Toshihiro Kusaka

Narrow-band imaging (NBI) magnifying endoscopic classification of colorectal tumors proposed by the Japan NBI Expert Team.

Many clinical studies on narrow‐band imaging (NBI) magnifying endoscopy classifications advocated so far in Japan (Sano, Hiroshima, Showa, and Jikei classifications) have reported the usefulness of NBI magnifying endoscopy for qualitative and quantitative diagnosis of colorectal lesions. However, discussions at professional meetings have raised issues such as: (i) the presence of multiple terms for the same or similar findings; (ii) the necessity of including surface patterns in magnifying endoscopic classifications; and (iii) differences in the NBI findings in elevated and superficial lesions. To resolve these problems, the Japan NBI Expert Team (JNET) was constituted with the aim of establishing a universal NBI magnifying endoscopic classification for colorectal tumors (JNET classification) in 2011. Consensus was reached on this classification using the modified Delphi method, and this classification was proposed in June 2014. The JNET classification consists of four categories of vessel and surface pattern (i.e. Types 1, 2A, 2B, and 3). Types 1, 2A, 2B, and 3 are correlated with the histopathological findings of hyperplastic polyp/sessile serrated polyp (SSP), low‐grade intramucosal neoplasia, high‐grade intramucosal neoplasia/shallow submucosal invasive cancer, and deep submucosal invasive cancer, respectively.

Serum miR-21, miR-29a, and miR-125b Are Promising Biomarkers for the Early Detection of Colorectal Neoplasia.

Purpose: Circulating microRNAs (miRNA) are emerging as promising diagnostic biomarkers for colorectal cancer, but their usefulness for detecting early colorectal neoplasms remains unclear. This study aimed to identify serum miRNA biomarkers for the identification of patients with early colorectal neoplasms. Experimental Design: A cohort of 237 serum samples from 160 patients with early colorectal neoplasms (148 precancerous lesions and 12 cancers) and 77 healthy subjects was analyzed in a three-step approach that included a comprehensive literature review for published biomarkers, a screening phase, and a validation phase. RNA was extracted from sera, and levels of miRNAs were examined by real-time RT-PCR. Results: Nine miRNAs (miR-18a, miR-19a, miR-19b, miR-20a, miR-21, miR-24, miR-29a, miR-92, and miR-125b) were selected as candidate biomarkers for initial analysis. In the screening phase, serum levels of miR-21, miR-29a, and miR-125b were significantly higher in patients with early colorectal neoplasm than in healthy controls. Elevated levels of miR-21, miR-29a, and miR-125b were confirmed in the validation phase using an independent set of subjects. Area under the curve (AUC) values for serum miR-21, miR-29a, miR-125b, and their combined score in discriminating patients with early colorectal neoplasm from healthy controls were 0.706, 0.741, 0.806, and 0.827, respectively. Serum levels of miR-29a and miR-125b were significantly higher in patients who had only small colorectal neoplasms (≤5 mm) than in healthy subjects. Conclusions: Because serum levels of miR-21, miR-29a, and miR-125b discriminated patients with early colorectal neoplasm from healthy controls, our data highlight the potential clinical use of these molecular signatures for noninvasive screening of patients with colorectal neoplasia. Clin Cancer Res; 21(18); 4234–42. ©2015 AACR.

NBI magnifying endoscopic classification of colorectal tumors proposed by the Japan NBI Expert Team (JNET)

