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1.
Dis Esophagus ; 36(4)2023 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-36190185

RESUMO

Our study aimed to compare the treatment outcomes between endoscopic submucosal dissection (ESD) with an insulated-tip knife (ESD-IT) and a needle-type knife (ESD-N) for large superficial esophageal neoplasms, as no study of this kind has been previously reported. We used the dataset of a multicenter, randomized controlled trial that compared conventional ESD (C-ESD) and traction-assisted ESD (TA-ESD) for superficial esophageal neoplasms. We compared the procedural outcomes between ESD-IT and ESD-N in a post hoc analysis and conducted sub-analyses based on traction assistance and electrical knife type. We included 223 (EST-IT, n = 169; ESD-N, n = 54) patients with no significant differences in baseline characteristics. The operator handover rate due to ESD difficulties was significantly higher in ESD-N (ESD-IT = 0.6% vs. ESD-N = 13.0%, P = 0.001), while the injection volume was significantly higher in ESD-IT than in ESD-N (40.0 vs. 20.5 mL, P < 0.001). Other outcomes were comparable between both groups (procedural time: 51.0 vs. 49.5 minute, P = 0.89; complete resection: 90.5% vs. 90.7%, P > 0.99; and complication rate: 1.8% vs. 3.7%, P = 0.60 for ESD-IT and ESD-N, respectively). In the sub-analyses, the handover rate was significantly lower with TA-ESD than with C-ESD for ESD-N (3.2% vs. 26.1%, P = 0.034), and a significantly smaller injection volume was used in TA-ESD than in C-ESD for ESD-IT (31.5 vs. 47.0 mL, P < 0.01). ESD with either endoscopic device achieved favorable treatment outcomes with low complication rates. The handover rate in ESD-N and the injection volume in ESD-IT improved with the traction method.


Assuntos
Ressecção Endoscópica de Mucosa , Neoplasias Esofágicas , Humanos , Ressecção Endoscópica de Mucosa/métodos , Neoplasias Esofágicas/cirurgia , Instrumentos Cirúrgicos , Resultado do Tratamento
2.
J Am Chem Soc ; 144(13): 5871-5877, 2022 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-35345883

RESUMO

Colloidal crystals (CCs) constructed from inorganic nanoparticle (NP) building blocks exhibit properties that cannot be realized from isolated NPs or corresponding bulk counterparts. Because the arrangement of NPs in CCs is crucial in the CC's collective properties, development of a procedure to modulate the assembly of NP constituents is important. We demonstrate rapid formation of nickel (phosphide) CCs with tunable crystallinity through van der Waals force-driven spontaneous self-assembly of NPs in a facile one-pot colloidal synthesis. The quantity of size-regulating reagent (tri-n-octylphosphine) modulates the assembly of NPs from ordered close-packed to a disordered configuration in CCs. Synchrotron-based in situ small-angle X-ray scattering revealed that the size uniformity of the NPs determines the crystallinity of CCs, indicating the importance of regulating the growth kinetics of NPs during the synthesis. Our work will be useful for universal scalable preparation of CCs from a variety of materials and structures, with tunable concerted properties.

3.
Esophagus ; 19(3): 516-524, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35106667

RESUMO

OBJECTIVE: Benign esophageal strictures (BES) cause dysphagia and decrease patients' quality of life. Although mechanical dilation is the standard of care for BES, in some patients, dysphagia is unrelieved despite repeated procedures. The biodegradable stent was developed to resolve refractory BES, with reported favorable outcomes, but it is unapproved in Japan. Thus, we evaluated the safety and efficacy of the biodegradable stent (BDS) for patients with refractory BES for regulatory approval. METHODS: This was a nonrandomized single-arm prospective trial conducted at eight institutions. We included patients with BES after ≥ 5 times of dilation or ≥ one time of radial incision and cutting whose dysphagia score (DS) was 2 or worse and an endoscope could not admit. The primary endpoint was the proportion of patients whose DS improvement of ≤ 1 was maintained at 3 months. RESULTS: Thirty patients (median age: 69 years, male/female: 27:3) were enrolled and treated; BDS placement failed in 1 patient. Fourteen patients maintained their DS improvement until 3 months after placement (proportion of DS improvement at 3 months 46.7% [95% CI: 28.3-65.7]), and the median dysphagia-free survival was 98 days [95% CI: 68-123]. Most adverse events could be managed conservatively; however, a patient with BES after chemoradiotherapy (CRT) developed an esophago-left atrium fistula and died approximately 4 months after stent placement. CONCLUSION: The BDS was effective for refractory BES and the safety was acceptable. However, the indication for this procedure in patients RECEIVING CRT for esophageal cancer should be carefully considered.


