Authorship：Lead author   Publishing type：Research paper (scientific journal)  

DOI： 10.1111/den.14809

researchmap

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.vgie.2024.05.014

PubMed

researchmap

Publishing type：Research paper (scientific journal)  

Peroral endoscopic myotomy (POEM) is a safe and effective endoscopic treatment for achalasia and other esophageal motility disorders, and TTJ (Triangle Tip Knife J; Olympus, Tokyo, Japan) is currently widely used in POEM. Recently, we reported a novel modification of TTJ, which was adjusted to knife length 2 mm by attaching a disposable clip (QuickClip Pro; Olympus) sheath to the tip as a hood attachment. In this study, we compared the safety and effectiveness of TTJ and TTJ with hood attachment (TTJ-H) in POEM. In this 1:1 propensity score matched retrospective cohort study, we compared the procedure time, myotomy efficiency, number of coagulation forceps usage, adverse events, length of hospital stay after POEM, procedural success and clinical success between TTJ and TTJ-H groups. We examined 682 consecutive patients who underwent POEM between January 2021 and June 2023. We excluded 134 patients who had already undergone POEM or laparoscopic Heller myotomy as prior myotomy. Finally, we identified 98 propensity score-matched pairs (n = 196). The mean procedure time was shortened from 93.5 to 80.2 min (14% reduction, P = 0.012) when comparing TTJ-H group to TTJ group. The mean myotomy efficiency was improved from 2.76 to 2.32 min/cm (16% improvement, P = <0.001), and usage of coagulation forceps for hemostasis was decreased from 3.87 to 0.55 (86% reduction, P = <0.001). This study showed that use of TTJ-H could reduce total procedure time, improve myotomy efficiency, and reduce costs compared to TTJ.

DOI： 10.1016/j.gie.2023.12.001

PubMed

researchmap

Publishing type：Research paper (scientific journal)  

<h4>Background and aims</h4>Killian-Jamieson diverticulum (KJD) is a relatively uncommon variant of pharyngoesophageal diverticula, distinct from the more prevalent Zenker's diverticulum. However, literature on endoscopic management of KJD remains limited. This study aimed to elucidate the efficacy and safety of peroral endoscopic septotomy (POES) as a treatment approach for symptomatic KJD.<h4>Methods</h4>In this retrospective observational study, we investigated the outcomes of 9 consecutive patients who underwent POES for KJD between January 2019 and May 2023. Follow-up data of at least 2 months post-treatment were analyzed. The primary outcome measure was the technical success rate of POES. Secondary outcomes encompassed the clinical success rate, defined as symptomatic improvement 2 months after POES, and the incidence of adverse events.<h4>Results</h4>All patients presented with dysphagia, with a median symptom duration of 6 months (interquartile range [IQR]: 3-12 months). The median diverticulum size was 32mm (IQR;24-42mm). The median duration of the operation time was 66 minutes (IQR; 60-109). A 100% technical success rate was achieved, with complete closure of the defect in all cases. There were no adverse events related to this treatment. The median hospitalization duration was 5 days (IQR: 4-6), and the clinical success rate was 88.9%. Follow-up barium esophagograms exhibited significant improvement in the flow of the barium for all patients.<h4>Conclusions</h4>Despite the relatively limited case volume, our findings underscore that POES is a safe and efficacious approach for managing symptomatic KJD.

DOI： 10.1111/den.14738

PubMed

researchmap

Publishing type：Research paper (scientific journal)  

<h4>Background and aims</h4>Anti-reflux mucosectomy (ARMS) and anti-reflux mucosal ablation (ARMA) were developed as interventions for PPI refractory/dependent GERD. Although ARMS and ARMA are established treatments for PPI-refractory GERD, but reliance on natural healing for ulcer scar formation introduces uncertainty and bleeding risk. To address these issues, we introduced a novel approach called anti-reflux mucoplasty (ARM-P), which involves immediate closure of mucosal defects following mucosectomy. This pilot study aims to evaluate the safety, feasibility, and efficacy of ARM-P.<h4>Methods</h4>A retrospective single-center study was conducted using prospectively-collected data spanning from October 2022 to July 2023. Patients with PPI refractory/dependent GERD who underwent ARM-P were included. The study evaluated technical success of ARM-P, pre and post ARM-P GERD-Health Related Quality of Life Questionnaire (GERD-HRQL), GerdQ, and Frequency Scale for the Symptoms of GERD (FSSG) scores, along with PPI discontinuation and endoscopic EGJ morphology.<h4>Results</h4>A total of 20 patients with a median age of 61.5 years underwent the ARM-P procedure. The procedure achieved 100% technical success without adverse events. After ARM-P, 55.0% discontinued PPI usage, and 15.0% reduced PPI dose by half. Median GERD-HRQL score improved from 21 to 6 (P = 0.0026), median GERDQ score improved from 9 to 7 (P = 0.0022), and median FSSG score decreased from 16 to 7 (P = 0.0003). Median Hill's Classification significantly improved from Grade III to Grade I (P = 0.0001).<h4>Conclusions</h4>This study presents the first pilot report of ARM-P, demonstrating its procedural safety, technical feasibility, and short-term efficacy.

