Tomoko Tagata

Tokyo Women's Medical University

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Tetsuya Hamano

Tokyo Women's Medical University

Izumi Shirato

Tokyo Women's Medical University

Atsushi Mitsunaga

Tokyo Women's Medical University

Miho Shirato

Tokyo Women's Medical University

Takayoshi Nishino

Tokyo Women's Medical University

Yutaka Mitsunaga

Toranomon Hospital

Shuhei Yoshida

Kanazawa University

Honami Teramoto

Tokyo Women's Medical University Yachiyo Medical Center

Masahiko Shimada

Tokyo Medical and Dental University

Yuichi Ikarashi

Tokyo Women's Medical University

Cooperative Institutions

Tokyo Women's Medical University

Tokyo Women's Medical University Yachiyo Medical Center

The University of Tokyo

The Japanese Society of Gastroenterological Surgery

American Society for Gastrointestinal Endoscopy

Jikei University School of Medicine

Iwate Medical University

Keio University

National Cancer Center Hospital East

RELX Group (Netherlands)

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Clinical evaluation of the Tokyo Guidelines 2013 for severity assessment of acute cholangitis

Journal of Hepato-Biliary-Pancreatic Sciences (2014)

Takayoshi Nishino Tetsuya Hamano Yutaka Mitsunaga Izumi Shirato Miho Shirato

Background We evaluated the severity assessment criteria for acute cholangitis (AC) of the Tokyo Guidelines 2013 (TG13) and developed a scoring system for predicting the need for urgent/early biliary drainage. Methods We retrospectively reviewed 66 AC cases prospectively managed based on the TG07 and divided into an urgent/early biliary drainage group (n = 30) and elective biliary drainage group (n = 36). Results There were 26 mild, 27 moderate, and 13 severe cases based on the TG13. The TG13 assessment in 12 of the 17 cases requiring early biliary drainage based on the TG07 was moderate, but underestimated the other five cases as mild AC. When five predictors (blood urea nitrogen >20 mg/dL, SIRS presence, platelet count <120 000/μL, serum albumin level <3.0 g/dL, age ≥75 years old) were used to devise a scoring system, the receiver-operator characteristic curve of the scores showed good test performance for predicting the need for urgent/early biliary drainage. The area under the curve (AUC) was 0.95 and higher than the TG13 AUC (0.80). Conclusions The TG13 is practical, but some AC cases requiring urgent/early biliary drainage were underestimated as mild AC. The scoring system allows identification of high-risk AC patients and will improve the TG13.

Biliary Drainage

10.1002/jhbp.189

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Citations (34)

Proposed new simple scoring system to identify indications for urgent ERCP in acute cholangitis based on the Tokyo Guidelines

Journal of Hepato-Biliary-Pancreatic Sciences (2011)

Takayoshi Nishino Shunsuke Onizawa Mie Hamano Izumi Shirato Miho Shirato

Abstract Background/purpose The Tokyo Guidelines (TG) have enabled more accurate diagnosis of acute cholangitis (AC). This study was undertaken to develop a new prognostic scoring system to predict the need for urgent endoscopic retrograde cholangiopancreatography (ERCP) based on the clinical findings on admission. Methods We prospectively reviewed 40 consecutive cases of AC and divided them into an urgent‐ERCP group and an elective‐ERCP group. Results Univariate analysis identified four factors that predicted the need for urgent ERCP: serum albumin level below 3.0 g/dl, blood urea nitrogen level above 20 mg/dl, platelet count below 120,000/μl, and the presence of systemic inflammatory response syndrome. These four predictors plus four predictors of organ dysfunction in the TG: shock, consciousness disturbance, respiratory failure, and prothrombin time/international normalized ratio >1.5, were used to devise a scoring system in which 1 point was assigned for the first four predictors and 2 points were assigned for the latter four predictors (maximum score possible: 12 points). The receiver‐operator characteristic curve of the scores showed good test performance for predicting the need for urgent ERCP and for predicting a positive blood culture, and the areas under the concentration curves (AUCs) were 0.96 and 0.97, respectively. The optimal cut‐off value for urgent ERCP was 2 points. Conclusions This new simple scoring system allows identification of high‐risk AC patients soon after admission to hospital.

