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1.
J Clin Med ; 13(17)2024 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-39274314

RESUMO

Background: Recently, there has been a significant increase in the utilization of self-expandable metallic stents (SEMSs) for treating malignant colorectal obstructions through colorectal stenting. The mechanical properties of SEMSs are usually considered to affect clinical outcomes of patients with malignant colorectal obstructions. Methods: This single-arm, prospective, multicenter study of SEMS with a lower axial force and high axial force zero-border included 200 patients with malignant colorectal obstruction. Technical and clinical success, stent patency, and adverse events associated with SEMS placement were evaluated. Results: One patient was excluded, and 199 patients were evaluated. The treatment intent was bridge-to-surgery in 129 and palliation in 70 patients. Technical and clinical success rates were 99.5% and 97.0%, respectively. The percentage of the ColoRectal Obstruction Scoring System scores of 3 or higher improved significantly from 19.2% before placement to 93.9% after placement. Clinical success was not achieved in five patients due to insufficient stent expansion in four patients and stent occlusion in one patient. Only one patient underwent emergency surgery for perforation of the proximal colon, far from where the stent was placed; the rescue procedure was not performed, despite no improvement in proximal dilatation due to insufficient stent expansion. Among the palliation cohort, 15 patients received chemotherapy, including molecular-targeted agents such as bevacizumab. There were no fatal cases related to stent placement. Conclusions: For management of malignant colorectal obstruction, this newly developed SEMS with low axial force and a high axial force zero-border showed high technical and clinical success rates, and an extremely low perforation rate (0.5%).

2.
Dis Esophagus ; 2024 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-38869095

RESUMO

Although esophageal cancers invading the muscularis mucosa (pT1a-MM) or submucosa (pT1b-SM) after endoscopic resection (ER) are associated with a risk of lymph node metastasis, details of metastatic recurrence after additional treatment remain unknown. We aimed to identify the risk factors for metastatic recurrence and recurrence patterns in patients receiving additional treatment after ER for esophageal cancer. Between 2006 and 2017, patients with pT1a-MM/pT1b-SM esophageal cancer who underwent ER with additional treatment (esophagectomy, chemoradiotherapy [CRT], and radiation therapy) at 21 institutions in Japan were enrolled. We evaluated the risk factors for metastatic recurrence after ER with additional treatment. Subsequently, the rate and pattern (locoregional or distant) of metastatic recurrence were investigated for each additional treatment. Of the 220 patients who received additional treatment, 57, 125, and 38 underwent esophagectomy, CRT, and radiation therapy, respectively. In the multivariate analysis, lymphatic invasion was the sole risk factor for metastatic recurrence after additional treatment (hazard ratio, 3.50; P = 0.029). Although the risk of metastatic recurrence with additional esophagectomy was similar to that with CRT (hazard ratio, 1.01; P = 0.986), the rate of locoregional recurrence tended to be higher with additional esophagectomy (80.0% (4/5) vs. 36.4% (4/11)), leading to a better prognosis in patients with metastatic recurrence after additional esophagectomy than CRT (survival rate, 80.0% (4/5) vs. 9.1% (1/11)). Patients with lymphatic invasion have a high risk of metastatic recurrence after ER with additional treatment for pT1a-MM/pT1b-SM esophageal cancer. Additional esophagectomy may result in a better prognosis after metastatic recurrence.

3.
BMC Gastroenterol ; 24(1): 61, 2024 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-38310266

RESUMO

BACKGROUND: Sodium picosulfate (SP)/magnesium citrate (MC) and polyethylene glycol (PEG) plus ascorbic acid are recommended by Western guidelines as laxative solutions for bowel preparation. Clinically, SP/MC has a slower post-dose defaecation response than PEG and is perceived as less cleansing; therefore, it is not currently used for major bowel cancer screening preparation. The standard formulation for bowel preparation is PEG; however, a large dose is required, and it has a distinctive flavour that is considered unpleasant. SP/MC requires a small dose and ensures fluid intake because it is administered in another beverage. Therefore, clinical trials have shown that SP/MC is superior to PEG in terms of acceptability. We aim to compare the novel bowel cleansing method (test group) comprising SP/MC with elobixibat hydrate and the standard bowel cleansing method comprising PEG plus ascorbic acid (standard group) for patients preparing for outpatient colonoscopy. METHODS: This phase III, multicentre, single-blind, noninferiority, randomised, controlled, trial has not yet been completed. Patients aged 40-69 years will be included as participants. Patients with a history of abdominal or pelvic surgery, constipation, inflammatory bowel disease, or severe organ dysfunction will be excluded. The target number of research participants is 540 (standard group, 270 cases; test group, 270 cases). The primary endpoint is the degree of bowel cleansing (Boston Bowel Preparation Scale [BBPS] score ≥ 6). The secondary endpoints are patient acceptability, adverse events, polyp/adenoma detection rate, number of polyps/adenomas detected, degree of bowel cleansing according to the BBPS (BBPS score ≥ 8), degree of bowel cleansing according to the Aronchik scale, and bowel cleansing time. DISCUSSION: This trial aims to develop a "patient-first" colon cleansing regimen without the risk of inadequate bowel preparation by using both elobixibat hydrate and SP/MC. TRIAL REGISTRATION: Japan Registry of Clinical Trials (jRCT; no. s041210067; 9 September 2021; https://jrct.niph.go.jp/ ), protocol version 1.5 (May 1, 2023).