Assuntos
Transtornos de Deglutição , Estenose Esofágica , Idoso , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/cirurgia , Estenose Esofágica/etiologia , Estenose Esofágica/cirurgia , Feminino , Humanos , Masculino , Estudos Prospectivos , Qualidade de Vida , Stents/efeitos adversos
4.
J Gastroenterol Hepatol ; 36(7): 1927-1934, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33533505

RESUMO

BACKGROUND AND AIM: Magnifying endoscopy (ME) diagnostic algorithm for early gastric cancer (EGC) relies on qualitative features such as microvascular (MV) architecture and microsurface structure; however, it is a "static" diagnostic algorithm that uses still images. ME can visualize red blood cell flow within subepithelial microvessels in real time. Here, we evaluated the utility of using the MV blood flow rate in combination with ME for the diagnosis of EGC as a retrospective study. METHODS: Patients with differentiated-type EGC (n = 10) or patchy redness (n = 10) underwent ME with blue laser imaging. The mean MV blood flow rates of EGC, patchy redness, and background mucosa were calculated by the mean movement distance of one tagging red blood cell using split images of ME with blue laser imaging videos. We compared the mean MV blood flow rate between EGC, patchy redness, and background mucosa and also calculated the MV blood flow imaging ratio (inside lesion/background mucosa) between EGC and patchy redness. RESULTS: Mean MV blood flow rate was significantly lower in EGC (1481 µm/s; range 1057-1762) than in patchy redness (3859 µm/s; 2435-5899) or background mucosa (4140.6 µm/s; 2820-6247) (P < 0.01). The MV blood flow imaging ratio was significantly lower in EGC (0.39; 0.27-0.62) than in patchy redness (0.90; 0.78-1.1) (P < 0.01). CONCLUSIONS: Dynamic diagnosis with MV blood flow rate using ME may be useful for the differential diagnosis of EGC and patchy redness. Endoscopic assessment of dynamic processes within the gastric mucosa may facilitate the diagnosis of EGC.


Assuntos
Neoplasias Gástricas , Gastroscopia , Humanos , Microcirculação , Imagem de Banda Estreita , Projetos Piloto , Estudos Retrospectivos , Neoplasias Gástricas/diagnóstico por imagem
5.
J Gastroenterol Hepatol ; 36(2): 482-489, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32681536

RESUMO

BACKGROUND AND AIM: Magnifying endoscopy with narrow-band imaging (ME-NBI) has made a huge contribution to clinical practice. However, acquiring skill at ME-NBI diagnosis of early gastric cancer (EGC) requires considerable expertise and experience. Recently, artificial intelligence (AI), using deep learning and a convolutional neural network (CNN), has made remarkable progress in various medical fields. Here, we constructed an AI-assisted CNN computer-aided diagnosis (CAD) system, based on ME-NBI images, to diagnose EGC and evaluated the diagnostic accuracy of the AI-assisted CNN-CAD system. METHODS: The AI-assisted CNN-CAD system (ResNet50) was trained and validated on a dataset of 5574 ME-NBI images (3797 EGCs, 1777 non-cancerous mucosa and lesions). To evaluate the diagnostic accuracy, a separate test dataset of 2300 ME-NBI images (1430 EGCs, 870 non-cancerous mucosa and lesions) was assessed using the AI-assisted CNN-CAD system. RESULTS: The AI-assisted CNN-CAD system required 60 s to analyze 2300 test images. The overall accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of the CNN were 98.7%, 98%, 100%, 100%, and 96.8%, respectively. All misdiagnosed images of EGCs were of low-quality or of superficially depressed and intestinal-type intramucosal cancers that were difficult to distinguish from gastritis, even by experienced endoscopists. CONCLUSIONS: The AI-assisted CNN-CAD system for ME-NBI diagnosis of EGC could process many stored ME-NBI images in a short period of time and had a high diagnostic ability. This system may have great potential for future application to real clinical settings, which could facilitate ME-NBI diagnosis of EGC in practice.


Assuntos
Inteligência Artificial , Detecção Precoce de Câncer/métodos , Endoscopia Gastrointestinal/métodos , Imagem de Banda Estreita/métodos , Redes Neurais de Computação , Neoplasias Gástricas/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/patologia
6.
Digestion ; 102(5): 663-670, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32516774

