Yoichiro Ono

Long-term outcome of endoscopic balloon dilation for small bowel strictures in patients with Crohn's disease.

Endoscopic balloon dilation (EBD) is an alternative to surgery for small bowel strictures of patients with Crohns disease (CD). However, little is known about the long‐term efficacy of EBD. The aim of the present study was to clarify the long‐term outcome of EBD for small bowel strictures in patients with CD.

Value of concomitant endoscopic balloon dilation for intestinal stricture during long‐term infliximab therapy in patients with crohn's disease

Aim:  We assessed the long‐term outcome of infliximab (IFX) therapy in patients with Crohns disease (CD) and investigated the efficacy of concomitant endoscopic balloon dilation (EBD) for intestinal stricture during treatment.

Mucosal healing of ileal lesions is associated with long-term clinical remission after infliximab maintenance treatment in patients with Crohn's disease.

The aim of the present study was to endoscopically evaluate ileal mucosal healing during maintenance therapy with infliximab in order to investigate the clinical significance of endoscopic examination of ileal lesions in Crohns disease patients.

Long‐term course of Crohn's disease in Japan: Incidence of complications, cumulative rate of initial surgery, and risk factors at diagnosis for initial surgery

Intestinal complications of stenosis or fistula may occur during the course of Crohns disease (CD), and surgery is performed in a fair number of patients. The risk factors for initial surgery in a Japanese hospital‐based cohort of CD patients were evaluated.

CLINICAL AND ENDOSCOPIC FEATURES OF AMYLOIDOSIS SECONDARY TO CROHN'S DISEASE: DIAGNOSTIC VALUE OF DUODENAL OBSERVATION AND BIOPSY

Aim:  Recent reports have focused on the development of secondary amyloidosis (AMY) as a complication of Crohns disease (CD). The present study was carried out to investigate the frequency of AMY secondary to CD, its clinical and endoscopic features, and the importance of duodenal biopsy in detecting this disease.

Lipid is absorbed in the stomach by epithelial neoplasms (adenomas and early cancers): a novel functional endoscopy technique

Background and study aims: The authors have successfully demonstrated that the white opaque substance (WOS) identified in gastric epithelial neoplasms is an accumulation of minute lipid droplets on the epithelial neoplasm. It is not known whether the lipid droplets originate from externally ingested lipids (typically foods). The purpose of this study was to investigate whether the oral ingestion of foods containing emulsified fats increases the density of the WOS in epithelial neoplasms. Patients and methods: We examined 92 gastric epithelial neoplastic lesions in 89 patients. The patients were given emulsified fatty foods before the procedure, and magnifying endoscopy with narrow-band imaging (M-NBI) was used to image the lesions. An increase in WOS density after the ingestion of emulsified fatty foods was defined as a positive fat-loading test result. The patients were divided into the following groups: control group, no emulsified fat administered; group 1, fatty food administered 16 hours prior; group 3, fatty food administered both 16 and 4 hours prior. The proportion of positive fat-loading test results was determined in all groups. Results: The rates of positive fat-loading test results were as follows: control group, 9 %; group 1, 26 %; group 2, 52 %; group 3, 78 %. The increase in the rates of positive fat-loading test results in groups 2 and 3 relative to the rate in the control group was statistically significant (chi-squared test). Conclusions: This study demonstrated for the first time that the ingestion of external lipids causes lipid droplets to aggregate in situ on the gastric epithelial neoplasm. These results can be used to develop a novel functional endoscopy technique that harnesses the lipid absorption capacity of neoplasms.

Incidence, Clinical Characteristics, Long-Term Course, and Comparison of Progressive and Nonprogressive Cases of Aphthous-Type Crohn's Disease: A Single-Center Cohort Study

Background/Aims: In Japan, aphthous-type Crohns disease (type A CD) is thought to represent an early phase of Crohns disease (CD), and diagnosis of type A CD is possible in the diagnostic criteria for CD in Japan. However, the details of type A CD are not well understood. Methods: Subjects comprised 649 CD patients diagnosed between 1985 and 2011. The incidence of type A CD over time was clarified in two periods (1985-2004 and 2005-2011). The course of type A CD was also investigated, and cases that did and did not progress to typical CD were compared. Results: No significant difference was seen in the incidence of type A CD between the two periods (5.2 vs. 8.5%, p = 0.125). Type A CD patients followed at our hospital progressed to typical CD at a rate of 59.3%. In comparing progressive and nonprogressive cases, the frequency of large, densely distributed aphthous lesions in the small intestine was higher among progressive cases (p = 0.018). Conclusion: Type A CD is an early phase of CD, and CD diagnostic criteria including early cases are valid in Japan.

Trough level of infliximab is useful for assessing mucosal healing in Crohn's disease: a prospective cohort study

Background/Aims Decreased trough levels of infliximab (TLI) and antibodies to infliximab (ATI) are associated with loss of response (LOR) in Crohns disease. Two prospective studies were conducted to determine whether TLI or ATI better correlates with LOR (Study 1), and whether TLI could become a predictor of mucosal healing (MH) (Study 2). Methods Study 1 was conducted in 108 patients, including those with LOR and remission to compare ATI and TLI in discriminating the 2 conditions based on receiver operating characteristic (ROC) curve analyses. Study 2 involved 35 patients who were evaluated endoscopically. Results In Study 1, there were no differences between the 2 assays in ROC curve analyses; the TLI cutoff value for LOR was 2.6 µg/mL (sensitivity, 70.9%; specificity, 79.2%), and the ATI cutoff value was 4.9 µg/mL (sensitivity, 65.5%; specificity, 67.9%). The AUROC (area under the ROC curve) of TLI was greater than that of ATI. AUROC was useful for discriminating between the 2 conditions. In Study 2, the TLI was significantly higher in the colonic MH group than in the non-MH group (2.7 µg/mL vs. 0.5 µg/mL, P=0.032). Conclusions TLI is better than ATI for clinically diagnosing LOR, and a correlation was observed between TLI and colonic MH.

Newly developed magnifying endoscopic classification of the Japan Esophageal Society to identify superficial Barrett’s esophagus-related neoplasms

Aim and methodsThe Japan Esophageal Society created a working committee group consisting of 11 expert endoscopists and 2 pathologists with expertise in Barrett’s esophagus (BE) and esophageal adenocarcinoma. The group developed a consensus-based classification for the diagnosis of superficial BE-related neoplasms using magnifying endoscopy.ResultsThe classification has three characteristics: simplified, an easily understood classification by incorporating the diagnostic criteria for the early gastric cancer, including the white zone and demarcation line, and the presence of a modified flat pattern corresponding to non-dysplastic histology by adding novel diagnostic criteria. Magnifying endoscopic findings are composed of mucosal and vascular patterns, and are initially classified as “visible” or “invisible.” Morphologic features were evaluated for “visible” patterns, and were subsequently rated as “regular” or “irregular,” and the histology, non-dysplastic or dysplastic, was predicted.ConclusionWe introduce the process and outline of the magnifying endoscopic classification.

Case presentations: Ulcers

• Presented with abdominal pain, vomiting, and ileus. • A circumferential stenotic lesion was present in the jejunum, as a slightly discolored tumor with a gradual marginal rising appearance (a, b). • Half of the circumference of the tumor was covered with a thin white coat, and the lumen showed extremely poor distensibility, even with a large amount of insuffl ation. • Dye spraying clearly demarcated the boundary between the tumor and surrounding normal mucosa. • Partly nodular changes were also visible at the site of stenosis (c, d).