Assuntos
Citratos , Ácido Cítrico , Dipeptídeos , Compostos Organometálicos , Picolinas , Polietilenoglicóis , Pólipos , Tiazepinas , Humanos , Catárticos , Pacientes Ambulatoriais , Ácido Ascórbico/efeitos adversos , Método Simples-Cego , Colonoscopia/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Multicêntricos como Assunto , Ensaios Clínicos Fase III como Assunto
4.
Dig Endosc ; 36(3): 314-322, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37343173

RESUMO

OBJECTIVES: Clinical outcomes of endoscopic submucosal dissection (ESD) for esophageal squamous cell carcinoma (ESCC) with esophageal varices (EVs) are obscure. We aimed to elucidate the clinical outcomes of ESD for ESCC with EVs in a multicenter, retrospective study. METHODS: We established a retrospective cohort of 30 patients with ESCC complicating EVs, who underwent ESD at 11 Japanese institutions. Rates of en bloc resection and R0 resection, procedure time, and adverse events were evaluated as indicators of the feasibility and safety of ESD. Additional treatment, recurrence, and metastasis of the lesions were evaluated as indicators of the long-term efficacy of ESD. RESULTS: Portal hypertension was caused by cirrhosis, of which alcohol was the most common cause. En bloc resection was achieved in 93.3% and R0 resection in 80.0% of the patients. The median procedure time was 92 min. Adverse events included a case of uncontrolled intraoperative bleeding leading to discontinuation of ESD and a case of esophageal stricture due to extensive resection. During the follow-up period of a median for 42 months, a patient with local recurrence and another patient with liver metastasis were observed. One patient died of liver failure after receiving chemoradiotherapy as an additional treatment after ESD. No patient died of ESCC. CONCLUSION: This multicenter, retrospective cohort study demonstrated the safety and efficacy of ESD for ESCC with EVs. Further studies are needed to establish appropriate treatment methods for EVs before ESD and additional treatments for patients with insufficient ESD.


Assuntos
Carcinoma de Células Escamosas , Ressecção Endoscópica de Mucosa , Neoplasias Esofágicas , Carcinoma de Células Escamosas do Esôfago , Varizes Esofágicas e Gástricas , Humanos , Carcinoma de Células Escamosas/complicações , Carcinoma de Células Escamosas/cirurgia , Ressecção Endoscópica de Mucosa/efeitos adversos , Ressecção Endoscópica de Mucosa/métodos , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/cirurgia , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/cirurgia , Carcinoma de Células Escamosas do Esôfago/complicações , Carcinoma de Células Escamosas do Esôfago/cirurgia , Esofagoscopia/métodos , Estudos Retrospectivos , Resultado do Tratamento
5.
Nihon Shokakibyo Gakkai Zasshi ; 120(5): 433-440, 2023.
Artigo em Japonês | MEDLINE | ID: mdl-37183037

RESUMO

A 78-year-old female patient with stomach cancer (with hepatic metastasis and peritoneal dissemination) had received eight courses of an S-1 and oxaliplatin regimen as palliative chemotherapy. Computed tomography revealed liver deformities and incidental gastric varices. Esophagogastroduodenoscopy confirmed the findings of gastric varices in the cardia and fornix. It was suspected that oxaliplatin-based chemotherapy had induced non-variceal portal hypertension in the patient-similar to that which is seen in patients with colon cancer who are treated with oxaliplatin-based chemotherapy. We had chosen balloon-occluded retrograde transvenous obliteration (BRTO) for the preventive treatment of gastric varices because the patient had a gastro-renal shunt, which enabled access to the gastric varices via the vena cava. Our patient had undergone BRTO, which resulted in the endoscopic disappearance of gastric varices. Currently, the patient is continuing chemotherapy without bleeding from gastric varices. Our case suggests that patients with gastric cancer treated with oxaliplatin-based chemotherapy require careful follow-up for portal hypertension.