RESUMO

AIMS: We aimed to clarify the endoscopic/clinicopathological features of superficial non-ampullary duodenal epithelial tumors (SNADETs) based on their mucin phenotypes. METHODS: We analyzed 62 SNADET lesions and classified them based on mucin phenotypic expression. Endoscopic and clinicopathological findings were compared according to mucin phenotypes. RESULTS: Eleven lesions had the gastric phenotype (GP) and 43 lesions had the intestinal phenotype (IP). All GP lesions were located in the first portion of the duodenum, while most IP lesions (72.1%) were located in the second portion (p < 0.01). Tumor size was significantly larger in the GP than in the IP group (14.4 mm vs. 10.2 mm, p < 0.05). Reddish color (72.7% in GP vs. 37.2% in IP, p < 0.05), type 0-I (72.7% vs. 11.6%, p < 0.01), lobular/granular pattern (81.8% vs. 4.7%, p < 0.01), and category 4/5 in Vienna classification (81.8% vs. 30.2%, p < 0.01) were observed significantly more often in the GP than in the IP group. Regarding findings of magnifying endoscopy with narrow-band imaging (M-NBI), white opaque substance (22.2% in GP vs. 89.7% in IP, p < 0.01) and light blue crest (0% vs. 43.6%, p < 0.05) were significantly less frequently observed in the GP group. Oval-shaped marginal epithelium (66.7% vs. 17.9%, p < 0.01), dense pattern (55.6% vs. 2.6%, p < 0.01), and dilatation of the intervening part (100% vs. 12.8%, p < 0.01) were more frequently observed in the GP group. CONCLUSIONS: SNADETs showed distinct endoscopic/clinicopathological features according to the mucin phenotype. Tumor location, coloration, macroscopic type, and endoscopic findings including M-NBI are useful to distinguish the mucin phenotypes of SNADETs.


Assuntos
Neoplasias Duodenais , Neoplasias Duodenais/diagnóstico por imagem , Duodeno/diagnóstico por imagem , Endoscopia , Humanos , Mucinas , Fenótipo
7.
Sci Technol Adv Mater ; 22(1): 37-54, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33536840

RESUMO

Multielement rare earth (R)-transition metal (T) intermetallics are arguably the next generation of high-performance permanent magnetic materials for future applications in energy-saving and renewable energy technologies. Pseudobinary Sm2Fe17N3 and (R,Zr)(Fe,Co,Ti)12 (R = Nd, Sm) compounds have the highest potential to meet current demands for rare-earth-element-lean permanent magnets (PMs) with ultra-large energy product and operating temperatures up to 200°C. However, the synthesis of these materials, especially in the mesoscopic scale for maximizing the maximum energy product ( B H m a x ), remains a great challenge. Nonequilibrium processes are apparently used to overcome the phase-stabilization challenge in preparing the R-T intermetallics but have limited control of the material's microstructure. More radical bottom-up nanoparticle approaches based on chemical synthesis have also been explored, owing to their potential to achieve the desired composition, structure, size, and shape. While a great achievement has been made for the Sm2Fe17N3, progress in the synthesis of (R,Zr)(Fe,Co,Ti)12 magnetic mesoscopic particles (MMPs) and R-T/T exchange-coupled nanocomposites (NCMs) with substantial coercivity ( H c ) and remanence ( M r ) , respectively, remains marginal.

8.
Minim Invasive Ther Allied Technol ; 30(2): 72-80, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32108547

RESUMO

AIMS: To identify areas that are difficult to access by the single scope at the time of endoscopic submucosal dissection (ESD) and examine the effectiveness, en-bloc, R0 resection, and perforation rate after changing to multibending scope at the same site. MATERIAL AND METHODS: When the direct visualization of the submucosal layer became impossible with Q260J or in the position where the device became vertical and peeling became impossible in parallel, we decided to change to the multibending 2TQ260M scope to record the position where the change was effective and the perforation rate. RESULTS: A total of 315 lesions were studied. Of the 12 sites, ESD was completed using the Q260J alone at four sites. The 2TQ260M scope was used with greater frequency at the fornix (88.9%) and on the line of the lesser curvature of the stomach (37.1%). In the cases with observed perforations (0.9%), the submucosal layer was not elevated due to the adhesion caused by strong fibrosis. None of the cases involving the change to 2TQ260M was ineffective, nor were perforations observed, and all resected specimens were en-bloc and R0 resections. CONCLUSIONS: The success rate of this scope may help clinicians perform ESD with greater understanding.


Assuntos
Ressecção Endoscópica de Mucosa , Dissecação , Ressecção Endoscópica de Mucosa/efeitos adversos , Estômago , Resultado do Tratamento
9.
Nihon Shokakibyo Gakkai Zasshi ; 118(7): 661-670, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-34248079