Prothrombin time

Univariate analysis

Triage

10.1007/s00534-011-0488-0

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Citations (17)

Sa1432 A New Method of Endoscopic Ultrasonography for Determining the Depth of Early Gastric Cancer

Gastrointestinal Endoscopy (2011)

Atsushi Mitsunaga Tetsuya Hamano Honami Teramoto Tomoko Tagata Izumi Shirato

Endoscopic ultrasonography

10.1016/j.gie.2011.03.166

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Citations (0)

Sa1487 Proposed New Scoring System for Upper Gastrointestinal Tract Bleeding

Gastrointestinal Endoscopy (2014)

Yutaka Mitsunaga Takayoshi Nishino Yuichi Ikarashi Shuhei Yoshida Izumi Shirato

Upper Gastrointestinal Bleeding

10.1016/j.gie.2014.05.106

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A Novel Guide-Wire Technique for Repositioning a Nasobiliary Catheter from Mouth to Nostril without Using a Nelaton Tube

Medical Principles and Practice (2015)

Tetsuya Hamano Shuhei Yoshida Takayoshi Nishino Junichi Akao Izumi Shirato

Objective: We aimed to assess the usefulness of a novel guide-wire technique for repositioning without the use of a Nelaton tube and to compare this to the conventional technique. Subjects and Methods: A total of 50 patients who underwent endoscopic nasobiliary drainage (ENBD) at the Yachiyo Medical Center, Chiba, Japan, were enrolled into the study. The patients were randomly divided into 2 groups according to the use of a novel guide-wire technique (n = 28) or the conventional technique (n = 22). The ENBD catheters were repositioned from the mouth to the nose. The primary end point was the procedural time from the insertion of the Nelaton tube or guide wire into the nostril until the ENBD catheter had been repositioned in the nose. The secondary end point was the success rate of the procedure. Results: The mean procedure time of our technique (120.8 s) was shorter than the traditional technique (131.9 s), but this difference was not statistically significant (p = 0.56). Our technique did not involve the use of the Nelaton tube, and so could save the cost of USD 1.17 per patient. The novel technique did not require the removal of the mouthpiece with a laryngoscope or the use of a Nelaton tube, and no postural change was necessary. A single operator performed the novel procedure unassisted. No adverse events were observed relating to either the novel or the traditional technique. Conclusions: The novel guide-wire technique for repositioning ENBD catheters was effective and is recommended for use.

Nostril

Mouthpiece

10.1159/000382033

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The observation indicator induced from gastrointestinal stromal tumor under long-term monitoring by endoscopic ultrasonography

Endoscopic Ultrasound (2014)

A Mitsunaga Tomoko Tagata Tetsuya Hamano Honami Teramoto Yutaka Mitsunaga

We report a case of low-risk stomach gastrointestinal stromal tumor (GIST) which has been under a long-term observation, obtaining from this experience knowledge useful in determining the treatment formula for this disease.During the observation for 6 years, no such change as ulcer formation was observed in the appearance of the tumor. The measurement of tumor diameter, however, showed gradual growth of maximum tumor diameter from 2.7 to 5.0 cm. When the changes in the diameter of tumor during this period is plotted, taking the timeon the horizontal axis and the tumor diameter on the vertical axis, the growth of the tumor can be approximated with a secondary function, making it possible to estimate the developmental period of the GIST concerned from the approximated secondary function. Thus, the developmental period in this case was estimated to go back 19 years before the time when it was discovered for the 1(st) time. Further, it was considered that the coefficient of the secondary function represents the rate of tumor growth, and that comparison with this coefficient contributed to the evaluation of malignancy stage of the GIST concerned.The growth curve predicting the growth of tumor could be depicted by measuring the diameter of the tumor in GIST twice or more at an interval of 6-12 months with EUS, and it was thought that this was utilizable for determining treatment formula for GISTs.

Stromal tumor

Endoscopic ultrasonography

10.4103/2303-9027.129490

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Citations (3)

Peptide-induced hyperactivation-like vigorous flagellar movement in starfish sperm

Zygote (2006)

Kogiku Shiba Tomoko Tagata Junko Ohmuro Yoshihiro Mogami Midori Matsumoto

Asterosap, a sperm-activating peptide (SAP) from the starfish egg jelly coat, is diffusible and controls a cGMP-signalling pathway in starfish sperm in the same manner as resact, a potent chemoattracting SAP in sea urchins. This fact suggests that asterosap may serve as a chemoattractant like resact at concentrations with appropriate gradients. Since asterosap is one of three egg jelly components, which in concert induce the acrosome reaction, it is still worthwhile to evaluate how asterosap modulates sperm motility prior to this reaction. We analysed the flagellar movement of sperm of the starfish Aphelasterias japonica in artificial seawater (ASW) containing the asterosap isoform P15 at 1 μmol l −1 . We found that sperm swim straighter with more symmetrical flagellar movement in P15 than in ASW, but without any significant difference in the flagellar beat frequency and the swimming velocity. The flagellar movement is, however, dramatically different between sperm firmly attached to the solid surface by the head in P15 and those attached in ASW: in P15 the flagellum bends to a greater extent, with higher curvature and with higher shear angle up to a right angle to the flagellar wave axis, and beats at an increased frequency. The vigorous flagellar movement of sperm, which can be activated when sperm are placed in high-load circumstances just as entering into a jelly layer, may increase propulsive forces and hydrodynamic resistances, allowing sperm to undergo the acrosome reaction as effectively as possible.