Assuntos
Oclusão com Balão , Varizes Esofágicas e Gástricas , Hipertensão Portal , Neoplasias Gástricas , Feminino , Humanos , Idoso , Varizes Esofágicas e Gástricas/diagnóstico por imagem , Varizes Esofágicas e Gástricas/etiologia , Varizes Esofágicas e Gástricas/terapia , Neoplasias Gástricas/terapia , Neoplasias Gástricas/complicações , Oxaliplatina , Hipertensão Portal/complicações , Resultado do Tratamento , Hemorragia Gastrointestinal/terapia
6.
J Gastroenterol ; 58(4): 346-357, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-36633664

RESUMO

BACKGROUND: The guidelines recommend additional gastrectomy after noncurative endoscopic resection for early gastric cancers (EGCs). However, no additional treatment might be acceptable in some patients aged ≥ 85 years. We aimed to identify this patient group using the data in a highly aged area. METHODS: We enrolled patients aged ≥ 85 years after noncurative endoscopic resection for EGCs at 30 institutions of the Tohoku district in Japan between 2002 and 2017. Treatment selection and prognosis after noncurative endoscopic resection were investigated. Fourteen candidates were evaluated using the Cox model to identify risk factors for poor overall survival (OS) in patients with no additional treatment. RESULTS: Of 1065 patients aged ≥ 85 years, 143 underwent noncurative endoscopic resection. Despite the guidelines' recommendation, 88.8% of them underwent no additional treatment. The 5-year OS rates in those with additional gastrectomy and those with no additional treatment were 63.1 and 65.2%, respectively. Multivariate analysis showed independent risk factors for poor OS in patients with no additional treatment were the high-risk category in the eCura system (hazard ratio [HR], 2.91), Charlson comorbidity index (CCI) ≥ 3 (HR, 2.78), and male (HR, 2.04). In patients with no additional treatment, nongastric cancer-specific survival was low (69.0% in 5 years), whereas disease-specific survival rates were very high in the low- and intermediate-risk categories of the eCura system (100.0 and 97.1%, respectively, in 5 years). CONCLUSIONS: No additional treatment may be acceptable in the low- and intermediate-risk categories of the eCura system in patients aged ≥ 85 years with noncurative endoscopic resection for EGCs.


Assuntos
Ressecção Endoscópica de Mucosa , Neoplasias Gástricas , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Neoplasias Gástricas/cirurgia , Japão/epidemiologia , Gastrectomia , Mucosa Gástrica/cirurgia
7.
Dig Dis Sci ; 68(5): 2050-2060, 2023 05.
Artigo em Inglês | MEDLINE | ID: mdl-36445654

RESUMO

BACKGROUND: Although additional treatment is considered for patients with esophageal squamous cell carcinoma (ESCC) invading into the muscularis mucosa (pT1a-MM) or submucosa (pT1b-SM) after endoscopic submucosal dissection (ESD), the actual benefits of this method remain to be elucidated. AIMS: We aimed to evaluate the prognostic benefits of additional treatment in such patients. METHODS: Between 2006 and 2017, we enrolled patients with pT1a-MM/pT1b-SM ESCC after ESD at 21 institutions in Japan. Overall survival (OS) and disease-specific survival (DSS) were compared between the additional treatment and follow-up groups after propensity score matching, to reduce the bias of baseline characteristics. A subgroup analysis was performed according to the pathological findings: category A, pT1a-MM but negative for lymphovascular invasion (LVI) and vertical margin (VM); category B, tumor invasion into the submucosa ≤ 200 µm but negative for LVI and VM; category C, others. RESULTS: Of 593 patients with pT1a-MM/pT1b-SM ESCC after ESD, 101 matched pairs were extracted after propensity score matching. The OSs were similar between the additional treatment and follow-up groups (80.6% vs. 78.6% in 5 years; P = 0.972). In a subgroup analysis, the OS in the additional treatment group was significantly lower than that in the follow-up group (65.7% vs. 95.2% in 5 years; P = 0.037) in category A, whereas OS did not significantly differ in category C (76.8% vs. 69.5% in 5 years; P = 0.360). CONCLUSIONS: Additional treatment after ESD in patients with pT1a-MM/pT1b-SM ESCC was not associated with an improved prognosis.


Assuntos
Ressecção Endoscópica de Mucosa , Neoplasias Esofágicas , Carcinoma de Células Escamosas do Esôfago , Humanos , Carcinoma de Células Escamosas do Esôfago/cirurgia , Carcinoma de Células Escamosas do Esôfago/patologia , Prognóstico , Neoplasias Esofágicas/patologia , Ressecção Endoscópica de Mucosa/métodos , Estudos Retrospectivos , Resultado do Tratamento
8.
J Cancer Res Clin Oncol ; 149(4): 1521-1530, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35546359

