroblast into myofibroblasts, a smooth muscle cell-like phenotype and tissue contraction are crucial processes in wound healing. No study has evaluated mechanism by which luminal esophageal nitric oxide (NO) affect Rho-associated coiled coil-forming protein kinase (Rho-ROCK) signaling pathway, a key factor of tissue contraction, in stromal fibroblasts to develop Barrett's esophagus. Using esophageal fibroblasts, we performed collagen-based cell contraction assays and evaluated influence of Rho-ROCK signaling in the exposure to acidic bile salts and NOC-9, which is an NO donor. We found that enhanced cell contraction induced by acidic bile salts was inhibited by NO, accompanied by decrease in phosphorylated myosin light chain expression and stress fiber formation. NO directly S-nitrosylated GTP-RhoA and consequently blocked Rho-ROCK signaling. Moreover, exposure to NO and Y27632, a Rho-ROCK signaling inhibitor, decreased α-SMA expression and increased bone morphogenetic protein-4 (BMP4) expression and secretion. These findings could account for the increased expression of BMP4 in the columnar epithelial cells and stromal fibroblasts in human Barrett's esophagus. NO could impair wound contraction by blocking the Rho-ROCK signaling pathway and promote the development of Barrett's esophagus.NEW & NOTEWORTHY Barrett's esophagus is the condition where esophageal epithelium damaged by gastroesophageal reflux disease (GERD) is abnormally healed via replacing of metaplastic columnar epithelium, but very few studies have conducted focusing wound healing in the development of Barrett's esophagus. Esophageal luminal nitric oxide inhibits Rho-ROCK signaling pathway in esophageal fibroblasts, which leads to delay tissue contraction, a pivotal step in proper wound healing. Moreover, this inhibition increases tissue BMP4 expression. Impaired wound healing could be related to Barrett's esophagus.

  84. Predictors of early and late mortality after the treatment for early gastric cancers. International-journal

    Yohei Ogata, Waku Hatta, Yuki Ohara, Tomoyuki Koike, Hiroko Abe, Masahiro Saito, Xiaoyi Jin, Takeshi Kanno, Kaname Uno, Naoki Asano, Akira Imatani, Akihiro Yamamura, Naoki Tanaka, Takashi Kamei, Michiaki Unno, Tomohiro Nakamura, Naoki Nakaya, Atsushi Masamune

    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society　34　(4)　816-825　2021/10/18

    DOI： 10.1111/den.14172 　

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    OBJECTIVES: Although many patients with early gastric cancers (EGCs) die of non-gastric cancer-related causes, the association of the risk categories of lymph node metastasis (LNM) with all-cause mortality remains unclear. We aimed to clarify the predictors of early and late mortality, separately. METHODS: Patients with endoscopic resection or gastrectomy for EGCs between 2003 and 2017 were retrospectively enrolled. We analyzed predictors for early and late mortality, including risk categories of LNM, treatment method, and nine non-cancer-related indices, separately, with a cut-off value of 3 years. RESULTS: We enrolled 1439 patients with a median follow-up period of 79 months. The 5-year overall survival rate was 86.8%. In the multivariate Cox analysis, the most important predictors for early and late mortality were age ≥85 years (hazard ratio [HR] 2.88 and 4.54, respectively) and Eastern Cooperative Oncology Group Performance Status ≥2 (HR 3.00 and 4.19, respectively). Charlson comorbidity index ≥2 (HR 2.76 and 1.99, respectively), American Society of Anesthesiologists Physical Status ≥3 (HR 2.35 and 1.79, respectively), and C-reactive protein/albumin ratio ≥0.028 (HR 2.30 and 1.58, respectively) were also predictors for both early and late mortality. Male (HR 2.26), intermediate- (HR 2.12)/high-risk (HR 1.85) of LNM in eCura system, and sarcopenia evaluated by the psoas muscle mass index (HR 1.70) were predictors for early mortality. CONCLUSION: The combined assessment of multiple predictors might help to predict early and/or late mortality in patients with EGCs. The eCura system was associated with early mortality.

  85. GERDの診断・病態・治療の最新の知見 Postprandial HRIMにおける胃食道逆流の検討

    伊丹 英昭, 中川 健一郎, 齊藤 真弘, 金 笑奕, 菅野 武, 八田 和久, 宇野 要, 浅野 直喜, 今谷 晃, 小池 智幸, 正宗 淳

    日本食道学会学術集会プログラム・抄録集　75回　15-15　2021/09

    Publisher: (NPO)日本食道学会

  86. PPI治療抵抗性NERDにおけるNABに対するvonoprazanの治療効果(The therapeutic effect of vonoprazan on NAB in PPI-refractory NERD)

    齊藤 真弘, 小池 智幸, 正宗 淳

    日本食道学会学術集会プログラム・抄録集　75回　77-77　2021/09

    Publisher: (NPO)日本食道学会

  87. 表在型Barrett食道腺癌に対するLCIの視認性に関する検討

    大原 祐樹, 齊藤 真弘, 小池 智幸, 阿部 寛子, 金 笑奕, 菅野 武, 八田 和久, 宇野 要, 浅野 直喜, 今谷 晃, 正宗 淳

    日本食道学会学術集会プログラム・抄録集　75回　132-132　2021/09

    Publisher: (NPO)日本食道学会

  88. 【消化管がん検診・スクリーニングの手引き】(第V章)上部消化管の検診で知っておくべき前癌状態と腫瘍性疾患 Barrett食道とBarrett腺癌

    小池 智幸, 齊藤 真弘, 大原 祐樹, 八田 和久, 宇野 要, 正宗 淳

    臨床消化器内科　36　(8)　982-994　2021/07

    Publisher: (株)日本メディカルセンター

    ISSN： 0911-601X

    eISSN： 2433-2488

  89. Prevention of delayed bleeding with vonoprazan in upper gastrointestinal endoscopic treatment.

    Hiroko Abe, Waku Hatta, Yohei Ogata, Tomoyuki Koike, Masahiro Saito, Xiaoyi Jin, Kenichiro Nakagawa, Takeshi Kanno, Kaname Uno, Naoki Asano, Akira Imatani, Tomohiro Nakamura, Naoki Nakaya, Kunio Tarasawa, Kenji Fujimori, Kiyohide Fushimi, Atsushi Masamune

    Journal of gastroenterology　56　(7)　640-650　2021/07

    DOI： 10.1007/s00535-021-01781-4 　

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    BACKGROUND: Delayed bleeding is the major adverse event in upper gastrointestinal endoscopic treatment (UGET). We aimed to investigate the efficacy of vonoprazan, which is the novel strong antisecretory agent, to reduce the risk for delayed bleeding in comparison with proton pump inhibitors (PPIs) in UGET. METHODS: This retrospective population-based cohort study used the Diagnosis Procedure Combination database in Japan. We included patients on vonoprazan or PPI in UGET between 2014 and 2019. The primary outcome was delayed bleeding. We conducted propensity score matching to balance the comparison groups, and logistic regression analyses to compare the bleeding outcomes. RESULTS: We enrolled 124,422 patients, in which 34,822 and 89,600 were prescribed with vonoprazan and PPI, respectively. After propensity score matching, the risk for delayed bleeding was lower in vonoprazan than in PPI (odds ratio [OR], 0.75; 95% confidence interval [CI], 0.71-0.80), consistent with sensitivity analysis results. In the subgroup analyses of seven UGET procedures, vonoprazan was significantly advantageous in esophageal endoscopic submucosal dissection (E-ESD) (OR, 0.71; 95% CI, 0.54-0.94) and gastroduodenal endoscopic submucosal dissection (GD-ESD) (OR, 0.70; 95% CI, 0.65-0.75), although correction for multiple testing of the outcome data removed the significance in E-ESD. These results were also consistent with sensitivity analysis results. In the five other procedures, no significant advantage was found. CONCLUSIONS: This nationwide study found that, compared with PPI, vonoprazan can reduce delayed bleeding with approximately 30% in GD-ESD. Vonoprazan has the possibility to become a new treatment method for preventing delayed bleeding in this procedure.

