Yoshitaka Hirahara

Tochigi Cancer Center

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Nozomu Kobayashi

Tochigi Cancer Center

Ryuzo Sekiguchi

Nanao hospital

Seiji Igarashi

National Institutes for Quantum and Radiological Science and Technology

Jun Fukunaga

Tochigi Cancer Center

Jun Horiguchi

International University of Health and Welfare

Reiji Kasukawa

Ohta Nishinouchi Hospital

Jun Konishi

Tochigi Cancer Center

Michizou Sasagawa

Tochigi Cancer Center

Tsutomu Ishikawa

Yamagata University

Kayako Shimamura

Tokyo National Hospital

Cooperative Institutions

Tochigi Cancer Center

Imperial Household Agency

Fukushima Medical University

National Cancer Center Hospital East

The University of Tokyo

Dokkyo Medical University

Dokkyo University

Toho University

National Hospital Organization

Tokyo Medical University

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A Useful New Endoscopic Marking Technique for Endoscopic Mucosal Resection of Early Gastric Cancer

Endoscopy (2004)

H. Ooyanagi Kuang I. Fu T Ishikawa Yoshitaka Hirahara S Igarashi

Endoscopic mucosal resection (EMR) is a widely used and less invasive alternative to open surgery for early gastric cancer. The benefits include preservation of the stomach, noninvasiveness, and shorter hospital stays. In addition, the technique is indicated for lesions in which there is minimal risk of lymph-node involvement. Before the procedure, endoscopic marking of the tissue is very important to ensure a tumor-free margin and complete resection; in Japan, the marking is usually carried out with a needle-knife (Olympus KD-1L-1) [1]. The needle-knife is also used for precut procedures and mucosal incision for circumferential mucosal resection [2] [3]. Argon plasma coagulation (APC) is a recently introduced therapeutic technique in the digestive tract, used to treat hemorrhagic and neoplastic lesions. Its advantages include effective and safe coagulation, controllable coagulation depth, a noncontact operating mode, and axial, radial, and retrograde application [4]. To avoid the risk of perforation during endoscopic marking with the needle-knife, we investigated the safety of APC and tested the use of the technique to create circumferential marks around early gastric cancer lesions before EMR. To the best of our knowledge, this is the first report of the use of APC for endoscopic marking before EMR. In a pilot study, we found that APC is safe and useful for carrying out endoscopic marking for EMR. In addition, APC combined with the use of a needle-knife also allows different types of mark to be made, making it much easier to differentiate the distal margin from the proximal margin in the retrieved resected specimens (Figures [1], [2]). Our group is currently conducting a prospective study to evaluate the safety and usefulness of this technique in a large number of patients. Research for this report was supported in part by a Grant-in-Aid for Cancer Research (12 - 4) from the Japanese Ministry of Health, Labor, and Welfare.

Endoscopic mucosal resection

Perforation

Resection margin

10.1055/s-2004-814128

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Citations (3)

Abnormal serum liver chemistry related to pneumoperitoneum after endoscopic submucosal dissection

Endoscopy (2007)

Nozomu Kobayashi Toru Ishikawa K.-I. Fu Tatsuya Yamamoto Yoshitaka Hirahara

A 61-year-old man had been followed after endoscopic submucosal dissection (ESD) for early gastric cancer. In his youth, the patient had undergone total colectomy because of Crohn’s disease. Surveillance esophagogastroduodenoscopy revealed metachronous early gastric cancer, so a second ESD was performed. Although gastric perforation occurred during the procedure, it was closed completely using endoclips ([Fig. 1] and [2]). Antibiotic therapy was started with fasting. The following day, 12 h after the second ESD, laboratory data included aspartate aminotransferase 225 U/L (normal range 12 - 32 U/L), alanine aminotransferase 201 U/L (2-38 U/L), lactate dehydrogenase 526 U/L (119 - 229 U/L), creatine phosphokinase 512 U/L (40 - 218 U/L), C-reactive protein 3.47 mg/dl (< 0.3 mg/dl), and white blood cell count 27.75 × 103/L (3.4 - 9.4 × 103/L). As electrocardiography and troponin test ruled out ischemic heart disease, an effect of pneumoperitoneum was strongly suspected. An abdominal CT scan showed severe pneumoperitoneum with compression of the inferior vena cava ([Fig. 3]), and therefore abdominal decompression with a 14-gauge puncture needle was performed. Immediately after the puncture, the abdominal fullness and back pain improved. Four days later, almost all of the laboratory parameters recovered to within the normal ranges, and the patient made an uneventful recovery during the 14 months of follow-up after the procedure.