RESUMO

PURPOSE: Little is known about the prognostic factors for survival after endoscopic submucosal dissection (ESD) in elderly patients with early gastric cancer (EGC). The aim of this study is to determine prognostic factors and a prediction model of 3-year survival after ESD for EGC in patients aged ≥ 85 years. METHODS: We retrospectively evaluated the clinical outcomes of 740 patients with EGC aged ≥ 85 years, who were treated by ESD at 30 institutions in Japan. Overall survival (OS) and disease-specific survival (DSS) were calculated with the Kaplan-Meier method. Prediction models for 3-year OS after ESD were estimated using the Cox proportional hazards model based on Uno's C-statistics. RESULTS: During the follow-up period, 309 patients died of any cause and 10 patients died of gastric cancer. OS and DSS after 3 years were 82.7% and 99.2%, respectively. No significant differences in OS were found among curability categories. The Cox proportional hazards model revealed the geriatric nutritional risk index (GNRI) and the Charlson comorbidity index (CCI) to be predictors of 3-year survival. We established a final model (EGC-2 model) expressed by GNRI - (2.2×CCI) with a cutoff value of 96. The overall survival rate was significantly lower in the model value < 96 group than in the model value ≥ 96 group (P < 0.001). CONCLUSIONS: The prediction model using GNRI and CCI will be useful to support decision-making for the treatment of EGC in elderly patients aged ≥ 85 years.


Assuntos
Ressecção Endoscópica de Mucosa , Neoplasias Gástricas , Idoso , Humanos , Estudos Retrospectivos , Neoplasias Gástricas/cirurgia , Ressecção Endoscópica de Mucosa/métodos , Gastrectomia , Detecção Precoce de Câncer , Resultado do Tratamento , Mucosa Gástrica
9.
Asian Pac J Cancer Prev ; 23(7): 2325-2332, 2022 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-35901338

RESUMO

OBJECTIVE: To improve the efficacy of colorectal cancer (CRC) screening, decreasing the occurrence of interval cancers is essential. Most interval CRCs develop from fecal immunochemical test (FIT)-negative CRC. This study examined the clinical characteristics of FIT-negative advanced neoplasms (AN) and sessile serrated lesions (SSL), which are main candidate precursors of FIT-negative CRC, and the eligibility criteria for total colonoscopy (TCS) screening following negative FIT. METHODS: Asymptomatic participants in their 50s were divided into two groups. The FIT-negative group underwent TCS following negative FIT, and the TCS-only group underwent TCS without FIT. One endoscopist reviewed the endoscopic images. Plausible risk factors for colorectal polyps were extracted. The clinical features of AN and SSL were compared between the groups. RESULT: Of 2,437 participants, 56.2% were included in the FIT-negative group. No between-group differences were recorded for the prevalence of different colorectal polyp types. By multivariate analysis, a significantly lower adjusted odds ratio (AOR) of AN was shown in women, and significantly higher AORs of AN were found for aging, smoking, and a family history of CRC. The AOR of SSL was higher for smokers. The proportion of AN in the right colon was higher in the FIT-negative group. No between-group differences were recorded for SSL. CONCLUSION: FIT screening was less likely to detect CRC and certain precancerous lesions in the right colon. Combining annual FIT with TCS for the high-risk population based on a scoring system, may detect FIT-negative CRC and colorectal polyps, thus, reducing interval cancer.


Assuntos
Adenoma , Pólipos do Colo , Neoplasias Colorretais , Adenoma/patologia , Pólipos do Colo/diagnóstico , Pólipos do Colo/epidemiologia , Colonoscopia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/patologia , Detecção Precoce de Câncer/métodos , Fezes , Feminino , Humanos , Programas de Rastreamento/métodos , Sangue Oculto
10.
Dig Endosc ; 34(7): 1382-1391, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-35702926

RESUMO

OBJECTIVES: We aimed to clarify the prognostic factors for patients with esophageal squamous cell carcinoma (ESCC) invading into the muscularis mucosa (pT1a-MM) or submucosa (pT1b-SM) after endoscopic submucosal dissection (ESD). METHODS: This retrospective study enrolled such patients at 21 institutions in Japan between 2006 and 2017. We evaluated 15 factors, including pathological risk categories for ESCC-specific mortality, six non-cancer-related indices, and treatment strategies. RESULTS: In the analysis of 593 patients, the 5-year overall and disease-specific survival rates were 83.0% and 97.6%, respectively. In a multivariate Cox analysis, male sex (hazard ratio [HR] 3.56), Charlson comorbidity index (CCI) ≥3 (HR 2.53), ages of 75-79 (HR 1.61) and ≥80 years (HR 2.04), prognostic nutrition index (PNI) <45 (HR 1.69), and pathological intermediate-risk (HR 1.63) and high-risk (HR 1.89) were prognostic factors. Subsequently, we developed a clinical risk classification for non-ESCC-related mortality based on the number of prognostic factors (age ≥75 years, male sex, CCI ≥3, PNI <45): low-risk, 0; intermediate-risk, 1-2; and high-risk, 3-4. The 5-year non-ESCC-related mortality rates for patients without additional treatment were 0.0%, 10.2%, and 45.8% in the low-, intermediate-, and high-risk groups, respectively. Meanwhile, the 5-year ESCC-specific mortality rates for the pathological low-, intermediate-, and high-risk groups were 0.3%, 5.3%, and 18.2%, respectively. CONCLUSIONS: We clarified prognostic factors for patients with pT1a-MM/pT1b-SM ESCC after ESD. The combined assessment of non-ESCC- and ESCC-related mortalities by the two risk classifications might help clinicians in deciding treatment strategies for such patients.