  90. 【Barrett食道・Barrett腺癌の病態と臨床】Barrett食道の発癌リスクとサーベイランス

    小池 智幸, 齊藤 真弘, 正宗 淳

    消化器内科　3　(6)　56-64　2021/06

    Publisher: (株)医学出版

  91. 【食道胃接合部がんとHelicobacter pylori感染】食道胃接合部がんの成因

    小池 智幸, 齊藤 真弘, 大原 祐樹, 正宗 淳

    Helicobacter Research　25　(1)　25-30　2021/06

    Publisher: (株)先端医学社

    ISSN： 1342-4319

  92. 【Barrett食道・Barrett腺癌の病態と臨床】Barrett食道の発癌リスクとサーベイランス

    小池 智幸, 齊藤 真弘, 正宗 淳

    消化器内科　3　(6)　56-64　2021/06

    Publisher: (株)医学出版

  93. 【食道胃接合部がんとHelicobacter pylori感染】食道胃接合部がんの成因

    小池 智幸, 齊藤 真弘, 大原 祐樹, 正宗 淳

    Helicobacter Research　25　(1)　25-30　2021/06

    Publisher: (株)先端医学社

    ISSN： 1342-4319

  94. 【消化器癌;診断と治療のすべて】消化器癌の診断・病期分類・治療・成績 食道癌 内視鏡診断と内視鏡治療

    小池 智幸, 齊藤 真弘, 八田 和久, 正宗 淳

    消化器外科　44　(6)　649-658　2021/05

    Publisher: (株)へるす出版

    ISSN： 0387-2645

  95. 新規内視鏡シミュレーターを用いた、消化管止血術学習プログラムによる教育介入研究

    畑山 裕, 菅野 武, 齊藤 真弘, 中川 健一郎, 金 笑奕, 八田 和久, 宇野 要, 浅野 直喜, 今谷 晃, 小池 智幸, 正宗 淳

    日本消化器病学会雑誌　118　(臨増総会)　A329-A329　2021/03

    Publisher: (一財)日本消化器病学会

    ISSN： 0446-6586

    eISSN： 1349-7693

  96. Helicobacter pylori感染による分化制御遺伝子Notch1の発現抑制を介した胃粘膜萎縮機序の解明

    金 笑奕, 浅野 直喜, 今谷 晃, 齋藤 方志, 竹内 章夫, 斉藤 真弘, 中川 健一郎, 菅野 武, 八田 和久, 宇野 要, 小池 智幸, 正宗 淳

    日本消化器病学会雑誌　118　(臨増総会)　A330-A330　2021/03

    Publisher: (一財)日本消化器病学会

    ISSN： 0446-6586

    eISSN： 1349-7693

  97. 歯周病菌リポ多糖類刺激によるピロリ菌除菌療法後の胃粘膜バリア傷害の検討

    織内 優好, 宇野 要, 李 秀載, 齊藤 真弘, 中川 健一郎, 金 笑奕, 菅野 武, 八田 和久, 浅野 直喜, 小池 智幸, 今谷 晃, 正宗 淳

    日本消化器病学会雑誌　118　(臨増総会)　A332-A332　2021/03

    Publisher: (一財)日本消化器病学会

    ISSN： 0446-6586

    eISSN： 1349-7693

  98. Barrett食道腺癌の周在性に関する食道内逆流因子と基線値の検討

    大原 祐樹, 齊藤 真弘, 小池 智幸, 中川 健一郎, 金 笑奕, 菅野 武, 八田 和久, 宇野 要, 浅野 直喜, 今谷 晃, 正宗 淳

    日本消化器病学会雑誌　118　(臨増総会)　A345-A345　2021/03

    Publisher: (一財)日本消化器病学会

    ISSN： 0446-6586

    eISSN： 1349-7693

  99. 新規内視鏡シミュレーターを用いた、消化管止血術学習プログラムによる教育介入研究

    畑山 裕, 菅野 武, 齊藤 真弘, 中川 健一郎, 金 笑奕, 八田 和久, 宇野 要, 浅野 直喜, 今谷 晃, 小池 智幸, 正宗 淳

    日本消化器病学会雑誌　118　(臨増総会)　A329-A329　2021/03

    Publisher: (一財)日本消化器病学会

    ISSN： 0446-6586

    eISSN： 1349-7693

  100. Helicobacter pylori感染による分化制御遺伝子Notch1の発現抑制を介した胃粘膜萎縮機序の解明

    金 笑奕, 浅野 直喜, 今谷 晃, 齋藤 方志, 竹内 章夫, 斉藤 真弘, 中川 健一郎, 菅野 武, 八田 和久, 宇野 要, 小池 智幸, 正宗 淳

    日本消化器病学会雑誌　118　(臨増総会)　A330-A330　2021/03

    Publisher: (一財)日本消化器病学会

    ISSN： 0446-6586

    eISSN： 1349-7693

  101. 歯周病菌リポ多糖類刺激によるピロリ菌除菌療法後の胃粘膜バリア傷害の検討

    織内 優好, 宇野 要, 李 秀載, 齊藤 真弘, 中川 健一郎, 金 笑奕, 菅野 武, 八田 和久, 浅野 直喜, 小池 智幸, 今谷 晃, 正宗 淳

    日本消化器病学会雑誌　118　(臨増総会)　A332-A332　2021/03

    Publisher: (一財)日本消化器病学会

    ISSN： 0446-6586

    eISSN： 1349-7693

  102. Barrett食道腺癌の周在性に関する食道内逆流因子と基線値の検討

    大原 祐樹, 齊藤 真弘, 小池 智幸, 中川 健一郎, 金 笑奕, 菅野 武, 八田 和久, 宇野 要, 浅野 直喜, 今谷 晃, 正宗 淳

    日本消化器病学会雑誌　118　(臨増総会)　A345-A345　2021/03

    Publisher: (一財)日本消化器病学会

    ISSN： 0446-6586

    eISSN： 1349-7693

  103. 【ついつい教えたくなる、とっておきのコツ】その他・全般 検査好きの不定愁訴の患者への対応

    小池 智幸, 齋藤 真弘, 正宗 淳

    消化器内視鏡　33　(2)　428-431　2021/02

    Publisher: (株)東京医学社

    ISSN： 0915-3217

  104. 胃十二指腸ESDにおけるP-CABの後出血予防効果 propensity scoreを用いたデータベース解析

    阿部 寛子, 八田 和久, たら澤 邦男, 尾形 洋平, 齊藤 真弘, 菅野 武, 金 笑奕, 中川 健一郎, 宇野 要, 小池 智幸, 今谷 晃, 藤森 研司, 伏見 清秀, 正宗 淳

    日本消化器病学会東北支部例会プログラム・抄録集　210回　45-45　2021/02

    Publisher: 日本消化器病学会-東北支部

  105. 胃十二指腸ESDにおけるP-CABの後出血予防効果 propensity scoreを用いたデータベース解析

    阿部 寛子, 八田 和久, たら澤 邦男, 尾形 洋平, 齊藤 真弘, 菅野 武, 金 笑奕, 中川 健一郎, 宇野 要, 小池 智幸, 今谷 晃, 藤森 研司, 伏見 清秀, 正宗 淳

    日本消化器病学会東北支部例会プログラム・抄録集　210回　45-45　2021/02

    Publisher: 日本消化器病学会-東北支部

  106. 【Barrett食道腺癌の内視鏡診断と治療2021】Barrett食道腺癌のsurveillance LSBEを中心に

    小池 智幸, 齊藤 真弘, 大原 祐樹, 伊丹 英昭, 外田 修裕, 竹内 章夫, 大方 智樹, 李 秀載, 中川 健一郎, 金 笑奕, 菅野 武, 八田 和久, 宇野 要, 浅野 直喜, 今谷 晃, 正宗 淳

    胃と腸　56　(2)　163-173　2021/02

    Publisher: (株)医学書院

    ISSN： 0536-2180

    eISSN： 1882-1219

  107. Linked-color Imaging May Help Improve the Visibility of Superficial Barrett's Esophageal Adenocarcinoma by Increasing the Color Difference.

    Masahiro Saito, Tomoyuki Koike, Yuki Ohara, Kenichiro Nakagawa, Takeshi Kanno, Xiaoyi Jin, Waku Hatta, Kaname Uno, Naoki Asano, Akira Imatani, Atsushi Masamune

    Internal medicine (Tokyo, Japan)　60　(21)　3351-3358　2021

    DOI： 10.2169/internalmedicine.6674-20 　

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    Objective Linked-color imaging (LCI), a new technology for image-enhanced endoscopy, emphasizes the color of the mucosa, and its practicality in the detection of early gastric and colon cancers has been reported. However, whether or not LCI is useful for the diagnosis of Barrett's adenocarcinoma (BA) has been unclear. In this study, we explored whether or not LCI enhances the color difference between a BA lesion and the surrounding mucosa. Methods Twenty-one lesions from 20 consecutive patients with superficial BA who underwent endoscopic submucosal dissection between November 2014 and September 2017 were retrospectively examined. The color differences (ΔE*) between the inside and outside of the lesion were evaluated retrospectively using white-light imaging (WLI), blue-light imaging (BLI), and LCI objectively, based on a Commission Internationale de l'Eclairage (CIE) lab color system. Furthermore, we compared the morphology, color, and circumferential location of the lesion. Results The median values of the color difference (ΔE*) in WLI and BLI were 9.1 and 5.8, respectively, and no difference was observed. In LCI, the median color difference was 17.6, which was higher than that of WLI and BLI. Regardless of the morphology, color, and circumferential location of BA lesions, the color difference was larger in LCI than in WLI. Conclusion LCI increases the color difference between the BA and the surrounding Barrett's mucosa.