Many clinical studies on narrow‐band imaging (NBI) magnifying endoscopy classifications advocated so far in Japan (Sano, Hiroshima, Showa, and Jikei classifications) have reported the usefulness of NBI magnifying endoscopy for qualitative and quantitative diagnosis of colorectal lesions. However, discussions at professional meetings have raised issues such as: (i) the presence of multiple terms for the same or similar findings; (ii) the necessity of including surface patterns in magnifying endoscopic classifications; and (iii) differences in the NBI findings in elevated and superficial lesions. To resolve these problems, the Japan NBI Expert Team (JNET) was constituted with the aim of establishing a universal NBI magnifying endoscopic classification for colorectal tumors (JNET classification) in 2011. Consensus was reached on this classification using the modified Delphi method, and this classification was proposed in June 2014. The JNET classification consists of four categories of vessel and surface pattern (i.e. Types 1, 2A, 2B, and 3). Types 1, 2A, 2B, and 3 are correlated with the histopathological findings of hyperplastic polyp/sessile serrated polyp (SSP), low‐grade intramucosal neoplasia, high‐grade intramucosal neoplasia/shallow submucosal invasive cancer, and deep submucosal invasive cancer, respectively.

A multicenter, prospective trial of total colonoscopy using a short double-balloon endoscope in patients with previous incomplete colonoscopy

BACKGROUND There is no specific insertion method for patients who previously underwent an incomplete colonoscopy. No multicenter prospective study using a double-balloon endoscope (DBE) for total colonoscopy was previously performed. OBJECTIVE To demonstrate the effectiveness and safety of using short DBEs in patients who previously underwent incomplete colonoscopies. DESIGN A multicenter, prospective trial. SETTING Four tertiary care academic centers and 6 community hospitals. PATIENTS Patients with a history of incomplete colonoscopy, ages 20 to 79 years, were included. Exclusion criteria were colonoscopy performed by endoscopists with experience in fewer than 1000 cases, history of colectomy, poor bowel preparation, inflammatory bowel disease, active bowel obstruction, and active bleeding. INTERVENTION Total colonoscopies using short DBEs were attempted in all patients. MAIN OUTCOME MEASUREMENTS Primary endpoint was the cecal intubation rate. Secondary endpoints were time to cecal intubation, complications, and tolerability. RESULTS A total of 110 patients (62 males, median age 66.5 years) were included. Fifty-four patients had a history of abdominal surgery. The cecal intubation rate was 100% (110/110). Median intubation time was 12 minutes (range 4-47 minutes). Mild mucosal tears without symptoms occurred in 1 patient. For 64.5% of patients, intravenous sedatives and/or analgesics were used during examinations. Based on questionnaires, 50.9% had no pain, 31.8% slight pain, and 17.3% tolerable pain. Moreover, 96.4% of patients answered that their examination was more comfortable than their previous colonoscopy. LIMITATION Uncontrolled trial. CONCLUSION The use of a short DBE is an effective and safe method for total colonoscopy in patients who previously underwent incomplete colonoscopies. ( CLINICAL TRIAL REGISTRATION NUMBER UMIN3464.).

Efficacy of probiotic treatment with Bifidobacterium longum 536 for induction of remission in active ulcerative colitis: A randomized, double‐blinded, placebo‐controlled multicenter trial

We conducted a randomized, double‐blinded, placebo‐controlled trial to investigate the efficacy of Bifidobacterium longum 536 (BB536) supplementation for induction of remission in Japanese patients with active ulcerative colitis (UC).

Multivariate Analysis for Factors Predicting Rapid Response of Leukocytapheresis in Patients With Steroid-resistant Ulcerative Colitis: A Multicenter Prospective Open-label Study

Leukocytapheresis (LCAP) has been advocated as a treatment for moderate to severe active ulcerative colitis (UC) in Japan. To clarify the predictive factors for a rapid response to LCAP treatment, we conducted a multicenter prospective open‐label study. A total of 105 patients with UC were analyzed. LCAP was performed using a Cellsorba EX column once a week for 5–10 sessions. The response was evaluated by the clinical activity index (CAI). When the CAI score decreased to less than half the pretreatment value or to less than 5 points within 3 weeks, the patient was considered to be a rapid responder. The average CAI significantly decreased from 11.7 to 4.2 (P < 0.01). Seventy‐four percent of the patients responded to the therapy, and 53% of these patients were rapid responders. The following significant factors correlated with the rapid LCAP response: (i) steroid resistance (P < 0.05), (ii) severe disease indicated by a CAI score greater than 11 (P = 0.05), (iii) disease duration of less than 1 year (P < 0.05), and (iv) C‐reactive protein levels before treatment (P < 0.01). These results suggest that the early initiation of LCAP is beneficial in patients with steroid‐resistant UC.