RESUMO

Celiac disease has a morbidity of 0.2 to 1% in Europe and the United States (US), but appears to be extremely rare in Japan with only a few case reports. This report details a Japanese woman with celiac disease diagnosed by histopathological findings and the improvement of her clinical symptoms on a gluten-free diet. The woman was in her 60s and presented with diarrhea, abdominal pain, and vomiting which were repeatedly exacerbated over several weeks. Therefore, she was referred to our hospital for a detailed examination and treatment. Upper gastrointestinal endoscopy revealed a crude granular mucosa with an erythematous color in the duodenum. No special findings were noted on colonoscopy or capsular endoscopy. Histopathological findings of the duodenum noted villous atrophy, crypt hyperplasia, and lymphocytic infiltration within the surface epithelium, which were suspicious for celiac disease. A gluten-free diet was started which resulted in improved clinical symptoms. Repeat endoscopic imaging and histopathological findings after initiation of the gluten-free diet demonstrated improved small bowel villous atrophy. In this case, appropriate testing had ruled out inflammatory bowel disease, amyloidosis, infectious enteritis, parasitic disease, and allergies. Although anti-gliadin antibody (AGA) and anti-tissue transglutaminase antibody (ATTGA) were serologically negative, and HLA typing was HLA-DQ6, the patient was ultimately diagnosed as having celiac disease based on the characteristic pathological findings and clinical course. In many cases of celiac disease reported in Japan, serum antibodies such as AGA and ATTGA have not been detected, and HLA testing has been negative for DQ2 or DQ8. Therefore, it is possible that celiac disease in Japan might have different genetic and immunological characteristics than the disease in the US and Europe. In the future, additional cases with histology and molecular biological analysis are necessary to test this hypothesis.


Assuntos
Doença Celíaca , Dieta Livre de Glúten , Europa (Continente) , Feminino , Gliadina , Humanos , Mucosa Intestinal , Japão
10.
Gastrointest Endosc ; 91(1): 55-65.e2, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31445039

RESUMO

BACKGROUND AND AIMS: Endoscopic submucosal dissection (ESD) is widely used as a minimally invasive treatment for large esophageal cancers, but prolonged procedure duration and life-threatening adverse events remain matters of concern. We aimed to determine whether traction-assisted ESD (TA-ESD) is superior to conventional ESD in terms of technical outcomes. METHODS: A superiority, randomized, phase III trial was conducted at 7 institutions across Japan. Patients with large esophageal cancer (defined as tumor diameter >20 mm) were eligible for this study. Enrolled patients were randomly assigned to undergo conventional ESD or TA-ESD. The primary endpoint was ESD procedure duration. RESULTS: Two hundred forty-one patients were recruited and randomized. On applying exclusion criteria, 117 and 116 patients who underwent conventional ESD and TA-ESD, respectively, were included in the baseline analysis. In 1 patient, conventional ESD was discontinued because of severe perforation. Thus, the final analysis included 116 patients per group (primary analysis). The ESD procedure duration was significantly shorter for TA-ESD than for conventional ESD (44.5 minutes vs 60.5 minutes, respectively; P < .001). Moreover, no adverse events were noted in the TA-ESD group. The rate of horizontal margin involvement did not differ between the groups (10.3% vs 6.9% for conventional ESD and TA-ESD, respectively; P = .484). CONCLUSIONS: TA-ESD was superior to conventional ESD in terms of procedure duration and was not associated with any adverse events. TA-ESD should be considered the procedure of choice for large esophageal cancers. (Clinical trial registration number: UMIN000024080.).


Assuntos
Carcinoma Basocelular/cirurgia , Carcinoma de Células Escamosas/cirurgia , Ressecção Endoscópica de Mucosa/métodos , Neoplasias Esofágicas/cirurgia , Tração/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Basocelular/patologia , Carcinoma de Células Escamosas/patologia , Neoplasias Esofágicas/patologia , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Duração da Cirurgia , Resultado do Tratamento
11.
BMC Gastroenterol ; 20(1): 356, 2020 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-33109095