  108. 好酸球性食道炎・GERD診療の最前線 当科のPPI抵抗性GERD患者におけるsupragastric belchingの占める割合に関する検討

    伊丹 英昭, 中川 健一郎, 大原 祐樹, 齊藤 真弘, 八田 和久, 宇野 要, 浅野 直喜, 今谷 晃, 小池 智幸, 正宗 淳

    日本消化管学会雑誌　5　(Suppl.)　202-202　2021/01

    Publisher: (一社)日本消化管学会

    ISSN： 2433-3840

  109. 逆流性食道炎に対するVonoprazanの維持療法中に出現した腺窩上皮型胃癌の1例

    齊藤 真弘, 小池 智幸, 藤島 史喜, 中川 健一郎, 管野 武, 金 笑変, 八田 和久, 宇野 要, 浅野 直喜, 今谷 晃, 正宗 淳

    日本消化管学会雑誌　5　(Suppl.)　285-285　2021/01

    Publisher: (一社)日本消化管学会

    ISSN： 2433-3840

  110. Predictors of Early and Late Mortality after Endoscopic Resection for Esophageal Squamous Cell Carcinoma.

    Yohei Ogata, Waku Hatta, Tomoyuki Koike, Masahiro Saito, Xiaoyi Jin, Kenichiro Nakagawa, Takeshi Kanno, Kaname Uno, Naoki Asano, Akira Imatani, Tomohiro Nakamura, Naoki Nakaya, Atsushi Masamune

    The Tohoku journal of experimental medicine　253　(1)　29-39　2021/01

    DOI： 10.1620/tjem.253.29 　

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    In esophageal squamous cell carcinoma (ESCC) comprising 90% of cases with esophageal cancer, endoscopic resection (ER) is recommended for patients with negligible risk of ESCC-related mortality. In fact, a main cause of death in patients underwent ER is not ESCC. We thus aimed to clarify the predictors for early and late mortality among patients underwent ER of ESCC between 2005 and 2018 at our institution. In this retrospective cohort study, we investigated the prognosis and predictors of early and late mortality with the cut-off value of 3 years. We enrolled 407 patients with a median 69 months follow-up. The 5-year overall survival and disease-specific survival, an indicator of ESCC-related mortality, were 83.4% and 98.4%, respectively. In multivariate Cox analyses, Eastern Cooperative Oncology Group performance status (ECOG-PS), consisting of six grades by a patient's level of activity, ≥ 2 was a predictor for early and late morality [hazard ratio (HR), 7.21 (P = 0.007) and 15.62 (P = 0.021), respectively]. Charlson comorbidity index (CCI), which is an index for predicting mortality by comorbid conditions, ≥ 2 was also a predictor for both mortality [HR, 2.97 (P = 0.017) and 1.90 (P = 0.019), respectively]. However, age was a predictor only for late mortality [HR, 3.08 (P = 0.010) in 80-84 years and 8.38 (P < 0.001) in ≥ 85 years]. Considering the predictive ability for early mortality, we propose that ECOG-PS and/or CCI are better indices compared with age in deciding treatment strategy after ER for ESCC.

  111. A Rare Case of Localized Esophageal Amyloidosis.

    Taku Fujiya, Waku Hatta, Tomoyuki Koike, Yohei Ogata, Masahiro Saito, Xiaoyi Jin, Kenichiro Nakagawa, Takeshi Kanno, Kiyotaka Asanuma, Kaname Uno, Naoki Asano, Akira Imatani, Fumiyoshi Fujishima, Nagaaki Katoh, Tsuneaki Yoshinaga, Atsushi Masamune

    Internal medicine (Tokyo, Japan)　60　(10)　1529-1532　2020/12/07

    DOI： 10.2169/internalmedicine.6321-20 　

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    A 72-year-old man without any symptoms was referred to our hospital. Esophagogastroduodenoscopy revealed an elevated esophageal lesion that was covered with normal mucosa. The examination of biopsy specimens from the lesion revealed AL (λ) type amyloid deposits, but there were no amyloid deposits elsewhere in the gastrointestinal tract. Further examinations did not indicate systemic amyloidosis. Thus, this case was diagnosed as a localized esophageal amyloidosis. As the clinical outcome of localized amyloidosis is favorable, this case was scheduled for close follow-up. Localized amyloidosis should be considered in the differential diagnosis of esophageal submucosal tumors.

  112. Long-term endoscopic surveillance for Barrett's esophagus in Japan: A multicenter prospective cohort study. International-journal

    Kazuaki Norita, Tomoyuki Koike, Masahiro Saito, Hirohiko Shinkai H, Reiko Ami, Yasuhiko Abe, Naohiro Dairaku, Yoshifumi Inomata, Shoichi Kayaba, Fumitake Ishiyama, Tomoyuki Oikawa, Motoki Ohyauchi, Hirotaka Ito, Sho Asonuma, Tatsuya Hoshi, Katsuaki Kato, Shuichi Ohara, Yosuke Shimodaira, Kenta Watanabe, Tooru Shimosegawa, Atsushi Masamune, Katsunori Iijima

    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society　2020/12/04

    DOI： 10.1111/den.13910 　

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    OBJECTS: Although a recent study showed the cancer incidence of Barrett's esophagus (BE) to be 1.2%/year in 251 patient-years in Japan, the long-term outcomes remain unclear. The present study estimated the cancer risk of BE in Japan using our original prospective multicenter cohort. METHODS: A total of 98 patients with BE of maximum length of ≥2 cm were enrolled during the period of 2010 to 2012 and received at least 1 follow-up endoscopy over 5 years thereafter. Cancer incidence rates with 95% confidence interval for occurrence of esophageal adenocarcinoma were calculated as the number of events divided by patient-years of follow-up and were expressed as %/year. RESULTS: Overall, the median endoscopic follow-up period was 59.9 (first and third quartiles: 48.5-60.8) months, constituting a total of 427 patient-years of observation. Since 2 esophageal adenocarcinoma cases developed, the cancer incidence was 0.47% (0.01%-1.81%)/year. The cancer incidence was 0.39% (-0.16%-2.44%) in 232 patient-years and 0.31% (-0.13%-1.95%)/year in 318 patient-years for 55 cases with specialized intestinal metaplasia and 70 with BE ≥3 cm (maximum), respectively. At the end of follow-up, 12 of 92 patients (13.0%) died, but none died from esophageal adenocarcinoma. CONCLUSION: This is the largest prospective follow-up study with endoscopy to investigate the incidence of esophageal adenocarcinoma in unequivocal BE with the maximum length of ≥2 cm in Japan. Although a further large-scale study will be required to validate our results, the cancer risk of BE in Japan would be lower than previously reported (0.47% vs. 1.2%/year).

  113. 食道胃接合部癌の治療戦略 内視鏡診断から外科治療まで(領域横断的セッション) 表在型Barrett食道腺癌の内視鏡的特徴と治療に関する検討

    齊藤 真弘, 小池 智幸, 大原 祐樹, 阿部 泰明, 中川 健一郎, 八田 和久, 淺沼 清孝, 宇野 要, 今谷 晃, 正宗 淳

    日本食道学会学術集会プログラム・抄録集　74回　41-41　2020/12

    Publisher: (NPO)日本食道学会

  114. 【GERD診療を考える-内視鏡専門医が教える軽症から重症例に対する検査と薬剤の使い方-】GERDの症状と内視鏡所見は一致しているか?

    小池 智幸, 齊藤 真弘, 中川 健一郎, 正宗 淳

    消化器内科　2　(12)　27-34　2020/12

    Publisher: (株)医学出版

  115. Supragastric belching in Japan: lower prevalence and relevance for management of gastroesophageal reflux disease compared to United Kingdom.