Assuntos
Ressecção Endoscópica de Mucosa , Neoplasias Esofágicas , Carcinoma de Células Escamosas do Esôfago , Humanos , Masculino , Idoso de 80 Anos ou mais , Idoso , Carcinoma de Células Escamosas do Esôfago/patologia , Neoplasias Esofágicas/patologia , Estudos Retrospectivos , Prognóstico , Mucosa/cirurgia , Mucosa/patologia , Resultado do Tratamento
11.
Dig Endosc ; 34(1): 113-122, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33615547

RESUMO

OBJECTS: Although anti-thrombotic use is recognized as a risk factor for upper gastrointestinal bleeding (UGIB), there has been no clear evidence that it worsens the outcomes after the bleeding. The aim of this study is to investigate the effects of anti-thrombotic agents on in-hospital mortality following UGIB. METHODS: Information on clinical parameters, including usage of anti-thrombotic agents, was retrospectively collected from consecutive patients with UGIB at 12 high-volume centers in Japan between 2011 and 2018. The all-cause in-hospital mortality rate was evaluated according to the usage of anti-thrombotic agents. RESULTS: Clinical data were collected from 2205 patients with endoscopically confirmed UGIB. Six hundred and forty-five (29.3%) patients used anti-thrombotic agents. The all-cause in-hospital mortality rate was 5.7% (125 deaths). After excluding 29 cases in which death occurred due to end-stage malignancy, 96 deaths (bleeding-related, n = 22 ; non-bleeding-related, n = 74) were considered "preventable." Overall, the "preventable" mortality rate in anti-thrombotic users was significantly higher than that in non-users (6.0% vs. 3.7%, P < 0.05). However, the "preventable" mortality of anti-thrombotic users showed a marked improvement over time; although the rate in users remained significantly higher than that in non-users until 2015 (7.3% vs. 4.2%, P < 0.05), after 2016, the difference was no longer statistically significant (4.8% vs. 3.5%). CONCLUSIONS: Although the usage of anti-thrombotic agents worsened the outcomes after UGIB, the situation has recently been improving. We speculate that the recent revision of the Japanese guidelines on the management of anti-thrombotic treatment after UGIB may have partly contributed to improving the survival of users of anti-thrombotic agents.


Assuntos
Hemorragia Gastrointestinal , Preparações Farmacêuticas , Hemorragia Gastrointestinal/etiologia , Mortalidade Hospitalar , Humanos , Japão/epidemiologia , Estudos Retrospectivos , Fatores de Risco
12.
J Gastroenterol ; 56(8): 758-768, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34143312

RESUMO

BACKGROUND: No prediction scores for the mortality of both inpatients and outpatients who developed nonvariceal upper gastrointestinal bleeding (UGIB) without endoscopic findings have been established. We aimed to derive and validate a novel prediction score for in-hospital mortality. METHODS: We conducted a three-stage, multicenter retrospective study. In the derivation stage, patients with nonvariceal UGIB at six institutions were enrolled to derive the prediction score by logistic regression analysis. External validation of the score was performed to analyze discrimination by patients at six other institutions. Then the performance of this score was compared with that of four existing scores. RESULTS: We enrolled 1380 and 825 patients in the derivation and validation cohorts, respectively. A prediction score (CHAMPS-R Score) comprising seven variables (Charlson Comorbidity Index ≥ 2, in-hospital onset, albumin < 2.5 g/dL, altered mental status, Eastern Cooperative Oncology Group performance status ≥ 2, steroids, and rebleeding) with equal-weight scores was established, with high discriminative ability in both derivation and validation cohorts (c statistic, 0.91 and 0.80, respectively). When rebeeding was excluded from the score (an onset model; CHAMPS Score), this score also achieved high discriminative ability (c statistic, 0.90 and 0.81, respectively). The prediction scores had significantly higher discriminative ability than the Glasgow Blatchford Score, AIMS65, ABC Score, and clinical Rockall Score in both cohorts (all, p < 0.05). CONCLUSIONS: We derived and externally validated prediction scores for in-hospital mortality in patients with nonvariceal UGIB. The CHAMPS Score might be optimal for managing such patients. Its mobile application is freely available ( https://apps.apple.com/app/id1565716902 for iOS and https://play.google.com/store/apps/details?id=hatta.CHAMPS for Android).