RESUMO

BACKGROUND: With more prevalent gastroesophageal reflux disease comes increased cases of Barrett's esophagus and esophageal adenocarcinoma. Image-enhanced endoscopy using linked-color imaging (LCI) differentiates between mucosal colors. We compared LCI, white light imaging (WLI), and blue LASER imaging (BLI) in diagnosing reflux esophagitis (RE). METHODS: Consecutive RE patients (modified Los Angeles [LA] classification system) who underwent esophagogastroduodenoscopy using WLI, LCI, and BLI between April 2017 and March 2019 were selected retrospectively. Ten endoscopists compared WLI with LCI or BLI using 142 images from 142 patients. Visibility changes were scored by endoscopists as follows: 5, improved; 4, somewhat improved; 3, equivalent; 2, somewhat decreased; and 1, decreased. For total scores, 40 points was considered improved visibility, 21-39 points was comparable to white light, and < 20 points equaled decreased visibility. Inter- and intra-rater reliabilities (Intra-class Correlation Coefficient [ICC]) were also evaluated. Images showing color differences (ΔE*) and L* a* b* color values in RE and adjacent esophageal mucosae were assessed using CIELAB, a color space system. RESULTS: The mean age of patients was 67.1 years (range: 27-89; 63 males, 79 females). RE LA grades observed included 52 M, 52 A, 24 B, 11 C, and 3 D. Compared with WLI, all RE cases showed improved visibility: 28.2% (40/142), LA grade M: 19.2% (10/52), LA grade A: 34.6% (18/52), LA grade B: 37.5% (9/24), LA grade C: 27.3% (3/11), and LA grade D: 0% (0/3) in LCI, and for all RE cases: 0% in BLI. LCI was not associated with decreased visibility. The LCI inter-rater reliability was "moderate" for LA grade M and "substantial" for erosive RE. The LCI intra-rater reliability was "moderate-substantial" for trainees and experts. Color differences were WLI: 12.3, LCI: 22.7 in LA grade M; and WLI: 18.2, LCI: 31.9 in erosive RE (P < 0.001 for WLI vs. LCI). CONCLUSION: LCI versus WLI and BLI led to improved visibility for RE after subjective and objective evaluations. Visibility and the ICC for minimal change esophagitis were lower than for erosive RE for LCI. With LCI, RE images contrasting better with the surrounding esophageal mucosa were more clearly viewed.


Assuntos
Esôfago de Barrett , Esofagite Péptica , Adulto , Idoso , Idoso de 80 Anos ou mais , Esofagite Péptica/diagnóstico por imagem , Feminino , Humanos , Aumento da Imagem , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos
12.
Digestion ; : 1-8, 2020 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-33321493

RESUMO

BACKGROUND: Gastric adenocarcinoma of foveolar type (GA-FV) is a raspberry-shaped gastric cancer (RSGC) and garners much attention as H. pylori (Hp)-uninfected gastric cancer. However, the classification and clinicopathological and endoscopic features of RSGCs in Hp-uninfected patients are poorly defined. We designed a new histopathological classification of RSGC and compared them via endoscopic and clinicopathological characteristics. SUMMARY: From 996 patients with early gastric cancers resected by endoscopy in our hospital, we studied 24 RSGC lesions from 21 (2.4%) Hp-uninfected patients. RSGCs were classified into 3 histological types as follows: GA-FV (n = 19), gastric adenocarcinoma of fundic gland type (GA-FG, n = 2), and gastric adenocarcinoma of fundic gland mucosa type (GA-FGM, n = 3). Most of the lesions were found at the greater curvature of the upper or middle third of the stomach. GA-FV lesions were homogeneously reddish and frequently accompanied with a whitish area around the tumor and an irregular microvascular (MV) pattern; these features were confirmed histopathologically by the presence of homogeneous neoplastic foveolar epithelium with foveolar hyperplasia around the tumors. GA-FG lesions might be heterogeneously reddish with a submucosal tumor shape and regular MV pattern; these were confirmed by the presence of covered or mixed nonneoplastic epithelium on deeper regions of tumors. GA-FGM lesions might be homogeneously reddish and occasionally had a submucosal tumor shape and irregular MV pattern; these were confirmed by the presence of homogeneous neoplastic foveolar epithelium on deeper regions of the tumors. Key Messages: RSGCs in Hp-uninfected patients are classified into 3 histopathological types. For accurate diagnosis of RSGCs, it may be necessary to fully understand endoscopic features of these lesions based on these histological characteristics and to take a precise biopsy.

13.
Digestion ; 101(5): 598-607, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31302654

RESUMO

BACKGROUND/AIMS: To compare white light imaging (WLI) with linked color imaging (LCI) and blue LASER imaging (BLI) in endoscopic findings of Helicobacter pylori presently infected, previously infected, and uninfected gastric mucosae for visibility and inter-rater reliability. METHODS: WLI, LCI and BLI bright mode (BLI-bright) were used to obtain 1,092 endoscopic images from 261 patients according to the Kyoto Classification of Gastritis. Images were evaluated retrospectively by 10 experts and 10 trainee endoscopists and included diffuse redness, spotty redness, map-like redness, patchy redness, red streaks, intestinal metaplasia, and an atrophic border (52 cases for each finding, respectively). Physicians assessed visibility as follows: 5 (improved), 4 (somewhat improved), 3 (equivalent), 2 (somewhat decreased), and 1 (decreased). Visibility was assessed from totaled scores. The inter-rater reliability (intraclass correlation coefficient) was also evaluated. RESULTS: Compared with WLI, all endoscopists reported improved visibility with LCI: 55.8% for diffuse redness; LCI: 38.5% for spotty redness; LCI: 57.7% for map-like redness; LCI: 40.4% for patchy redness; LCI: 53.8% for red streaks; LCI: 42.3% and BLI-bright: 80.8% for intestinal metaplasia; LCI: 46.2% for an atrophic border. For all endoscopists, the inter-rater reliabilities of LCI compared to WLI were 0.73-0.87. CONCLUSION: The visibility of each endoscopic finding was improved by LCI while that of intestinal metaplasia was improved by BLI-bright.