    Akinari Sawada, Hideaki Itami, Kenichiro Nakagawa, Shinji Hirano, Hiroyuki Kitamura, Rieko Nakata, Shingo Takashima, Yasuaki Abe, Masahiro Saito, Etsuro Yazaki, Osamu Kawamura, Fumio Tanaka, Toshihisa Takeuchi, Tomoyuki Koike, Atsushi Masamune, Yasuhiro Fujiwara, Kazuhide Higuchi, Daniel Sifrim

    Journal of gastroenterology　55　(11)　1046-1053　2020/11

    DOI： 10.1007/s00535-020-01720-9 　

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    BACKGROUND: Supragastric belching (SGB) may play a role in the pathophysiology of proton pump inhibitors (PPIs)-refractoriness in gastroesophageal reflux disease (GERD). SGB may be present in up to 40% of reflux symptoms in PPI-refractory GERD. Most reports on SGB have come from Western countries, and little is known about the prevalence and relevance of SGB in Asian refractory GERD patients. This study aimed at comparing the role of SGB in GERD patients in Japan and the UK. METHODS: We re-analyzed impedance-pH monitoring tracings from patients who were referred to tertiary centers in Japan and the UK due to PPI-refractory reflux symptoms. The prevalence of excessive SGB and the impact of SGB on reflux symptoms were compared between the two countries. RESULTS: Impedance-pH tracings from124 Japanese and 83 British patients were re-analyzed. Japanese patients were significantly younger and had smaller body mass index than the British (P < 0.001). Japanese patients had significantly lower prevalence of excessive SGB (18.5%) than the UK (36.1%) irrespective of reflux phenotype (P = 0.006). Logistic regression analysis showed that the geographical/cultural difference was the only factor associated with the different prevalence of SGB (odds ratio; 2.91, 95% CI 1.09-7.73, P = 0.032). SGB were related to typical reflux symptoms very rarely in Japan [0% (0-4.9)] compared to the UK [35% (0-54.1)] (P = 0.071). CONCLUSIONS: The prevalence of SGB and their impact on reflux symptoms is significantly lower in Japan compared to the UK. The difference is not related to reflux parameters but might come from ethnic/cultural factors to be further characterized.

  116. 食道扁平上皮癌における分化制御遺伝子Sox2の発現増強による発癌・血管新生機序の解明

    高橋 貴一, 浅野 直喜, 今谷 晃, 金 笑奕, 竹内 章夫, 齋藤 方志, 齊藤 真弘, 中川 健一郎, 菅野 武, 八田 和久, 宇野 要, 小池 智幸, 正宗 淳

    日本消化器病学会雑誌　117　(臨増大会)　A692-A692　2020/10

    Publisher: (一財)日本消化器病学会

    ISSN： 0446-6586

    eISSN： 1349-7693

  117. 食道扁平上皮癌における分化制御遺伝子Sox2の発現増強による発癌・血管新生機序の解明

    高橋 貴一, 浅野 直喜, 今谷 晃, 金 笑奕, 竹内 章夫, 齋藤 方志, 齊藤 真弘, 中川 健一郎, 菅野 武, 八田 和久, 宇野 要, 小池 智幸, 正宗 淳

    日本消化器病学会雑誌　117　(臨増大会)　A692-A692　2020/10

    Publisher: (一財)日本消化器病学会

    ISSN： 0446-6586

    eISSN： 1349-7693

  118. Localized Gastric Amyloidosis that Displayed Morphological Changes over 10 Years of Observation.

    Yasushi Takahashi, Waku Hatta, Tomoyuki Koike, Yohei Ogata, Taku Fujiya, Masahiro Saito, Xiaoyi Jin, Kenichiro Nakagawa, Takeshi Kanno, Kiyotaka Asanuma, Kaname Uno, Naoki Asano, Akira Imatani, Fumiyoshi Fujishima, Nagaaki Katoh, Tsuneaki Yoshinaga, Atsushi Masamune

    Internal medicine (Tokyo, Japan)　60　(4)　539-543　2020/09/30

    DOI： 10.2169/internalmedicine.5031-20 　

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    We herein report an extremely rare case of localized gastric amyloidosis (LGA) with morphological changes during the follow-up. A 71-year-old woman who had a depressed lesion with central elevation in the gastric lower body was diagnosed with LGA. Esophagogastroduodenoscopy at 10 years after the initial examination showed that the lesion had grown and changed morphologically, exhibiting a submucosal tumor-like appearance. Since the lesion was confined to the submucosa, the patient underwent endoscopic submucosal dissection. The final pathological diagnosis was amyloid light-chain (AL)-type LGA. This case may provide useful information regarding the natural history of AL-type LGA.

  119. A Case of the Development of Foveolar-type Gastric Adenocarcinoma during Maintenance Therapy of Vonoprazan for Reflux Esophagitis.

    Masahiro Saito, Tomoyuki Koike, Yasuaki Abe, Kenichiro Nakagawa, Takeshi Kanno, Xiaoyi Jin, Waku Hatta, Kaname Uno, Naoki Asano, Akira Imatani, Fumiyoshi Fujishima, Atsushi Masamune

    Internal medicine (Tokyo, Japan)　60　(3)　391-396　2020/08/29

    DOI： 10.2169/internalmedicine.5431-20 　

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    We herein report the first case of foveolar-type gastric adenocarcinoma that developed after the initiation of vonoprazan (VPZ). A 51-year-old man had heartburn at the first visit and reflux esophagitis endoscopically, so he started taking VPZ. An approximately 5-mm-sized reddish polyp with a raspberry-like morphology was detected at the anterior wall of the upper body of the stomach 156 weeks after starting maintenance therapy with VPZ 10 mg/day. It was diagnosed as foveolar-type gastric adenocarcinoma based on a biopsy. Another approximately 4-mm-sized foveolar-type gastric adenocarcinoma was also detected at the posterior wall of the middle body of the stomach.

  120. 食道胃接合部領域の内視鏡診療 Barrett食道腺癌の局在に関する内視鏡的特徴と食道内逆流因子の検討

    大原 祐樹, 齊藤 真弘, 小池 智幸

    Gastroenterological Endoscopy　62　(Suppl.1)　1065-1065　2020/08

    Publisher: (一社)日本消化器内視鏡学会

    ISSN： 0387-1207

    eISSN： 1884-5738

  121. 噴切後の十二指腸液逆流による難治性逆流性食道炎に対してduodenal switchを施行した1例(Duodenal switch for reflux esophagitis due to duodenal juice reflux after proximal gastrectomy)

    田中 直樹, 武者 宏昭, 井本 博文, 山村 明寛, 青木 豪, 齊藤 真弘, 小池 智幸, 正宗 淳, 内藤 剛, 亀井 尚, 海野 倫明

    日本胃癌学会総会記事　92回　479-479　2020/03

    Publisher: (一社)日本胃癌学会

  122. 噴切後の十二指腸液逆流による難治性逆流性食道炎に対してduodenal switchを施行した1例(Duodenal switch for reflux esophagitis due to duodenal juice reflux after proximal gastrectomy)

    田中 直樹, 武者 宏昭, 井本 博文, 山村 明寛, 青木 豪, 齊藤 真弘, 小池 智幸, 正宗 淳, 内藤 剛, 亀井 尚, 海野 倫明

    日本胃癌学会総会記事　92回　479-479　2020/03

    Publisher: (一社)日本胃癌学会

  123. The Ameliorating Effect of Switching to Vonoprazan: A Novel Potassium-Competitive Acid Blocker in Patients with Proton Pump Inhibitor Refractory Non-Erosive Reflux Disease. International-journal

    Yasuaki Abe, Tomoyuki Koike, Masahiro Saito, Tomoki Okata, Kenichiro Nakagawa, Waku Hatta, Kiyotaka Asanuma, Kaname Uno, Naoki Asano, Akira Imatani, Atsushi Masamune

    Digestion　102　(3)　1-9　2020/02/14

    DOI： 10.1159/000506152 　

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    INTRODUCTION: Weakly acidic reflux has been reported to be the major cause of symptoms in patients with proton pump inhibitor (PPI)-refractory nonerosive reflux disease (NERD) undergoing PPI treatment. We previously reported that reflux at pH 4-5 was the main factor that induced symptoms in such patients. The present study aimed to elucidate the symptom-ameliorating effect of vonoprazan (VPZ) by evaluating the change in the pH value of the refluxate using multichannel intraluminal impedance and pH (MII-pH) monitoring. METHODS: We retrospectively evaluated the records of MII-pH monitoring in 29 symptom index (SI) and/or symptom association probability (SAP)-positive patients with PPI-refractory NERD. After switching to VPZ 20 mg/day, we performed MII-pH monitoring again. We assessed the change in the score of the frequency scale for the symptoms of gastroesophageal reflux disease (FSSG), the pH value of the refluxate, and the percent times of intragastric pH <4 or <5 before and after switching. We divided the patients into the following 2 groups according to the FSSG score after switching: effective and noneffective groups. RESULTS: Among of the 29 SI/SAP-positive patients, 16 underwent switching to VPZ. Furthermore, of these 16 patients, 10 underwent MII-pH monitoring again after switching. The FSSG score decreased, the pH value of the refluxate increased, and the percent times of intragastric pH <4 or <5 reduced after switching when compared with the findings before switching. In the effective group, both the proportion of reflux at pH <4 and that of reflux at pH 4-5 decreased while taking VPZ when compared with the findings while taking double-dose PPI. In the noneffective group, the proportion of reflux at pH <4 decreased but that of reflux at pH 4-5 increased and that of reflux at pH <5 did not change overall while taking VPZ. In addition, the percent times of intragastric pH <5 values were low in the effective group. CONCLUSION: Symptom suppression appears to be inadequate in patients with persistent reflux at pH 4-5 even with VPZ 20 mg/day. Strong acid suppressive therapy with VPZ to increase the pH value of the refluxate to ≥5 is useful for symptom improvement.