Assuntos
Hemorragia/diagnóstico , Mortalidade Hospitalar/tendências , Trato Gastrointestinal Superior/anormalidades , Idoso , Estudos de Coortes , Feminino , Hemorragia Gastrointestinal/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Curva ROC , Estudos Retrospectivos , Medição de Risco/métodos , Índice de Gravidade de Doença , Trato Gastrointestinal Superior/fisiopatologia
13.
J Gastroenterol ; 56(7): 620-632, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33881632

RESUMO

BACKGROUND: We aimed to elucidate the risk of metastatic recurrence after endoscopic resection (ER) without additional treatment for esophageal squamous cell carcinomas (ESCCs) with tumor invasion into the muscularis mucosa (pT1a-MM) or submucosa (T1b-SM). METHODS: We retrospectively enrolled patients with pT1a-MM/pT1b-SM ESCC after ER at 21 institutions in Japan between 2006 and 2017. We compared metastatic recurrence between patients with and without additional treatment, stratified into category A (pT1a-MM with negative lymphovascular invasion [LVI] and vertical margin [VM]), B (tumor invasion into the submucosa ≤ 200 µm [pT1b-SM1] with negative LVI and VM), and C (others). Subsequently, using multivariate Cox analysis, we evaluated risk factors for metastatic recurrence after ER without additional treatment. RESULTS: We enrolled 593 patients, and metastatic recurrence occurred in 38 patients. Metastatic recurrence after additional treatment was significantly lower than that after no additional treatment in category C (9.1% vs. 23.6% in 5 years, p = 0.001), whereas no significant difference was noted in categories A (0.0% vs. 2.6%) and B (0.0% vs. 4.3%). In patients without additional treatment after ER, risk factors for metastatic recurrence were lymphatic invasion (hazard ratio [HR], 5.61), positive VM (HR, 4.55), and tumor invasion into the submucosa > 200 µm (HR, 3.25), and, but near half of the patients with metastatic recurrence had no further recurrence after salvage treatment, resulting in excellent 5-year disease-specific survival in categories A (99.6%) and B (100.0%). CONCLUSIONS: Closed follow-up with no additional treatment may be an acceptable option after ER in pT1a-MM/pT1b-SM1 ESCC with negative LVI and VM.


Assuntos
Ressecção Endoscópica de Mucosa/métodos , Carcinoma de Células Escamosas do Esôfago/terapia , Mucosa/fisiopatologia , Idoso , Distribuição de Qui-Quadrado , Estudos de Coortes , Ressecção Endoscópica de Mucosa/estatística & dados numéricos , Carcinoma de Células Escamosas do Esôfago/epidemiologia , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Recidiva , Estudos Retrospectivos , Resultado do Tratamento
14.
Eur J Gastroenterol Hepatol ; 33(11): 1400-1407, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-32804841

RESUMO

OBJECTIVE: Two-dimensional shear wave elastography (2D-SWE) is a new ultrasound-based elastography method to evaluate liver fibrosis in the daily practice. However, the utility of 2D-SWE among the other liver fibrosis markers is unclear. METHODS: We enrolled 141 consecutive patients with hepatitis C virus infection, 66 men and 75 women (median age, 67 years), who underwent liver biopsy and 2D-SWE (LOGIQ E9, GE Healthcare, Wauwatosa, WI, USA). We compared the diagnostic accuracy of the 2D-SWE with those of magnetic resonance elastography (MRE; MR-Touch, GE Healthcare, Milwaukee, WI, USA), Mac-2 binding protein glycosylation isomer (M2BPGi), fibrosis-4 index (FIB-4) and platelet counts (PLT), using the histologic METAVIR scoring as the reference standard. RESULTS: The areas under the receiver operating characteristics curves (AUROCs) of 2D-SWE, MRE, M2BPGi, FIB-4 and PLT for ≥F2, ≥F3 and F4 were 0.86, 0.88, 0.79, 0.81 and 0.77; 0.92, 0.93, 0.86, 0.87 and 0.83; and 0.91, 0.97, 0.85, 0.85 and 0.82, respectively. For diagnosing ≥F2 and ≥F3, the AUROCs of 2D-SWE and those of MRE showed no significant differences, and both 2D-SWE and MRE showed significantly higher AUROCs than the other markers. For diagnosing F4, the AUROC of MRE was significantly higher than those of other fibrosis markers. CONCLUSION: 2D-SWE has an excellent diagnostic accuracy equivalent to that of MRE for assessing significant (≥F2) and severe (≥F3) fibrosis. MRE demonstrated a higher AUROC than 2D-SWE, but this last one has advantages such as lower cost, fewer contraindications and greater ease of performance than MRE.