Immunohistochemical expression of cyclooxygenase (COX)-2 in colorectal adenomas.

polyposis or cancer. In all subjects basal GH, Insulin Growth Factor-I (IGF-I), maximal suppresion of GH (maxGH) and plasma insulin after a standarized meal were measured and a colonoscopy was performed . All patients had been diagnosed by tipical symptoms, increased GH (greater than 2 nglml after oral glucose overload) and increased levels of IGF-l. Results: 19 patients(50%) had polyps (8 mill 1):15 (39,5 %) adenomatous and 4 (10,5%) hyperplasic . 19 patients (50 %) had no polyps (9 milO I) . One patient with adenomatous polyps had colonic carcinoma (2.6 %). In a control group (subjects referred to colonoscopy for other reasons with the same age and sex) the prevalence of polyps was 25 %. Conclusions: The prevalence of polyps and colon cancer in active acromegaly patients is higher than in the general population and in the subjects referred to colonoscopy for other reasons. Except for age, no significant differences were observed in the risk factors studied. We recommend a colonoscop y examination in acromegalic patients, especially those over 50 years of age.

Efficacy and safety of endoscopic interventions using the short double-balloon endoscope in patients after incomplete colonoscopy

We have previously reported excellent cecal intubation rates using a short double‐balloon endoscope in patients with a history of incomplete colonoscopy. However, data on the endoscopic treatment of colorectal tumors using a double‐balloon endoscope are limited. The aim of the present study was to evaluate the efficacy and safety of endoscopic intervention of colorectal tumors using a short double‐balloon endoscope.

A Huge Polypoid Type Early Gastric Neuroendocrine Cell Carcinoma

Abstract: We report a case of a huge polypoid‐type early gastric neuroendocrine cell carcinoma. Upper gastrointestinal endoscopy in a 77‐year‐old man revealed a gastric polyp on the anterior wall of the corpus. Endoscopically biopsied material from the polyp suggested that the lesion was malignant; specifically a poorly and moderately differentiated tubular adenocarcinoma or adenocarcinoma with neuroendocrine differentiation. Endoscopically the lesion was a huge polypoid type with a broad stalk approximately 40 mm in diameter, and its surface was tabulated with a white coat and erosion. The patient underwent total gastrectomy. The resected specimen histopathologically showed a polypoid mass with medullary carcinoma and indicated endocrine cell differentiation. Immunohis‐tochemical findings supported the diagnosis of endocrine cell carcinoma. This case was an early and polypoid‐type gastric endocrine cell carcinoma. Since examples of such cases are rare in the literature, we report this case in brief.

Ischemic enteritis with intestinal stenosis.

A 75-year-old man was admitted to our hospital with sudden onset of vomiting and abdominal distension. The patient was taking medication for arrhythmia. Computed tomography showed stenosis of the ileum and a small bowel dilatation on the oral side from the region of stenosis. A transnasal ileus tube was placed. Enteroclysis using contrast medium revealed an approximately 6-cm afferent tubular stenosis 10 cm from the terminal ileum and thumbprinting in the proximal bowel. Transanal double-balloon enteroscopy showed a circumferential shallow ulcer with a smooth margin and edema of the surrounding mucosa. The stenosis was so extensive that we could not perform endoscopic balloon dilation therapy. During hospitalization, the patients nutritional status deteriorated. In response, we surgically resected the region of stenosis. Histologic examination revealed disappearance of the mucosal layer and transmural ulceration with marked fibrosis, especially in the submucosal layer. Hemosiderin staining revealed sideroferous cells in the submucosal layers. Based on the pathologic findings, the patient was diagnosed with ischemic enteritis. The patients postoperative course was uneventful.