  124. 【消化管症候群(第3版)-その他の消化管疾患を含めて-】食道 食道潰瘍

    小池 智幸, 阿部 泰明, 齊藤 真弘, 中川 健一郎, 正宗 淳

    日本臨床　別冊　(消化管症候群II)　24-30　2020/02

    Publisher: (株)日本臨床社

    ISSN： 0047-1852

  125. 「消化管機能性疾患の新展開」-消化管機能性疾患の現状と将来- 機能性胃腸症患者における十二指腸粘膜防御機能の検討

    大方 智樹, 淺沼 清孝, 小池 智幸, 阿部 泰明, 齋藤 真弘, 中川 健一郎, 正宗 淳

    日本消化管学会雑誌　4　(Suppl.)　147-147　2020/01

    Publisher: (一社)日本消化管学会

    ISSN： 2433-3840

  126. 食道限局性アミロイドーシスの一例

    藤谷 拓, 八田 和久, 小池 智幸, 齊藤 真弘, 中川 健一郎, 菅野 武, 金 笑奕, 淺沼 清孝, 宇野 要, 浅野 直喜, 今谷 晃, 正宗 淳

    日本消化器病学会東北支部例会プログラム・抄録集　208回　146-146　2020/01

    Publisher: 日本消化器病学会-東北支部

  127. 内視鏡下生検施行後に発症した巨大食道粘膜下血腫の一例

    伊丹 英昭, 淺沼 清孝, 金 笑奕, 齊藤 真弘, 八田 和久, 宇野 要, 浅野 直喜, 今谷 晃, 小池 智幸, 正宗 淳

    日本消化器病学会東北支部例会プログラム・抄録集　208回　146-146　2020/01

    Publisher: 日本消化器病学会-東北支部

  128. 壁細胞機能不全に伴う胃の多発NETの1例

    阿部 泰明, 八田 和久, 小池 智幸, 齊藤 真弘, 金 笑奕, 中川 健一郎, 菅野 武, 淺沼 清孝, 宇野 要, 浅野 直喜, 今谷 晃, 阿曽沼 祥, 正宗 淳

    日本消化器病学会東北支部例会プログラム・抄録集　208回　153-153　2020/01

    Publisher: 日本消化器病学会-東北支部

  129. Influence of the pH Value of Refluxate and Proximal Extent on Heartburn Perception in Patients with Proton Pump Inhibitor-Refractory Non-Erosive Reflux Disease. International-journal Peer-reviewed

    Yasuaki Abe, Tomoyuki Koike, Masahiro Saito, Tomoki Okata, Kazuaki Norita, Hiroki Kikuchi, Kenichiro Nakagawa, Waku Hatta, Kiyotaka Asanuma, Kaname Uno, Naoki Asano, Akira Imatani, Tooru Shimosegawa, Atsushi Masamune

    Digestion　101　(4)　375-381　2020

    DOI： 10.1159/000500133 　

    ISSN： 0012-2823

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    BACKGROUND AND OBJECTIVES: Weakly acidic reflux has been reported as the major cause of symptom occurrence in patients with proton pump inhibitor (PPI)-refractory non-erosive reflux disease (NERD). This study is aimed at clarifying whether the pH value of weakly acidic reflux affects the induction of symptoms. METHODS: We retrospectively evaluated the records of combined multichannel intraluminal impedance and pH monitoring in 57 patients with PPI-refractory NERD. Weakly acidic refluxes were divided into 3 categories based on the pH value of the refluxate: pH 4-5, 5-6, and 6-7. RESULTS: A total of 29 patients were positive in the symptom index. The symptom provocation rate in reflux of pH 4-5 (19%) was much higher than in that of pH 5-6 (11%) and pH 6-7 (12%). In the reflux at pH 4-5, the symptom provocation rate in the proximal reflux was higher than that in the distal reflux (p < 0.05), whereas the reflux at pH 5-6 and pH 6-7 was not significantly different in the symptom provocation rate between the proximal and distal refluxes. CONCLUSION: Reflux at pH <5 reaching the proximal esophagus was the main factor in the induced symptoms of patients with PPI-refractory NERD.

  130. Strong Intra-Esophageal Reflux May Contribute to the Development of Barrett's Adenocarcinoma and Affect the Localization. International-journal Peer-reviewed

    Masahiro Saito, Tomoyuki Koike, Kenichiro Nakagawa, Yasuaki Abe, Kazuaki Norita, Hiroki Kikuchi, Takeshi Kanno, Waku Hatta, Nobuyuki Ara, Kaname Uno, Kiyotaka Asanuma, Naoki Asano, Akira Imatani, Tooru Shimosegawa, Atsushi Masamune

    Digestion　101　(6)　752-760　2020

    DOI： 10.1159/000502377 　

    ISSN： 0012-2823

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    BACKGROUND: There has been no study that has directly measured the esophageal reflux factors in Barrett's adenocarcinoma (BA) using 24-h multichannel intraluminal impedance-pH monitoring (24-h MII-pH). We aimed to clarify the esophageal reflux factors in Barrett's esophagus (BE) and BA and the factors that determine the location of BA with 24-h MII-pH. METHODS: We performed 24-h MII-pH in 26 patients with superficial BA treated endoscopically (BA group) and 13 patients with BE (BE group) and examined the esophageal reflux factors (esophageal acid exposure time [AET], bolus exposure (acid, weakly acid, and alkaline), and number of reflux episodes. In the BA group, there were 16 cases in which the lesions were localized in an area in contact with the esophagogastric junction (EGJ; EGJ group), and 10 cases in which the lesions were proximal to the BE and separated from the EGJ (non-EGJ group). RESULTS: Total reflux in the bolus exposure in the BA group showed higher values compared to that in the BE group. The total of acid and weakly acid reflux of bolus exposure was significantly higher in the BA group than that in the BE group. The BA group also had greater numbers of total reflux episodes than the BE group. As for the cancer locations in BE, the cases in which the lesions were located proximally and separated from the EGJ had more AET and total reflux and acid reflux indicated by bolus exposure compared to the lesions adjacent to the EGJ. CONCLUSIONS: Stronger gastro-esophageal reflux appeared to be an important factor in the development of adenocarcinoma from BE. In addition, the cancer location in BE may be related to the intensity of esophageal reflux.