Assuntos
Técnicas de Imagem por Elasticidade , Hepatite C Crônica , Idoso , Biópsia , Feminino , Hepatite C Crônica/complicações , Hepatite C Crônica/diagnóstico por imagem , Hepatite C Crônica/patologia , Humanos , Fígado/diagnóstico por imagem , Fígado/patologia , Cirrose Hepática/diagnóstico por imagem , Cirrose Hepática/patologia , Masculino
15.
Immunol Med ; 42(3): 142-147, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31603739

RESUMO

A 45-year-old Japanese male patient who was diagnosed with celiac disease (CeD) developed type I enteropathy-associated T-cell lymphoma (EATL). In 2013, the patient was admitted to our hospital with worsening of diarrhea and weight loss. Pathological examination of biopsy specimens from the duodenum and ileum led to a diagnosis of suspected EATL. A previous total colonoscopy (TCS) indicated villous atrophy in the terminal ileum. The patient was changed to a gluten-free diet, and the nutritional status gradually improved. In September 2014, he experienced acute right lower abdominal pain. He underwent urgent surgery, and a perforation was identified in the ileum. A diagnosis of type I EATL was made following histopathological examination. After eight courses of CHOP therapy, the patient entered complete remission. TCS and esophagogastroduodenoscopy with magnifying narrow-band imaging performed in 2015 identified villous regrowth in the distal ileum and duodenum. Capsule endoscopy also found villous regrowth in the entire small intestine. To our knowledge, this is the first case of type I EATL following CeD with villous atrophy before EATL occurrence in a Japanese HLA-DQ2 carrier. The possibility of type I EATL occurring after CeD should be recognized, although CeD is quite rare in Japan.


Assuntos
Doença Celíaca , Linfoma de Células T Associado a Enteropatia , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Povo Asiático , Endoscopia por Cápsula , Doença Celíaca/complicações , Doença Celíaca/diagnóstico , Doença Celíaca/terapia , Ciclofosfamida/administração & dosagem , Doxorrubicina/administração & dosagem , Linfoma de Células T Associado a Enteropatia/diagnóstico , Linfoma de Células T Associado a Enteropatia/etiologia , Linfoma de Células T Associado a Enteropatia/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Prednisolona/administração & dosagem , Vincristina/administração & dosagem
16.
Intern Med ; 52(15): 1697-701, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23903502

RESUMO

A 60-year-old woman was admitted for the treatment of a gastric neuroendocrine tumor (NET) associated with type A chronic atrophic gastritis. The lesion measured 10 mm in diameter, and a computed tomography scan did not reveal any metastatic lesions. Endoscopic submucosal dissection (ESD) was subsequently performed. A histological examination revealed three gastric NETs, two of which exhibited vessel invasion. Endocrine cell micronests associated with a high risk of recurrence were also observed. Therefore, the patient underwent total gastrectomy with lymph node dissection. Because vessel invasion can occur in patients with small gastric NET G1, the use of ESD should be considered to carefully estimate the presence of invasion.


Assuntos
Metástase Linfática/diagnóstico , Neovascularização Patológica/diagnóstico , Tumores Neuroendócrinos/diagnóstico , Neoplasias Gástricas/diagnóstico , Endoscopia do Sistema Digestório , Feminino , Gastrectomia , Gastrite Atrófica/complicações , Humanos , Incidência , Excisão de Linfonodo , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/prevenção & controle , Neovascularização Patológica/etiologia , Neovascularização Patológica/cirurgia , Tumores Neuroendócrinos/etiologia , Tumores Neuroendócrinos/cirurgia , Neoplasias Gástricas/etiologia , Neoplasias Gástricas/cirurgia , Resultado do Tratamento
17.
Intern Med ; 52(4): 451-5, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23411700

RESUMO

A 70-year-old man reported dysphagia two months after undergoing thoracic endovascular aortic repair (TEVAR). An endoscopic examination revealed a fistula between the esophagus and the thoracic aortic aneurysm, and computed tomography (CT) showed that the thoracic aortic aneurysm had increased in size. The patient was diagnosed with an aortoesophageal fistula (AEF), and surgical replacement of the thoracic aorta was performed. AEFs are a rare but typically fatal complication after TEVAR. Physicians should consider a diagnosis of AEF and perform endoscopic examinations and CT in patients who undergo TEVAR and subsequently complain of dysphagia.


