Masaaki Inomata

Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: A single-center retrospective study

The aim of the present study was to examine the safety and efficacy of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) based on the long‐term outcomes.

Epithelial splenic cysts in an intrapancreatic accessory spleen and spleen

A rare case of cysts simultaneously occurring in the intrapancreatic accessory spleen and spleen in a 49‐year‐old female is reported. The patient underwent distal pancreatomy for a cystic tumor of the pancreas, and a splenectomy. A multilocular cyst (4.3 × 2.6 cm) in an accessory spleen at the pancreas tail, and a solitary cyst (1.2 × 0.9 cm) of the spleen were found. The cyst in the intrapancreatic accessory spleen was lined by non‐keratinizing stratified squamous epithelium, and the spleen cyst by a single layer of flat epithelium; these lining cells were positive for Alcian blue stain and periodic acid‐Schiff reaction, and were immunohistochemically positive for cytokeratin, HBME‐1 and Sialyl‐Tn. Epithelial membrane antigen, carcinoembryonic antigen and CA19‐9 were positive in the accessory spleen cyst but were negative in the spleen cyst. An electron microscopic examination of the flat epithelium of the spleen cyst revealed numerous microvilli on the surface, cytoplasmic microfilaments, and a number of tight junctions between adjacent cells. These features suggested that the two cysts differ in nature, and origin; the accessory spleen cyst may be an embryonic inclusion of the pancreas duct while the spleen cyst may be an inclusion cyst of the mesothelium.

NEW ENDOSCOPIC TECHNIQUE TO CLOSE LARGE MUCOSAL DEFECTS AFTER ENDOSCOPIC MUCOSAL RESECTION IN PATIENTS WITH GASTRIC MUCOSAL TUMORS

Endoscopic mucosal resection has been recognized as a standard method for treating mucosal tumors of the stomach in Japan. In our department, we have treated mucosal defects after this procedure by using metallic clips to prevent and manage complications related to endoscopic mucosal resection. In the present study, we explain the new technique, the ‘loop‐and‐clips’ method, which uses clips and a detachable snare to close large mucosal defects after endoscopic mucosal resection.

Analysis of mucin, p53 protein and Ki-67 expressions in gastric differentiated-type intramucosal neoplastic lesions obtained from endoscopic mucosal resection samples : A proposal for a new classification of intramucosal neoplastic lesions based on nuclear atypia

There are differing views between Western and Japanese pathologists on the use of histological criteria to classify gastrointestinal tumors. It is therefore a priority to create a new histological classification of the stomach in order to resolve the confusion. Expression patterns were examined of mucin (MUC2, CD10, MUC5AC, pyloric gland‐type mucin), p53 protein, and Ki‐67 in tumor cells according to the following new classification system for differentiated‐type intramucosal neoplastic lesions of the stomach, based on nuclear atypia: borderline neoplasia (adenoma (including dysplasia), indefinite tumor of adenoma or low‐grade cancer, and low‐grade cancer) and definite carcinoma (intermediate cancer, and high‐grade cancer). The resulting grades were: adenoma, 23; indefinite tumor for adenoma or low‐grade cancer, 6; low‐grade cancer, 28; intermediate cancer, 48; high‐grade cancer, 20. While the frequency of intestinal‐type borderline neoplasias was higher than that of definite carcinomas, the mixed‐type of definite carcinomas occurred with higher frequency than borderline neoplasias. The p53 protein overexpression and the Ki‐67‐positive rate increased with an increase in the grade assigned according to the new classification. The correlated expression levels of p53 protein, Ki‐67, and various mucins, support the conclusion that this classification of intramucosal neoplastic lesions is useful for obtaining a consensus diagnosis of gastric intramucosal neoplasia between pathologists and gastrointestinal clinicians.

A case of a lipoma in the colon complicated by intussusception.

A 61-year-old man was admitted for investigation of weight loss and abdominal swelling. Abdominal ultrasonography showed a rounded, 3–4 cm hyperechoic colonic mass. Computed tomography scanning revealed a low-density colonic tumour, while a barium enema examination demonstrated a 4 cm tumour in the ascending colon. At colonoscopy, a large, smooth, yellow tumour with a large stalk was evident in the ascending colon together with a submucosal mass that was too large for endoscopic resection (Fig. 1). On MRI examination, the tumour exhibited a high-intensity signal on T1and T2-weighted images. A clinical diagnosis of a lipoma in the ascending colon was therefore made.

Administration of additional analgesics can decrease the incidence of paradoxical reactions in patients under benzodiazepine‐induced sedation during endoscopic transpapillary procedures: Prospective randomized controlled trial

The aim of the present study was to evaluate the efficacy and safety of giving pentazocine as an analgesic with benzodiazepine during endoscopic retrograde cholangiopancreatography (ERCP).

Endoscopic closure of mucosal defects with metallic clips after endoscopic mucosal resection in patients with intramural tumors of the stomach: A retrospective study

Background:  Representative complications of endoscopic mucosal resection to treat intramural gastric tumors include bleeding and perforation. The purpose of the present study was to clarify whether endoscopic closure of mucosal defects using metallic clips decreases the incidence of delayed bleeding following endoscopic mucosal resection.

Effect of a muscarinic M3 receptor agonist on gastric motility.

Muscarinic M3 receptors exist in the gastrointestinal wall in humans and the muscarinic M3 agonist cevimeline hydrochloride (Evoxac) is a candidate therapeutic agent for the treatment of xerostomia in Sjögren’s syndrome. However, M3 receptor agonists are not known to show efficacy for diseases associated with abnormal gastrointestinal motility. Herein the effects are reported of cevimeline on gastric motility in two patients with non‐ulcer dyspepsia. The patients both received long‐term proton pump inhibitor therapy for 6 months, but their symptoms persisted. Then cevimeline was administered orally for 8 weeks at 30 mg three times daily (90 mg/day) and their dyspepsia symptoms improved. Electrogastrography was performed to examine gastric motility before and after administration of the M3 agonist. The fasting or nocturnal wave rate was significantly increased after administration compared with before administration, but no significant postprandial changes were seen. No adverse effects of cevimeline were observed. This drug might be a candidate therapeutic agent for non‐ulcer dyspepsia. Because its postprandial effects on gastrointestinal motility are unclear, a dose‐finding clinical study should be performed in the future.