  131. 【消化管症候群(第3版)-その他の消化管疾患を含めて-】胃 腫瘍性疾患 食道胃接合部癌

    小池 智幸, 齊藤 真弘, 大原 祐樹, 中川 健一郎, 正宗 淳

    日本臨床　別冊　(消化管症候群I)　288-295　2019/12

    Publisher: (株)日本臨床社

    ISSN： 0047-1852

  132. バレット腺癌の診断と治療の諸問題 Barrett食道腺癌の局在に関与する食道内逆流因子の検討

    齊藤 真弘, 小池 智幸, 正宗 淳

    Gastroenterological Endoscopy　61　(Suppl.2)　1990-1990　2019/10

    Publisher: (一社)日本消化器内視鏡学会

    ISSN： 0387-1207

    eISSN： 1884-5738

  133. Continuous liquid-suction catheter attachment for endoscope reduces volume of liquid reflux to the mouth in esophageal endoscopic submucosal dissection. International-journal Peer-reviewed

    Waku Hatta, Tomoyuki Koike, Hideki Okata, Takashi Hanzawa, Masahiro Saito, Yutaka Kondo, Nobuyuki Ara, Kiyotaka Asanuma, Kaname Uno, Naoki Asano, Akira Imatani, Katsunori Iijima, Tomohiro Nakamura, Naoki Nakaya, Atsushi Masamune

    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society　31　(5)　527-534　2019/09

    DOI： 10.1111/den.13392 　

    ISSN： 0915-5635

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    BACKGROUND AND AIM: Pooling of liquid in the esophageal lumen can worsen the field of vision and cause liquid reflux to the mouth, which leads to aspiration pneumonia, in esophageal endoscopic submucosal dissection (ESD). We developed a continuous liquid-suction catheter attachment for the endoscope (CLCA) that has multiple tiny holes and can suction the liquid without causing mucosal injury. Thus, we aim to show the efficacy of CLCA in esophageal ESD. METHODS: This was a single-blinded, randomized controlled trial involving patients with superficial esophageal cancer. The enrolled patients were randomly assigned to the conventional ESD (C-ESD) or ESD with CLCA (CLCA-ESD) groups. Primary endpoint was volume of liquid reflux to the mouth during the ESD procedure. Secondary endpoints were incidence of aspiration pneumonia and procedure time. RESULTS: Fifty patients were enrolled in this trial. Volume of liquid reflux to the mouth was significantly lower in the CLCA-ESD group than in the C-ESD group (mean: 10 vs 73 mL, P = 0.010). Furthermore, the incidence of aspiration pneumonia on computed tomography (CT) scan between the two groups was also significantly different (4.0% vs 32.0%, P = 0.023), although no significant difference was observed through chest radiography. In addition, procedure time tended to be shorter in the CLCA-ESD group (P = 0.054). CONCLUSION: This study first showed that use of CLCA in esophageal ESD reduced the volume of liquid reflux to the mouth and contributed to decreased incidence of aspiration pneumonia on CT scan (UMIN000018167).

  134. A Primary Barrett's Adenocarcinoma with a Squamous Cell Carcinoma Component. Peer-reviewed

    Akio Takeuchi, Waku Hatta, Tomoyuki Koike, Masahiro Saito, Xiaoyi Jin, Kiyotaka Asanuma, Kaname Uno, Naoki Asano, Akira Imatani, Fumiyoshi Fujishima, Atsushi Masamune

    Internal medicine (Tokyo, Japan)　58　(17)　2467-2472　2019/09/01

    DOI： 10.2169/internalmedicine.2722-19 　

    ISSN： 0918-2918

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    The present report describes an extremely rare case of Barrett's adenocarcinoma (BAC) with a squamous cell carcinoma (SCC) component. A 55-year-old man was diagnosed with esophageal adenocarcinoma on Barrett's esophagus. The patient underwent endoscopic submucosal dissection, but the pathology revealed deep submucosal invasive, moderately differentiated tubular adenocarcinoma and focal SCC with vascular invasion. In addition, morphological transition between adenocarcinoma and SCC components was confirmed. The patient underwent additional surgery, which revealed lymph node metastasis, and then received S-1 adjuvant chemotherapy. Based on the pathological findings, the transdifferentiation process may have a role in the histogenesis of this tumor.

  135. Difficult Preoperative Diagnosis of Lymphoepithelioma-Like Carcinoma of the Esophagus. International-journal Peer-reviewed

    Tomoki Okata, Kaname Uno, Fumiyoshi Fujishima, Masahiro Saito, Xiaoyi Jin, Waku Hatta, Kiyotaka Asanuma, Naoki Asano, Tomoyuki Koike, Akira Imatani, Atsushi Masamune

    ACG case reports journal　6　(8)　e00163　2019/08

    DOI： 10.14309/crj.0000000000000163 　

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    A 60-year-old man with a medical history of diabetes, liver cirrhosis, and distal gastrectomy was referred for further examination of a 10-mm pale-colored submucosal tumor around 40 cm from the incisors. Narrow band imaging-magnifying endoscopy revealed the lesion covered by smooth epithelium with irregular microvascular architecture in a sparse distribution. Endosonography showed an irregular-shaped hypoechoic lesion in the submucosa. With no evidence of metastases, we performed en bloc endoscopic submucosal dissection, whose specimen revealed esophageal lymphoepithelioma-like carcinoma invading up to 500 μm in the submucosa, a rare disease entity. Despite no additional treatment, he was alive without recurrence for longer than 88 months.

  136. 難治性胃潰瘍を呈した好酸球性胃腸炎の一例

    大原 祐樹, 斉藤 真弘, 中川 健一郎, 金 笑奕, 八田 和久, 淺沼 清孝, 宇野 要, 浅野 直喜, 小池 智幸, 今谷 晃, 正宗 淳

    日本消化器病学会東北支部例会プログラム・抄録集　207回　47-47　2019/07

    Publisher: 日本消化器病学会-東北支部

  137. LCIは表在型Barrett食道腺癌の視認性向上に有用である

    齊藤 真弘, 小池 智幸, 八田 和久, 阿部 泰明, 大方 智樹, 金 笑奕, 淺沼 清孝, 宇野 要, 浅野 直喜, 今谷 晃, 正宗 淳

    Gastroenterological Endoscopy　61　(Suppl.1)　892-892　2019/05

    Publisher: (一社)日本消化器内視鏡学会

    ISSN： 0387-1207

    eISSN： 1884-5738

  138. BLI・NBI拡大内視鏡による表在型食道扁平上皮癌深達度診断の比較検討

    八田 和久, 小池 智幸, 荒 誠之, 近藤 穣, 齊藤 真弘, 金 笑奕, 淺沼 清孝, 宇野 要, 浅野 直喜, 今谷 晃, 正宗 淳

    Gastroenterological Endoscopy　61　(Suppl.1)　893-893　2019/05

    Publisher: (一社)日本消化器内視鏡学会

    ISSN： 0387-1207

    eISSN： 1884-5738

  139. GERD診断、治療の最前線 PPI抵抗性NERD患者における症状関連因子の検討

    阿部 泰明, 小池 智幸, 齊藤 真弘

    日本消化器病学会雑誌　115　(臨増総会)　A91-A91　2018/03

    Publisher: (一財)日本消化器病学会

    ISSN： 0446-6586

    eISSN： 1349-7693

  140. バレット腺癌の基礎と臨床 食道内pHインピーダンスモニタリング検査を用いたBarrett食道腺癌の病態の検討

    阿部 泰明, 小池 智幸, 齊藤 真弘

    日本消化器病学会雑誌　115　(臨増総会)　A131-A131　2018/03

    Publisher: (一財)日本消化器病学会

    ISSN： 0446-6586

    eISSN： 1349-7693

  141. Barrett食道腺癌の内視鏡治療後の長期予後に関する検討

    中川 健一郎, 小池 智幸, 齋藤 真弘, 飯島 克則, 下瀬川 徹

    日本食道学会学術集会プログラム・抄録集　68回　43-43　2014/07

    Publisher: (NPO)日本食道学会

  142. Analysis of p53 abnormalities in endoscopic gastric biopsies

    Akira Imatani, Hironobu Sasano, Shigeru Asaki, Takayoshi Toyota, Masahiro Saito, Takayuki Masuda, Hiroshi Nagura

    Anticancer Research　16　(4 A)　2049-2056　1996/07

    ISSN： 0250-7005

Show all ︎Show first 5

Misc. 41

  1. PPI抵抗性GERD患者におけるexcessive supragastric belching(excessive SGB)の食道内逆流因子と有病率の検討

    首藤千博, 齊藤真弘, 小池智幸, 小泉薫, 皆瀬ゆみ子, 谷地一真, 八田和久, 宇野要, 浅野直喜, 正宗淳

    日本消化器病学会雑誌(Web)　121　2024

    ISSN： 1349-7693

  2. Barrett食道の発癌に対する食道内逆流因子と食道運動機能の影響

    谷地一真, 齊藤真弘, 小池智幸, 小泉薫, 皆瀬ゆみ子, 首藤千博, 八田和久, 宇野要, 浅野直喜, 正宗淳

    日本消化器病学会雑誌(Web)　121　2024

    ISSN： 1349-7693

  3. 一般成人におけるディスペプシアの疫学と内視鏡所見:がん検診事業のデータから

    鈴木直生, 菅野武, 菅野武, 小池智幸, 千葉隆士, 淺沼清孝, 加藤勝章, 尾形洋平, 齊藤真弘, 金笑奕, 八田和久, 宇野要, 浅野直喜, 今谷晃, 正宗淳

