Yu Takagi

Tailored eradication therapy based on fecal Helicobacter pylori clarithromycin sensitivities.

Background and Aim:  Helicobacter pylori (H. pylori) eradication rates using the PPI/AC regimen (proton pump inhibitor + amoxicillin + clarithromycin) are declining. We trialed tailoring eradication regimens according to clarithromycin (CAM) susceptibility.

Helicobacter pylori infection and reflux esophagitis in young and middle‐aged Japanese subjects

Background and Aims:  Helicobacter pylori infection rates are reported to be high in people over the age of 40 years, but are decreasing in younger age groups. A negative correlation has been reported between H. pylori infection and reflux esophagitis (RE).

Overexpression of Protein Kinase Cδ Enhances Cisplatin-Induced Cytotoxicity Correlated with p53 in Gastric Cancer Cell Line

Objective: An important issue in cancer therapy is to investigate the mechanism for cellular sensitivity to anticancer agents such as cisplatin. Cisplatin is one of the DNA-damaging agents and several factors including p53 are related to the sensitivity to cisplatin in cancer. Protein kinase C (PKC) δ is known as a positive regulator for cisplatin-induced cell death. In our present study, we examined whether overexpression of PKCδ and p53 increases the sensitivity of the human gastric cancer cell line, MKN28, which has a mutation of p53 gene, to cisplatin. Methods: Cell viability and DNA content were measured in MKN28 with adenovirus-mediated expression of PKCδ and p53 after exposure to cisplatin. In addition, the active form of caspase-3 was detected by Western blotting. Results: Overexpression of exogenous PKCδ did not induce cell death in MKN28 but inhibited cell growth at 1 µg/ml cisplatin as compared to that by cisplatin alone. Moreover, overexpression of both wild-type p53 and exogenous PKCδ in MKN28 increased cisplatin-induced cell death in MKN28. Conclusion: These results suggest that PKCδ, in cooperation with p53, possibly regulates cisplatin-induced caspase-3-mediated cell death in gastric cancer.

Narrow‐band imaging on screening of esophageal lesions using an ultrathin transnasal endoscopy

Background and Aim:  Ultrathin transnasal endoscopy, used extensively in Japan, is considered to have inferior image quality and suction performance, and questionable diagnostic performance. So the aim of the present study was to compare the diagnostic performance of white light (WL) examination and non‐magnified narrow‐band imaging (NBI) examination in screening for esophageal disorders with ultrathin transnasal endoscopy.

Impact of transnasal ultrathin esophagogastroduodenoscopy (UT-EGD) in the evaluation of esophageal peristaltic function.

Background:  We used transnasal ultrathin esophagogastroduodenoscopy (UT‐EGD) to simultaneously perform realtime esophageal manometry and observe esophageal peristalsis.

The role of trefoil factor family in apparently healthy subjects administrated gastroprotective agents for the primary prevention of gastrointestinal injuries from low-dose acetylsalicylic acid: a preliminary study

It is well-known that acetylsalicylic acid induces gastrointestinal complication. Recently, trefoil factor family has been reported as a mucosal protective factor. We focused on trefoil factor family as one of defensive system for gastrointestinal injuries. The aim of this trial was to evaluate trefoil factor family levels in the serum of healthy subjects with low-dose acetylsalicylic acid. Low-dose acetylsalicylic acid with placebo or proton pump inhibitor or rebamipide were administered in 30 healthy subjects. Transnasal endoscopy was performed at 0, 24 h, 3 and 7 day. Changing of trefoil factor family (1,2,3) and numbers of gastric injuries were evaluated. The numbers of gastric injuries were significantly increased in the placebo group at 3 and 7 days. Injuries in the proton pump inhibitor group were not induced, in the rebamipide group were slightly induced. Trefoil factor family level in the placebo group were decreased in 3 and 7 days compared with prior to starting the trial. Trefoil factor family may have an important association with acetylsalicylic acid-induced gastrointestinal damage. Proton pump inhibitor and rebamipide prevented low-dose acetylsalicylic acid-induced gastrointestinal complications compared with the placebo group.

Comparison of plastic prostheses and self-expandable metallic stents in the treatment of malignant esophageal stenosis

OBJECTIVE We compared the efficacy of plastic prostheses and self-expandable metallic stents in the treatment of malignant esophageal stenosis and/or fistula. SUBJECTS AND METHODS Subjects were 31 patients with esophageal cancer, 4 with esophagotracheal fistula, and 1 with esophageal stenosis. A plastic prosthesis was inserted in 15 patients (group A) and a self-expandable metallic stent in 21 patients (group B). We evaluated food ingestion improvement, effectiveness, complications, mean survival, food ingestion duration, the percentage of food ingestion capability in total survival time, and inhospital mortality. RESULTS No differences were seen in food intake improvement or in the effectiveness between groups, whereas fatal complications were higher in Group A. No significant differences were seen in mean survival, food ingestion duration, percentage of food ingestion capability, or inhospital mortality between groups. CONCLUSION We concluded that a self-expandable metallic stent was safer than a plastic prosthesis because of fewer serious complications such as bleeding, and recommended the use of metallic stents in the treatment of malignant esophageal stenosis and/or fistula.

Surgeon at Work: Hand-Assisted Laparoscopic Construction of Gastric Conduit for Thoracic Esophageal Cancer

A method for hand-assisted laparoscopic construction of gastric conduit for thoracic esophageal cancer was developed. Since this endoscopic surgical procedure is less invasive than open surgery, it contributes to improvement of post-operative respiratory functions and reduces respiratory complications. What distinguishes our surgical procedure is that unlike methods described in previous reports, it begins with treatment of the left gastroepiploic vessels at the height of the inferior edge of the spleen, followed by dissection from the esophageal hiatus to the lesser curvature and then dissection and excision of left gastric arteries and veins. Finally, the exposed esophagus and stomach are drawn outside the body and the right gastroepiploic blood vessels are preserved, followed by dissection of the greater omentum. This approach to gastric conduit construction was undertaken in 6 patients and the mean operating time was 123 minutes. Although in the first 3 of these patients the operating time was 150 minutes or more, the time required shortened to around 90 minutes for each of the last 3 cases, as the procedure was mastered. In each case, the volume of intraoperative hemorrhage did not exceed 50 ml.

Strategy for the Treatment of Carcinomata in the Advanced Aged Patients. Therapeutic Strategies for Esophageal Carcinoma in Elderly People.

We encountered 588 patients with esophageal carcinoma between 1986 and 1998. For 96 (16.4%) of the patients 75-year-old or older, we examined the features and issues of esophageal carcinoma in elderly people based on preoperative conditions and treatment results. 1) Cardiac dysfunction was observed in 39 patients (40.6%). Concerning respiratory function, there was a significant difference in forced expiratory volume in 1 second (FEV1.0%) and % vital capacity (%VC) compared to patients under 75 years of ages (t-test). Furthermore, disorders of several organs were observed in 31 patients (32.2%). 2) Eleven patients underwent right thoracotomy and laparotomy. Three (25%) of these patients died in hospital postoperatively. The 3-year survival rate was 27.3%. 3) Fourteen patients underwent esophagectomy. Four (28.6%) of these patients died in hospital. The 3-year survival rate was 7.7%. 4) In 66 patients who did not undergo resection, the 3-year survival rate was 11.7%. 5) With respect to postoperative complications, the incidences of pulmonary complications and postoperative delirium were high. Some patients died during surgery or during hospitalization. Careful perioperative management is important. 6) There was no significant difference in long-term results between treatment methods. However, none of the patients who underwent C0 surgery survived more than 2 years. Therefore, this procedure should be avoided if possible.