Assuntos
Aorta Torácica , Aneurisma da Aorta Torácica/etiologia , Doenças da Aorta/etiologia , Procedimentos Endovasculares/efeitos adversos , Fístula Esofágica/etiologia , Esofagoscopia , Fístula Vascular/etiologia , Idoso , Humanos , Masculino
18.
Nihon Shokakibyo Gakkai Zasshi ; 109(12): 2049-57, 2012 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-23221053

RESUMO

A 40-year-old man who underwent extra-anatomical bypass for aortic coarctation 25 years ago was admitted to another hospital with hematemesis and melena. Esophagogastroduodenoscopy revealed no bleeding site in the stomach or the first and second portion of the duodenum. He was transferred to our hospital due to hemorrhagic shock. Angiography showed the extravasation of the contrast medium from the graft. Emergency operation was performed due to graft-duodenal fistula. In patients with previous aortic graft surgery and present gastrointestinal bleeding, graft-enteric fistula should be suspected.


Assuntos
Coartação Aórtica/cirurgia , Prótese Vascular , Duodenopatias/etiologia , Fístula Intestinal/etiologia , Adulto , Humanos , Masculino , Complicações Pós-Operatórias , Fatores de Tempo , Fístula Vascular/etiologia
19.
Dig Endosc ; 24(5): 339-42, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22925286

RESUMO

BACKGROUND: The serum levels of pepsinogens (PG) have been considered to be a useful marker for assessing the risk of metachronous gastric cancer in patients who undergo endoscopic submucosal dissection. However, the influence of endoscopic submucosal dissection (ESD) on serum levels of PG has not yet been examined. The aim of this study was to examine whether the level of PG after ESD can be used to predict the risk of metachronous cancer. PATIENTS AND METHODS: The study included of 100 consecutive patients who underwent ESD for gastric cancer at Hirosaki University Hospital from September 2009 to February 2011. Serum levels of PG I and II on the day before and after ESD were compared. Stool antigen test was also performed to examine the presence of Helicobacter pylori infection. RESULTS: The mean serum level of PG I before and after ESD was 34.3 ± 31.6 ng/mL and 70.5 ± 100.0 ng/mL (P < 0.001), respectively. PG I/II ratio before and after ESD was 2.40 ± 1.51 and 2.79 ± 1.70 (P < 0.001). The serum level of PG I and the PG I/II ratio were significantly changed after ESD, regardless of the use of proton pump inhibitor, Helicobacter pylori infection or the location of the tumor. CONCLUSIONS: ESD treatment modulates the serum level of PG I and significantly increases the PG I/II ratio. Serum levels of PG should be measured before the ESD procedure is performed to predict the risk of developing metachronous gastric cancer after ESD.


Assuntos
Dissecação/métodos , Diagnóstico Precoce , Endoscopia Gastrointestinal/métodos , Mucosa Gástrica/cirurgia , Pepsinogênios/sangue , Neoplasias Gástricas/sangue , Idoso , Biomarcadores Tumorais/sangue , Feminino , Mucosa Gástrica/patologia , Humanos , Masculino , Estadiamento de Neoplasias , Estudos Retrospectivos , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia
20.
Dig Endosc ; 23(3): 233-9, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21699567

RESUMO

BACKGROUND AND AIM: Microvascular architecture is a variable characterizing early gastric cancer (EGC) against the background. The aims of the present study were to measure morphological variables of the microvessels and to compare the variables between EGC and the background. METHODS: Narrow band imaging (NBI)-equipped magnifying endoscopic pictures from 32 patients with EGC were used. The endoscopic pictures were taken under maximal magnification and processed for the microvessels in an in-focus area after correction of image distortion. The segmented microvessels were numbered for microvessel density (counts/mm(2)) and vascular bed area (% ratio of vascular bed against the region of interest). The microvessels were further processed for a set of skeletonized pixels to count the characteristic points, including end-points, crossing points, branching points and connecting points. RESULTS: Microvessels in cancer were found to have a significantly larger connected point number (20.5 ± 6.1, P = 0.0002) than those in the background (17.4 ± 3.9). Numbers of the end-points and branching points were found to be significantly larger in cancer than in the background (end-points 3.6 ± 0.7 for cancer vs 3.3 ± 0.4 for background, P = 0.0005; branching points 0.8 ± 0.4 for cancer vs 0.7 ± 0.2 for background, P = 0.0014). However, microvessel density, vascular bed area and mean diameter did not significantly differ between cancer and the background. CONCLUSION: This finding can be considered to reflect the reported observation of an irregular vascular pattern in gastric cancer. This method may provide a means for microvessel morphometry, regardless of the organ studied.


Assuntos
Adenocarcinoma/irrigação sanguínea , Diagnóstico Precoce , Endoscopia Gastrointestinal/métodos , Mucosa Gástrica/irrigação sanguínea , Aumento da Imagem/métodos , Microvasos/patologia , Neoplasias Gástricas/irrigação sanguínea , Adenocarcinoma/patologia , Diagnóstico Diferencial , Endoscópios Gastrointestinais , Desenho de Equipamento , Humanos , Reprodutibilidade dos Testes , Neoplasias Gástricas/patologia
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