    日本消化器病学会雑誌(Web)　121　2024

    ISSN： 1349-7693

  4. 薬剤性食道炎—Drug-induced esophagitis—特集 食道良性疾患の診断・治療

    小池 智幸, 谷地 一真, 首藤 千博, 伊丹 英明, 大原 祐樹, 齊藤 真弘, 正宗 淳

    消化器・肝臓内科 = Gastroenterology & hepatology / 消化器・肝臓内科編集委員会 編　12　(1)　22-26　2022/07

    ISSN： 2432-3446

  5. 食道扁平上皮癌患者の背景食道非腫瘍粘膜におけるアルコール曝露後のNRF2標的遺伝子発現低下

    外田修裕, 八田和久, 正宗淳, 淺沼清孝, 浅野直喜, 齊藤真弘, 金笑奕, 菅野武, 小池智幸, 今谷晃

    日本消化器病学会雑誌(Web)　119　2022

    ISSN： 1349-7693

  6. 難治性食道狭窄を呈した微小ガストリノーマの1例

    草野啓介, 宇野要, 小池智幸, 三浦晋, 齊藤真弘, 金笑奕, 菅野武, 八田和久, 浅野直喜, 今谷晃, 正宗淳, 益田邦洋, 大塚英郎, 海野倫明, 藤島史喜, 中堀昌人

    日本消化器病学会東北支部例会誌　212th　2022

  7. Prevention of delayed bleeding with P-CAB in upper gastrointestinal endoscopic treatment

    阿部寛子, 八田和久, たら澤邦男, 尾形洋平, 齊藤真弘, 菅野武, 金笑奕, 宇野要, 小池智幸, 今谷晃, 藤森研司, 伏見清秀, 正宗淳

    日本消化管学会雑誌(CD-ROM)　6　(Supplement)　2022

    ISSN： 2433-3840

  8. 内視鏡的に完全切除した胃平滑筋肉腫の一例

    谷地一真, 八田和久, 小池智幸, 齊藤真弘, 菅野武, 金笑奕, 宇野要, 浅野直喜, 今谷晃, 渡邊裕文, 藤島史喜, 正宗淳

    日本消化器病学会東北支部例会誌　212th　2022

  9. 歯周病菌リポ多糖類刺激によるピロリ菌除菌療法後の胃粘膜バリア傷害の検討

    織内優好, 宇野要, 李秀載, 齊藤真弘, 中川健一郎, 金笑奕, 菅野武, 八田和久, 浅野直喜, 小池智幸, 今谷晃, 正宗淳

    日本消化器病学会雑誌(Web)　118　2021

    ISSN： 1349-7693

  10. 新規内視鏡シミュレーターを用いた,消化管止血術学習プログラムによる教育介入研究

    畑山裕, 菅野武, 齊藤真弘, 中川健一郎, 金笑奕, 八田和久, 宇野要, 浅野直喜, 今谷晃, 小池智幸, 正宗淳

    日本消化器病学会雑誌(Web)　118　2021

    ISSN： 1349-7693

  11. Helicobacter pylori感染による分化制御遺伝子Notch1の発現抑制を介した胃粘膜萎縮機序の解明

    金笑奕, 浅野直喜, 今谷晃, 齋藤方志, 竹内章夫, 斉藤真弘, 中川健一郎, 菅野武, 八田和久, 宇野要, 小池智幸, 正宗淳

    日本消化器病学会雑誌(Web)　118　2021

    ISSN： 1349-7693

  12. Sox2 induces tumorigenesis and angiogenesis of early-stage esophageal squamous cell carcinoma through secretion of Suprabasin. International-journal

    Kiichi Takahashi, Naoki Asano, Akira Imatani, Yutaka Kondo, Masashi Saito, Akio Takeuchi, Xiaoyi Jin, Masahiro Saito, Waku Hatta, Kiyotaka Asanuma, Kaname Uno, Tomoyuki Koike, Atsushi Masamune

    Carcinogenesis　41　(11)　1543-1552　2020/11/13

    DOI： 10.1093/carcin/bgaa014 　

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    Early stage of esophageal squamous cell carcinoma (ESCC) is known to be accompanied by angiogenesis and morphological changes of microvessels. Transcription factor Sox2 is amplified in various cancers including ESCC, but the role of Sox2 in the carcinogenesis and angiogenesis has not been determined. Hence, we aimed to investigate the role of Sox2 in the early stage of ESCC. We found that the expression of Sox2 was significantly higher in early-stage ESCC tissues than that in their adjacent normal tissues. We then established Sox2-inducible normal human esophageal squamous cell line (HetSox2) to investigate the role of Sox2 in esophageal carcinogenesis and angiogenesis in vitro. Sox2 overexpression led to increased cell proliferation and spheroid formation. The culture supernatant of Sox2-overexpressing HetSox2 induced migration and sprouting of endothelial cell line HUVEC (human umbilical vein endothelial cell). As for the mechanism, we found that the expression of secreted protein Suprabasin was directly induced by Sox2. Suprabasin enhanced proliferation of normal human esophageal squamous cells when added to the culture. Moreover, Suprabasin enhanced migration and sprouting of HUVEC cells, which were observed with the culture supernatant of Sox2-overexpressing HetSox2. This angiogenic effect of Suprabasin was abolished by inhibiting AKT phosphorylation, which suggested its dependence on AKT signaling. Finally, we showed that Suprabasin expression and the density of microvessels were significantly higher in ESCC tissues with high Sox2 expression. Our study suggested that increased Sox2 expression in esophageal squamous cells induced Suprabasin expression, and as a result initiated the carcinogenesis via increased cell proliferation and angiogenesis.

  13. Barrett食道癌の診断

    小池 智幸, 齊藤 真弘, 大原 祐樹, 大方 智樹, 阿部 泰明, 中川 健一郎, 金 笑奕, 菅野 武, 八田 和久, 淺沼 清孝, 宇野 要, 浅野 直喜, 今谷 晃, 菊地 亮介, 猪股 芳文, 正宗 淳

    胃と腸　55　(5)　514-529　2020/05

  14. 食道扁平上皮癌における分化制御遺伝子Sox2の発現増強による発癌・血管新生機序の解明

    高橋貴一, 浅野直喜, 今谷晃, 金笑奕, 竹内章夫, 齋藤方志, 齊藤真弘, 中川健一郎, 菅野武, 八田和久, 宇野要, 小池智幸, 正宗淳

    日本消化器病学会雑誌(Web)　117　2020

    ISSN： 1349-7693

  15. Barrett食道腺癌の局在に関与する食道内逆流因子の検討

    齊藤真弘, 小池智幸, 正宗淳

    日本消化器がん検診学会雑誌　57　(Supplement)　978　2019/09/25

    ISSN： 1880-7666

  16. 食道の炎症を視る アレルギー性・自己免疫性 好酸球性食道炎の診断と治療

    浅野直喜, 小池智幸, 齊藤真弘, 中川健一郎, JIN Xiaoyi, 八田和久, 淺沼清孝, 宇野要, 今谷晃, 正宗淳

    消化器内視鏡　31　(8)　1179‐1184-1184　2019/08/25

    Publisher: (株)東京医学社

    ISSN： 0915-3217

  17. 難治性胃潰瘍を呈した好酸球性胃腸炎の一例

    大原 祐樹, 斉藤 真弘, 中川 健一郎, 金 笑奕, 八田 和久, 淺沼 清孝, 宇野 要, 浅野 直喜, 小池 智幸, 今谷 晃, 正宗 淳

    日本消化器病学会東北支部例会プログラム・抄録集　207回　47-47　2019/07

    Publisher: 日本消化器病学会-東北支部

  18. LCIは表在型Barrett食道腺癌の視認性向上に有用である

    齊藤 真弘, 小池 智幸, 八田 和久, 阿部 泰明, 大方 智樹, 金 笑奕, 淺沼 清孝, 宇野 要, 浅野 直喜, 今谷 晃, 正宗 淳

    Gastroenterological Endoscopy　61　(Suppl.1)　892-892　2019/05

    Publisher: (一社)日本消化器内視鏡学会

    ISSN： 0387-1207

  19. BLI・NBI拡大内視鏡による表在型食道扁平上皮癌深達度診断の比較検討

    八田 和久, 小池 智幸, 荒 誠之, 近藤 穣, 齊藤 真弘, 金 笑奕, 淺沼 清孝, 宇野 要, 浅野 直喜, 今谷 晃, 正宗 淳

    Gastroenterological Endoscopy　61　(Suppl.1)　893-893　2019/05

    Publisher: (一社)日本消化器内視鏡学会

    ISSN： 0387-1207

  20. 症状の季節変動を繰り返す好酸球性食道筋炎の1例

    外田 修裕, 宇野 要, 齊藤 真弘, 金 笑奕, 八田 和久, 淺沼 清孝, 浅野 直喜, 小池 智幸, 今谷 晃, 庄司 知隆, 佐藤 千晃, 亀井 尚, 正宗 淳