Endoscopic submucosal dissection

10.1055/s-2007-966818

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A case of primary biliary cirrhosis(PBC) associated with acute autoimmune hepatitis(AIH).

Kanzo (1992)

Ryoichi Ishihata Isao Shouji Yoshitaka Hirahara Yoshihiro Sato Y Ohkuma

44歳女性.1976年より肝機能障害を指摘.1981年第1回入院時,transaminaseと胆道系酵素値の中等度異常,IgMの高値,ASMA陽性を認め,ANAとAMAは陰性であり,組学的にCNSDCはなかったが,抗PDH抗体が陽性であり,無症候性PBCと考えられていた.1989年10月突然の黄疸,上腹部不快感出現し,第2回入院.T.bil, transaminase, γ-gl, IgMの急激な増加が認められ,加えてLE細胞現象陽性,ANA,抗DNA抗体,ASMA,抗M2抗体などが陽性となった(抗M4抗体は陰性).2回目の肝生検にて門脈域の炎症性細胞浸潤,piecemeal necrosis,線維性拡大などCAHの組織像が認められ,さらにCNSDC様の所見も見られたことより無症候性PBCに自己免疫性肝炎を急性発症した病態と推定した.PSL療法が著効し,自覚症状,transaminase, T.bilなどの肝機能,自己抗体力価,肝組織像は著明に改善した.

Primary Biliary Cirrhosis

Transaminase

Autoimmune Hepatitis

Elevated transaminases

Aspartate transaminase

10.2957/kanzo.33.49

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A Case of Gastric Malignant Lymphoma Showing Remarkable Change in Appearance for a Short Period

Progress of Digestive Endoscopy(1972) (1995)

Yoshitaka Hirahara Norihiko Saitou Jun Horiguchi Jun Fukunaga Michizou Sasagawa

The patient was a 50-years-old man. An abnormality of the stomach was found by mass survey. When endoscopic examination done by local doctor, he was found to have an elevated lesion with a central ulceration surrounded by an irregular margin in the lower part of the gastric body. When examined by endsocopy 2 months later, the lesion was demonstrated as a submucosal tumor with a fissure-like depression in the center at the anterior aspect of the lower body. When examined 3 months later, the lesion changed to a IIc-like appearance with converging folds. About 4 months later, the lesion looked like scarred multiple ulcers. Though pathologic appearance of the specimen taken by the local doctor were cosistent with malignant lymphoma, there have been no findings of malignancy, thereafter, since the tumor resolved by itself, the patient was placed under clinical observation. He has shown no sign of recurrence for 2 years and half.

Abnormality

10.11641/pdensks.46.0_158

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Depressed-type colon cancer in a patient with diverticulosis

Endoscopy (2008)

Nozomu Kobayashi K. Hirabayashi Takaaki Matsui Yoshitaka Hirahara Hideko Kurihara

A 63-year-old man was referred to our hospital with a history of hematochezia. He had no previous history of abdominal complaints or of abdominal surgery. Physical examination and laboratory parameters showed no abnormalities. Colonoscopy revealed diverticulosis in the sigmoid colon, and a 2-cm-diameter, hard mass within multiple diverticula. The mass was surrounded by normal mucosa, mimicking a submucosal tumor, and an apparently depressed area was identified at the top of the lesion ([Fig. 1]). Because chromoendoscopy using indigo carmine dye clearly showed the margin of the depressed area, the lesion was suspected to be a depressed-type neoplasm, and magnifying colonoscopy with crystal-violet staining showed type IIIL and type IIIs Kudo pit patterns ([Fig. 2]), mainly corresponding to an intramucosal neoplasm; a biopsy sample from the depressed area showed features characteristic of adenoma. The lesion was finally diagnosed as a depressed-type intramucosal neoplasm arising from the diverticulum. Although these lesions are usually treated endoscopically, the coexistence of diverticulosis was thought to pose a high risk of perforation. A sigmoidectomy was therefore performed, and histopathological evaluation of the resected specimen revealed an intramucosal depressed-type adenocarcinoma, 18 mm × 15 mm in size, accompanied by numerous diverticula ([Fig. 3]). No evidence of lymph node metastasis was found, and the patient recovered uneventfully.