Assuntos
Mucosa Gástrica/diagnóstico por imagem , Gastrite/diagnóstico , Gastroscopia/métodos , Aumento da Imagem/métodos , Imagem Óptica/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Cor , Feminino , Mucosa Gástrica/patologia , Gastrite/patologia , Gastroscopia/instrumentação , Gastroscopia/estatística & dados numéricos , Humanos , Aumento da Imagem/instrumentação , Masculino , Metaplasia/diagnóstico , Metaplasia/patologia , Pessoa de Meia-Idade , Variações Dependentes do Observador , Imagem Óptica/instrumentação , Imagem Óptica/estatística & dados numéricos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Adulto Jovem
14.
Nihon Shokakibyo Gakkai Zasshi ; 117(9): 802-810, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32908111

RESUMO

While hospitalized due to severe aortic stenosis, an 84-year-old woman developed repeated bleeding from angiodysplasia in the stomach leading to a diagnosis of Heyde syndrome. Following transcatheter aortic valve implantation (TAVI), there was no recurrence of bleeding from the angiodysplasia, and the decrease in von Willebrand factor levels that caused Heyde syndrome also improved. It was felt that the TAVI was able to prevent the recurrence of gastrointestinal bleeding due to angiodysplasia in Heyde syndrome.


Assuntos
Angiodisplasia/cirurgia , Estenose da Valva Aórtica/cirurgia , Doenças do Colo/cirurgia , Substituição da Valva Aórtica Transcateter , Idoso de 80 Anos ou mais , Feminino , Hemorragia Gastrointestinal , Humanos
15.
Digestion ; 98(3): 175-184, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29870997

RESUMO

BACKGROUND/AIMS: Early gastric cancer after Helicobacter pylori (Hp) eradication is difficult to demarcate. We used the vessel plus surface classification system (VSCS) to determine whether magnifying endoscopy with narrow-band imaging (ME-NBI) could demarcate differentiated-type early gastric cancers after Hp eradication, and to identify causes of an unclear demarcation line (DL). METHODS: Among 100 lesions of differentiated-type early gastric cancer resected endoscopically, 34 lesions in the Hp-eradicated group and 66 in the Hp-infected group were retrospectively compared. Clinicopathological factors and ME-NBI findings, including the presence or absence of the DL, were examined. Histopathologically, histological gastritis, the surface structure at the tumor border, well-differentiated adenocarcinoma with low-grade atypia (tub1-low), and non-neoplastic epithelium (NE) coverage rate on the tumor surface and at the tumor border were evaluated. RESULTS: DL (-) cases were more frequent in the Hp-eradicated group (11.8%, 4/34) than in the Hp-infected group (1.5%, 1/66; p < 0.05). The Hp-eradicated group had a higher NE coverage rate than the Hp-infected group (p < 0.05). All DL (-) cases had tub1-low or NE at the tumor border. CONCLUSION: ME-NBI with VSCS can identify the DL in most patients (88.2%) with differentiated-type early gastric cancer after Hp eradication.


Assuntos
Adenocarcinoma/diagnóstico por imagem , Antibacterianos/uso terapêutico , Detecção Precoce de Câncer/métodos , Infecções por Helicobacter/tratamento farmacológico , Infecções por Helicobacter/patologia , Helicobacter pylori/isolamento & purificação , Neoplasias Gástricas/diagnóstico por imagem , Adenocarcinoma/patologia , Idoso , Idoso de 80 Anos ou mais , Testes Respiratórios , Feminino , Mucosa Gástrica/diagnóstico por imagem , Mucosa Gástrica/microbiologia , Mucosa Gástrica/patologia , Gastroscopia/métodos , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/microbiologia , Helicobacter pylori/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Imagem de Banda Estreita/métodos , Gradação de Tumores , Estudos Retrospectivos , Neoplasias Gástricas/patologia
16.
Digestion ; 97(2): 183-194, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29320766