Hyperactivation

10.1017/s0967199405003503

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Citations (16)

Metachronous early gastric cancer over a period of 13 years after eradication of Helicobacter pylori

Clinical Journal of Gastroenterology (2014)

Atsushi Mitsunaga Tomoko Tagata Tetsuya Hamano Honami Teramoto Motoyasu Kan

Stomach cancer can occur during chronic inflammation from Helicobacter pylori (HP) infection, and its occurrence can be suppressed by eradication of HP. However, the effects of suppressing stomach cancer by HP eradication are limited, and the cancer is known to recur even after eradication of this infection. Here, we report the case of a 56-year-old male patient with gastric cancer who, although undergoing HP eradication after treatment of early gastric cancer with endoscopy, experienced five metachronous cancer recurrences over a period of 13 years. Whether observation of patients who undergo eradication of HP due to peptic ulcers or chronic gastritis and patients who undergo eradication after endoscopic treatment for early gastric cancer should be performed at the same interval is an issue that must be addressed in the future. The appropriate observation period for each patient must be established while considering the burdens to the patient and from the medical economic perspective.

Surgical oncology

Chronic gastritis

Peptic

Stomach cancer

10.1007/s12328-014-0536-9

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Citations (6)

Management of early gastric cancer with positive horizontal or indeterminable margins after endoscopic submucosal dissection: multicenter survey

Endoscopy International Open (2017)

Naoki Ishii Fumio Omata Junko Fujisaki Toshiaki Hirasawa Mitsuru Kaise

Background and study aims Positive horizontal margins in resected specimens are sometimes encountered after endoscopic submucosal dissection (ESD) for early gastric cancers, and appropriate treatment strategies for these cases are not established. The aim of this study was to evaluate current empirical treatments for patients with positive horizontal or indeterminable margins after ESD. Patients and methods We performed a multicenter survey and data from 14 hospitals were collected. The pooled proportions of positive horizontal or indeterminable margins and those of patients followed up without early intervention were calculated using a logistic-normal random-effects model. For calculating pooled estimates, subgroup analyses of high- and non-high-volume centers were conducted. Results A total of 11,796 ESD cases were enrolled and 229 patients (2 %) had positive horizontal or indeterminable margins. Ninety-eight cases were treated within 30 days of ESD and 131 cases were followed up without early treatments. Pooled estimates of positive margins in high- and non-high-volume centers were 1 % (95 % CI: 1 % - 2 %) and 2 % (95 % CI: 1 % - 4 %), respectively, and were not heterogeneous (P = 0.191). The proportion of patients followed up without early intervention ranged from 30 % to 100 %. The pooled estimate was 68 % (95 % CI: 50 % - 83 %). The pooled estimates of high- and non-high-volume centers were 65 % (95 % CI: 38 % - 85 %) and 72 % (95 % CI: 44 % - 89 %), respectively, and were not heterogeneous (P = 0.692). Conclusion There was insufficient consensus regarding treatment strategies used for early gastric cancer with positive horizontal or indeterminable margins after ESD. Further studies are required to establish a consensus.

Endoscopic submucosal dissection

10.1055/s-0043-104859

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A case of gastric aberrant pancreas with bleeding and diagnosed by endoscopic ultrasonography

Endoscopic Ultrasound (2014)

Tomoko Tagata Tetsuya Hamano Honami Teramoto A Mitsunaga A Mitsunaga

Aberrant pancreas is used to describe ectopic pancreatic tissue lying outside its normal location with no anatomic or vascular connection to the pancreas proper. Patients with aberrant pancreas are usually asymptomatic, so aberrant pancreas are typically discovered incidentally during endoscopy, surgery, or autopsy. This time, we report a case of gastric aberrant pancreas bleeding was repeated and endoscopic hemostasis was difficult. A 22-year-old man was admitted to a hospital with a complaint of epigastric pain and melena. Upper gastrointestinal endoscopy and endoscopic ultrasonography (EUS) revealed a submucosal tumor with a bleeding ulcer at the anterior wall of the antrum in the stomach, and diagnosed it as an aberrant pancreas. It was hard to stop bleeding by in total 7 times endoscopic hemostasis and anemia was gradually progressed, so partial gastrectomy was performed. This gastric tumor measured 40 mm × 30 mm × 20 mm and had a severe ulcerative change. The pathological diagnosis was aberrant pancreas with Langerhans islet, acinous cells and excretory duct. (Heinrich type) Until December 2013 in Japan, 13 cases of gastric aberrant pancreas with bleeding have been reported and in these, a surgery was done in 11 cases. In gastric aberrant pancreas cases with ulcer formation like this case, endoscopic hemostasis is expected to be difficult, and surgery is necessary. Hence, early accurate diagnosis by EUS is a very important to decide better treatment plan.

Melena

Ectopic pancreas

Gastrointestinal bleeding

10.4103/2303-9027.129506

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Citations (2)