    日本消化器病学会東北支部例会プログラム・抄録集　206回　85-85　2019/02

    Publisher: 日本消化器病学会-東北支部

  21. 食道内pH・インピーダンス検査を用いたPPI抵抗性NERDの逆流pHの評価

    阿部泰明, 小池智幸, 齊藤真弘, 正宗淳

    日本消化管学会雑誌　3　(Supplement)　216　2019/02

    ISSN： 2433-3840

  22. 高用量ステロイド投与は出血性胃十二指腸潰瘍内視鏡治療後再出血の危険因子である

    八田和久, 小池智幸, 齊藤真弘, 金笑奕, 淺沼清孝, 宇野要, 浅野直喜, 今谷晃, 正宗淳

    日本消化管学会雑誌　3　(Supplement)　157　2019/02

    ISSN： 2433-3840

  23. 表在型Barrett食道腺癌に対するLCI観察の有用性

    齊藤真弘, 小池智幸, 正宗淳

    日本消化管学会雑誌　3　(Supplement)　188　2019/02

    ISSN： 2433-3840

  24. 高用量ステロイド投与は出血性胃十二指腸潰瘍内視鏡治療後再出血の危険因子である

    八田和久, 小池智幸, 齊藤真弘, 金笑奕, 淺沼清孝, 宇野要, 浅野直喜, 今谷晃, 正宗淳

    日本消化管学会雑誌　3　(Supplement)　2019

    ISSN： 2435-8967

  25. バレット食道、食道癌の診療と研究の最前線-欧米との違いを含めて- 表在型Barrett食道腺癌の内視鏡的特徴と24時間食道pH多チャンネルインピーダンス検査(MII-pH)を用いた病態に関する検討

    齊藤 真弘, 小池 智幸, 正宗 淳

    日本消化器病学会雑誌　115　(臨増大会)　A493-A493　2018/10

    Publisher: (一財)日本消化器病学会

    ISSN： 0446-6586

    eISSN： 1349-7693

  26. バレット食道、食道癌の診療と研究の最前線-欧米との違いを含めて- 表在型Barrett食道腺癌の内視鏡的特徴と24時間食道pH多チャンネルインピーダンス検査(MII-pH)を用いた病態に関する検討

    齊藤 真弘, 小池 智幸, 正宗 淳

    Gastroenterological Endoscopy　60　(Suppl.2)　1919-1919　2018/10

    Publisher: (一社)日本消化器内視鏡学会

    ISSN： 0387-1207

    eISSN： 1884-5738

  27. バレット食道、食道癌の診療と研究の最前線-欧米との違いを含めて- 表在型Barrett食道腺癌の内視鏡的特徴と24時間食道pH多チャンネルインピーダンス検査(MII-pH)を用いた病態に関する検討

    齊藤 真弘, 小池 智幸, 正宗 淳

    日本消化器病学会雑誌　115　(臨増大会)　A493-A493　2018/10

    Publisher: (一財)日本消化器病学会

    ISSN： 0446-6586

  28. 胃酸分泌からみたバレット食道・がんの病態

    小池智幸, 大方智樹, 阿部泰明, 乗田一明, 菊池弘樹, 齊藤真弘

    胃病態機能研究会誌　50　(50)　40-40　2018/02/01

    Publisher: (株)勁草書房コミュニケーション事業部

    ISSN： 1880-3652

  29. PPI抵抗性NERD患者の病態とVonoprazanの有用性の検討

    齊藤真弘, 小池智幸

    胃病態機能研究会誌　50　(50)　31-31　2018/02/01

    Publisher: (株)勁草書房コミュニケーション事業部

    ISSN： 1880-3652

  30. PPI抵抗性NERDの症状関連逆流の特徴~ボノプラザン切り替え例の検討~

    阿部泰明, 小池智幸, 大方智樹, 乗田一明, 齊藤真弘, 正宗淳

    日本神経消化器病学会プログラム・抄録集　20th　72　2018

  31. PPI抵抗性NERD患者における粘膜防御機構の検討

    乗田一明, 淺沼清孝, 小池智幸, 大方智樹, 阿部泰明, 菊池弘樹, 齊藤真弘, 中川健一郎, 正宗淳, 下瀬川徹

    日本食道学会学術集会抄録集(CD-ROM)　72nd　247　2018

  32. 表在型Barrett食道腺癌の内視鏡的特徴と24時間食道pH多チャンネルインピーダンス検査(MII‐pH)を用いた病態に関する検討

    齊藤真弘, 小池智幸, 正宗淳

    Gastroenterological Endoscopy (Web)　60　(Supplement2)　1919(J‐STAGE)　2018

    ISSN： 1884-5738

  33. 24hr MII‐pHモニタリング検査における基線の検討によるPPI抵抗性NERDの病態

    菊池弘樹, 小池智幸, 阿部泰明, 乗田一明, 齊藤真弘, 下瀬川徹

    胃病態機能研究会誌　49　(49)　36-36　2017/02/01

    Publisher: (株)勁草書房コミュニケーション事業部

    ISSN： 1880-3652

  34. PPI抵抗性NERD患者における24hr MII‐pHによる診断と,Vonoprazanの有用性,とくにNABに対する治療効果の検討

    齊藤真弘, 小池智幸, 下瀬川徹

    日本消化管学会総会学術集会プログラム・抄録集　13th　141　2017

    ISSN： 2189-9037

  35. 当院における表在型Barrett食道癌の内視鏡治療成績

    菊池弘樹, 小池智幸, 齊藤真弘, 菅野武, 八田和久, 荒誠之, 淺沼清孝, 浅野直喜, 今谷晃, 下瀬川徹

    日本消化管学会総会学術集会プログラム・抄録集　13th　173　2017

    ISSN： 2189-9037

  36. 表在型Barrett食道癌の多発因子の検討

    菊池弘樹, 小池智幸, 齊藤真弘, 阿部泰明, 乗田一明, 八田和久, 荒誠之, 浅野直喜, 下瀬川徹

    日本食道学会学術集会抄録集(CD-ROM)　71st　ROMBUNNO.P81‐4-4　2017

    Publisher: (NPO)日本食道学会

  37. 難治性逆流性食道炎/NERDを診る Barrett食道・腺癌―逆流性食道炎との関連と診断の実際

    小池智幸, 小池智幸, 齊藤真弘, 菊池弘樹, 乗田一明, 八田和久, 荒誠之, 淺沼清孝, 浅野直喜, 下瀬川徹

    消化器の臨床　19　(2)　152‐159-101　2016/04/10

    Publisher: ヴァンメディカル

    ISSN： 1344-3070

  38. Intense Gastro-Esophageal Reflux May Influence the Localization of Barrett's Adenocarcinoma: Measured by 24-h pH-Impedance Monitoring

    Masahiro Saito, Tomoyuki Koike, Hiroki Kikuchi, Kazuaki Norita, Kenichirou Nakagawa, Takeshi Kanno, Gen Kusaka, Yutaka Kondo, Waku Hatta, Nobuyuki Ara, Kiyotaka Asanuma, Kaname Uno, Naoki Asano, Akira Imatani, Katsunori Iijima, Tooru Shimosegawa

    GASTROENTEROLOGY　150　(4)　S483-S483　2016/04

    ISSN： 0016-5085

    eISSN： 1528-0012

  39. PPI抵抗性NERD患者における24時間pHインピーダンスモニタリングによる治療の個別化の検討

    齊藤真弘, 小池智幸, 下瀬川徹

    胃病態機能研究会誌　48　(48)　53-53　2016/02/08

    Publisher: (株)勁草書房コミュニケーション事業部

    ISSN： 1880-3652

  40. GERD GERDの病態と診断・治療 GERDにおける逆流現象の評価

    中川健一郎, 飯島克則, 小池智幸, 乗田一明, 菊池弘樹, 齊藤真弘, 下瀬川徹

    JOHNS　32　(2)　169‐171-171　2016/02/01

    Publisher: (株)東京医学社

    ISSN： 0910-6820

  41. PPI抵抗性NERD患者における24hr MII‐pHによる診断と,Vonoprazanの有用性の検討

    齊藤真弘, 小池智幸, 菊池弘樹, 乗田一明, 八田和久, 荒誠之, 淺沼清孝, 浅野直喜, 今谷晃, 下瀬川徹

    日本食道学会学術集会抄録集(CD-ROM)　70th　ROMBUNNO.W1‐6-35　2016

    Publisher: (NPO)日本食道学会

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