Diverticulosis

Hematochezia

Tubular adenoma

10.1055/s-2007-966854

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Citations (5)

Evaluation of Seven Patients with Esophageal Papilloma

Progress of Digestive Endoscopy(1972) (1993)

Yoshitaka Hirahara Kouji Tsurui Hidemichi Takahashi Tatsurai Chou Takeo Tsukioka

当センターでは過去6年間に上部内視鏡検査を8,059例に施行し，7例の食道乳頭腫を経験した。性比は，男 : 女＝4 : 3であり，平均年齢は53.6歳であった。主訴は，心窩部違和感などの腹部愁訴が5例にみられた。基礎疾患は，肺癌，胃癌の手術後が2例，胃潰瘍が1例にみられた。内視鏡所見では，発生部位は中部食道4例，上部食道3例で，白色調，表面顆粒状の隆起として観察され，山田Ⅲ型の形態が5例と多くみられた。他の2例は，扁平隆起および集簇性小隆起として観察された。随伴した食道・胃病変では，食道裂孔ヘルニア2例，逆流性食道炎1例，胃潰瘍・胃炎各1例みられた。乳頭腫の発生要因との関連で，生検組織を用い，免疫染色法にてhuman papilloma virus antigenの検索を行ったが，全例陰性であった。乳頭腫は，組織学的には同様の形態を呈するが，発生要因は単一でないと考えられた。治療方針は，著者らは生検を機に脱落した2例を含め7例全例の経過を観察しているが，最長4年間で腫瘍に著明な変化は認められず，切除などの処置を加えなくとも，厳重な経過観察で十分と考えている。

10.11641/pdensks.42.0_154

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Mo1386 The Influence of Biopsy Before Treatment on the Outcome of Colorectal Endoscopic Submucosal Dissection

Gastrointestinal Endoscopy (2012)

Nozomu Kobayashi Jun Konishi Yoshitaka Hirahara Ryuzo Sekiguchi

Endoscopic submucosal dissection

Endoscopic mucosal resection

Endoscopic treatment

10.1016/j.gie.2012.03.1092

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[Complications of endoscopic sclerotherapy in esophageal varices, especially gastric ulcer and hemorrhagic gastritis].

PubMed (1990)

Katsutoshi Obara Yutaka Ejiri Hiromasa Ohira Yoshitaka Hirahara H Sakamoto

Gastric varices

Esophageal Ulcer

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A Case of 2 mm Sized IIc Type Early Colon Cancer

Progress of Digestive Endoscopy(1972) (1994)

Osamu Kunihiro Fuminori Horimukai Jun Horiguchi Norihiko Saito Yoshitaka Hirahara

We reported a case of 2 mm sized IIc type early colon cancer. The patient was 72-year-old male who had undergone sigmoidectomy for early cancer (IIc type) of the sigmoid colon. It was slightly depressed lesion measuring 14×15 mm in size. Histological finding of the lesion revealed that well differentiated adenocarcinoma invaded into the submucosal layer. Two years after the surgery, a minute (2 mm in size) IIc type intramucosal cancer of the transverse colon was incidentally discovered by colonofiberscopy, which was carried out as routine check up for surveillance. The cancer was identified as a red tinged spot. Close observation revealed that it had shallow depression bordered by irregular margin and surrounded by slightly elevated mucosa. The lesion was completely removed by hot biopsy and histological examination of the specimen revealed that infiltration of well differentiated adenocarcinoma was limited within the mucosa.

Transverse colon

Infiltration (HVAC)

Lymphovascular invasion

10.11641/pdensks.45.0_214

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A case of angiodysplasia of the colon

Acta gastro-enterologica belgica (1990)

Mitsuru Saka Shigeaki Ono Yoshitaka Hirahara Masaki Kurosawa Yoshinobu Iizuka

Angiodysplasia

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