DOI： 10.1111/den.14711

PubMed

researchmap

Publishing type：Research paper (scientific journal)  

The endoscopic pressure study integrated system (EPSIS) is a novel diagnostic tool used to evaluate lower esophageal sphincter (LES) function. EPSIS allows the measurement of intragastric pressure (IGP) during gastric insufflation through esophagogastroduodenoscopy (EGD) and records its pressure waveform. This study aimed to assess the usefulness and applicability of EPSIS as an adjunct diagnostic modality for achalasia. This case-control study was conducted using a database of patients who underwent EGD, barium swallow (BS), high-resolution manometry (HRM), and EPSIS between January 2022 and December 2022. The achalasia (experimental) group (n = 35) consisted of patients with a definitive diagnosis of achalasia. The control group (n = 34) consisted of patients with no abnormalities in EGD, BS, or HRM and no abnormal acid reflux confirmed with 24-hour pH-impedance monitoring. EPSIS findings were compared between the two groups and characterized by waveform pattern (uphill or flat), maximum IGP (IGP-Max), pressure difference, and the gradient of the waveform. All patients in the achalasia group showed an uphill pattern, in contrast to 21 patients (61.8%) in the control group. IGP-Max demonstrated the best diagnostic accuracy for achalasia, with a cutoff value of 15.8 mmHg (100% sensitivity, 58.8% specificity, and AUC: 0.78). The pressure gradient also demonstrated good diagnostic accuracy, with a cutoff value of 0.40 mmHg/sec (80% sensitivity, 61.8% specificity, and AUC: 0.76). This study demonstrated that EPSIS can be applied as a diagnostic modality in patients with achalasia.

DOI： 10.1111/den.14695

PubMed

researchmap

Publishing type：Research paper (scientific journal)  

<h4>Objectives</h4>Severe submucosal fibrosis is a crucial technical difficulty encountered during endoscopic submucosal dissection (ESD) in patients with ulcerative colitis (UC). We aimed to identify predictors of severe submucosal fibrosis in patients with UC.<h4>Methods</h4>We retrospectively included 55 tumors resected using ESD from 48 consecutive patients with UC. We analyzed the clinicopathological characteristics and treatment outcomes between the F0/1 (none to mild submucosal fibrosis) group (n = 28) and F2 (severe submucosal fibrosis) group (n = 27).<h4>Results</h4>No significant difference was found between the F0/1 and F2 groups in en bloc resection rate (100% vs. 96%, p = 0.49), R0 resection rate (100% vs. 93%, p = 0.24), and dissection speed (0.18 vs. 0.13 cm² /min, p = 0.07). Intraoperative perforation was more common in the F2 group (30%) than in the F0/1 group (8%; p = 0.01). Multivariable analysis showed that a longer duration of UC (≥ 10 years) (odds ratio, 6.11; 95% confidence interval (CI), 1.20-31.03; p = 0.03) and scarring of background mucosa of the tumor (odds ratio, 39.61; 95% CI, 3.91-400.78; p < 0.01) were independent predictors of severe submucosal fibrosis.<h4>Conclusions</h4>Long UC duration and scarring background mucosa were predictors of severe submucosal fibrosis associated with perforation during ESD.

DOI： 10.1111/den.14570

PubMed

researchmap

Authorship：Lead author   Publishing type：Research paper (scientific journal)  

Pregnancy is a known risk factor for amebic enteritis, which develops into potentially fatal fulminant amebic enteritis in some cases. We describe a case of a 27-year-old non-immunosuppressed pregnant woman with fulminant amebic enteritis complicated with cytomegalovirus enteritis. She improved with intensive care and intravenous metronidazole and ganciclovir but eventually required subtotal colectomy for intestinal stenosis. It is difficult to diagnose amebic enteritis, especially in a non-endemic area. Amebic enteritis must be considered as a differential diagnosis for refractory diarrhea with bloody stools in women in the perinatal period, even those without immunosuppression.

DOI： 10.2169/internalmedicine.0839-22

PubMed

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

researchmap

researchmap

researchmap

researchmap

researchmap

researchmap

researchmap