RESUMO

BACKGROUND/AIMS: To evaluate the usefulness of linked color imaging (LCI) and blue LASER imaging (BLI) in Barrett's esophagus (BE) compared with white light imaging (WLI). METHODS: Five expert and trainee endoscopists compared WLI, LCI, and BLI images obtained from 63 patients with short-segment BE. Physicians assessed visibility as follows: 5 (improved), 4 (somewhat improved), 3 (equivalent), 2 (somewhat decreased), and one (decreased). Scores were evaluated to assess visibility. The inter- and intra-rater reliability (intra-class correlation coefficient) of image assessments were also evaluated. Images were objectively evaluated based on L* a* b* color values and color differences (ΔE*) in a CIELAB color space system. RESULTS: Improved visibility compared with WLI was achieved for LCI: 44.4%, BLI: 0% for all endoscopists; LCI: 55.6%, BLI: 1.6% for trainees; and LCI: 47.6%, BLI: 0% for experts. The visibility score of trainees compared with experts was significantly higher for LCI (p = 0.02). Intra- and inter-rater reliability ratings for LCI compared with WLI were "moderate" for trainees, and "moderate-substantial" for experts. The ΔE* revealed statistically significant differences between WLI and LCI. CONCLUSION: LCI improved the visibility of short-segment BE compared with WLI, especially for trainees, when evaluated both subjectively and objectively.


Assuntos
Esôfago de Barrett/diagnóstico por imagem , Esofagoscopia/métodos , Esôfago/diagnóstico por imagem , Imagem de Banda Estreita/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Cor , Esôfago/patologia , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Estudos Retrospectivos , Adulto Jovem
17.
Dig Dis Sci ; 63(11): 2940-2949, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29796911

RESUMO

BACKGROUND: Recently, problems associated with proton pump inhibitor (PPI) use have begun to surface. PPIs influence the gut microbiota; therefore, PPI use may increase the risk of enteric infections and cause bacterial translocation. In this study, we investigated fecal microbiota composition, fecal organic acid concentrations and pH, and gut bacteria in the blood of the same patients before and after PPI use. METHODS: Twenty patients with reflux esophagitis based on endoscopic examination received 8 weeks of treatment with PPIs. To analyze fecal microbiota composition and gut bacteria in blood and organic acid concentrations, 16S and 23S rRNA-targeted quantitative RT-PCR and high-performance liquid chromatography were conducted. RESULTS: Lactobacillus species were significantly increased at both 4 and 8 weeks after PPI treatment compared with bacterial counts before treatment (P = 0.011 and P = 0.002, respectively). Among Lactobacillus spp., counts of the L. gasseri subgroup, L. fermentum, the L. reuteri subgroup, and the L. ruminis subgroup were significantly increased at 4 and 8 weeks after treatment compared with counts before treatment. Streptococcus species were also significantly increased at 4 and 8 weeks after PPI treatment compared with counts before treatment (P < 0.01 and P < 0.001, respectively). There was no significant difference in the total organic acid concentrations before and after PPI treatment. Detection rates of bacteria in blood before and after PPI treatment were 22 and 28%, respectively, with no significant differences. CONCLUSIONS: Our quantitative RT-PCR results showed that gut dysbiosis was caused by PPI use, corroborating previous results obtained by metagenomic analysis.


Assuntos
Sangue/microbiologia , Disbiose/induzido quimicamente , Fezes/microbiologia , Microbioma Gastrointestinal/efeitos dos fármacos , Inibidores da Bomba de Prótons/efeitos adversos , Idoso , Ácidos Carboxílicos/análise , Fezes/química , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
18.
Med Sci Monit ; 24: 523-530, 2018 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-29373569

RESUMO

BACKGROUND [color=black]Bowel preparation is an important factor for an optimal outcome of colonoscopy. Recently, polyethylene glycol (PEG) solution has been in common use for bowel cleansing for colonoscopy, but some patients are intolerant of PEG because of taste or volume. A low-volume PEG administered with ascorbic acid solution (PEG-Asc) was designed to improve tolerability, but the administration of this method is more complex than that with PEG alone. This study aimed to compare bowel cleansing efficacy, safety, and tolerability of 1 L PEG-Asc with a 2 L PEG preparation with use of sennosides and mosapride.[/color] MATERIAL AND METHODS [color=black]This was a prospective, single-center, non-inferiority trial that included 112 patients (PEG-Asc group, 68; PEG group, 44). The primary endpoint was the efficacy of colon cleansing assessed by endoscopists using a validated 4-point scale according to the Aronchick scale and was verified by a blinded investigator. Acceptability, tolerability, and adenoma detection rate (ADR) of these 2 regimens were secondary endpoints.[/color][color=black] [/color] RESULTS [color=black]We found no statistically significant differences between the groups in colon-cleansing efficacy or in the adenoma detection rate (ADR). Moreover, overall, patients significantly favored PEG-Asc over PEG, reflecting better acceptance of PEG-Asc. Additionally, more patients favored PEG-Asc over PEG for a hypothetical future colonoscopy. [/color] CONCLUSIONS [color=black]The alternate 1 L PEG-Asc regimen and standard 2 L PEG regimen were clinically equivalent with respect to cleansing efficacy, safety, and ADR, and more patients favored PEG-Asc than PEG. This alternate regimen may improve patient compliance and acceptance of surveillance colonoscopy.[/color].


Assuntos
Ácido Ascórbico/farmacologia , Benzamidas/farmacologia , Colonoscopia , Morfolinas/farmacologia , Polietilenoglicóis/farmacologia , Extrato de Senna/farmacologia , Adenoma/diagnóstico , Adulto , Idoso , Colite Ulcerativa/diagnóstico , Neoplasias do Colo/diagnóstico , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Senosídeos , Inquéritos e Questionários , Adulto Jovem
19.
Endoscopy ; 49(10): 957-967, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28637065

RESUMO

Background and study aim Magnifying narrow-band imaging (M-NBI) is useful for the accurate diagnosis of early gastric cancer (EGC). However, acquiring skill at M-NBI diagnosis takes substantial effort. An Internet-based e-learning system to teach endoscopic diagnosis of EGC using M-NBI has been developed. This study evaluated its effectiveness. Participants and methods This study was designed as a multicenter randomized controlled trial. We recruited endoscopists as participants from all over Japan. After completing Test 1, which consisted of M-NBI images of 40 gastric lesions, participants were randomly assigned to the e-learning or non-e-learning groups. Only the e-learning group was allowed to access the e-learning system. After the e-learning period, both groups received Test 2. The analysis set was participants who scored < 80 % accuracy on Test 1. The primary end point was the difference in accuracy between Test 1 and Test 2 for the two groups. Results A total of 395 participants from 77 institutions completed Test 1 (198 in the e-learning group and 197 in the non-e-learning group). After the e-learning period, all 395 completed Test 2. The analysis sets were e-learning group: n = 184; and non-e-learning group: n = 184. The mean Test 1 score was 59.9 % for the e-learning group and 61.7 % for the non-e-learning group. The change in accuracy in Test 2 was significantly higher in the e-learning group than in the non-e-learning group (7.4 points vs. 0.14 points, respectively; P < 0.001). Conclusion This study clearly demonstrated the efficacy of the e-learning system in improving practitioners' capabilities to diagnose EGC using M-NBI.Trial registered at University Hospital Medical Information Network Clinical Trials Registry (UMIN000008569).


Assuntos
Instrução por Computador , Educação Médica Continuada/métodos , Imagem de Banda Estreita , Neoplasias Gástricas/diagnóstico por imagem , Adulto , Feminino , Gastroscopia , Humanos , Aprendizagem , Masculino , Estudos Prospectivos , Neoplasias Gástricas/patologia
20.
Digestion ; 96(1): 5-12, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28605740

RESUMO

BACKGROUND/AIMS: Acotiamide, a prokinetic drug, is used to treat functional dyspepsia (FD), especially postprandial distress syndrome (PDS). However, a treatment for FD patients with PDS and/or epigastric pain syndrome (EPS) has not been established. We investigated the efficacy of famotidine in combination with acotiamide for FD. METHODS: Fifty blindly randomized FD patients received placebo with acotiamide, or famotidine with acotiamide, for 4 weeks. Treatment efficacy was assessed by overall treatment effects (OTE), total, PDS and EPS symptom scores, and impairment of quality of life (QOL). RESULTS: After OTE assessment, patients who felt affected by treatment comprised 40.9 and 57.9% of famotidine and placebo groups, respectively, after 4 weeks' treatment, with no significant difference between groups. A significant decrease was seen in total, PDS, and EPS symptom scores, and in QOL impairment, after 4 weeks' treatment compared with pretreatment scores for famotidine and placebo groups, but was not observed between groups. The proportion of patients showing a ≥50% decrease in EPS symptom scores was greater in the famotidine than that in the placebo group for every observation point, with the greatest difference observed after 2 weeks' treatment. CONCLUSION: The effectiveness of famotidine and acotiamide combination therapy in FD was similar to the effectiveness of acotiamide therapy alone.


Assuntos
Dor Abdominal/tratamento farmacológico , Inibidores da Colinesterase/farmacologia , Dispepsia/tratamento farmacológico , Período Pós-Prandial/efeitos dos fármacos , Inibidores da Bomba de Prótons/farmacologia , Adulto , Benzamidas/farmacologia , Benzamidas/uso terapêutico , Inibidores da Colinesterase/uso terapêutico , Método Duplo-Cego , Sinergismo Farmacológico , Quimioterapia Combinada/métodos , Famotidina/farmacologia , Famotidina/uso terapêutico , Feminino , Antagonistas dos Receptores H2 da Histamina/farmacologia , Antagonistas dos Receptores H2 da Histamina/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Placebos , Inibidores da Bomba de Prótons/uso terapêutico , Qualidade de Vida , Tiazóis/farmacologia , Tiazóis/uso terapêutico , Resultado do Tratamento
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