Publications by authors named "Kohei Takizawa"

Background And Aim: Perforation is one of the most important complications of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). Several studies have examined risk factors for intraoperative and delayed perforations, but most were retrospective analyses with small numbers of patients.

Methods: This study represents a secondary analysis of a Japanese multicenter prospective cohort study.

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Article Synopsis
  • A study was conducted to evaluate the effectiveness of endoscopic resection (ER) for elderly patients (≥75 years) with early gastric cancer (EGC), as previous evidence was limited.
  • The analysis involved 3,371 patients with 3,821 EGCs, highlighting key outcomes such as high rates of successful resections and low rates of complications, particularly for lesions within the established treatment guidelines.
  • The findings suggest that lesions of ≤3 cm and those classified as elderly-low have the potential to be new indicators for ER suitability, demonstrating favorable curative outcomes for elderly patients.
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  • The study investigates the relationship between alcohol consumption and the development of squamous cell carcinoma (SCC) in the upper aerodigestive tract, focusing on the 'field cancerization phenomenon' which can lead to multiple lesions known as Lugol-voiding lesions (LVL).
  • Out of 330 patients with newly diagnosed superficial esophageal SCC, 232 were assessed for LVL, with 158 of them successfully reducing or ceasing their alcohol intake, resulting in significant improvements in their LVL grade.
  • The findings suggest that reducing or stopping alcohol consumption can reverse the field cancerization process and significantly lower the risk of developing multiple SCCs in the esophagus and head and neck areas.
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  • Recent advancements in endoscopic diagnosis and treatment have improved the detection of duodenal tumors, but treatment approaches vary widely across institutions.
  • Current guidelines originated in Japan, highlighting the need for better quality diagnosis and safer treatment options.
  • There's potential for safer endoscopic treatments for intramucosal carcinomas, as lymph node metastases are rare, and enhanced methods are expected to reduce adverse events.
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Objectives: Extension of adenocarcinoma of the esophagogastric junction under the squamous epithelium may lead to errors when determining lateral margins. However, the characteristics of subsquamous extension are unclear. Herein, we evaluated the prevalence and characteristics of subsquamous extension of adenocarcinoma of the esophagogastric junction and the diagnostic performance of endoscopy for this condition.

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Objectives: The multi-institutional, single-arm, confirmatory trial JCOG0607 showed excellent efficacy of endoscopic submucosal dissection (ESD) for the expanded indication of intramucosal intestinal-type early gastric cancer (EGC), which consists of two groups: lesions >2 cm if clinical finding of ulcer (cUL)-negative, or those ≤3 cm if cUL-positive because of the expected low risk of lymph node metastasis. However, the proportion of noncurative resections (NCR) requiring additional surgery was high (32.4%).

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Our study aimed to compare the treatment outcomes between endoscopic submucosal dissection (ESD) with an insulated-tip knife (ESD-IT) and a needle-type knife (ESD-N) for large superficial esophageal neoplasms, as no study of this kind has been previously reported. We used the dataset of a multicenter, randomized controlled trial that compared conventional ESD (C-ESD) and traction-assisted ESD (TA-ESD) for superficial esophageal neoplasms. We compared the procedural outcomes between ESD-IT and ESD-N in a post hoc analysis and conducted sub-analyses based on traction assistance and electrical knife type.

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Background & Aims: We aimed to clarify the long-term outcomes of endoscopic resection (ER) for early gastric cancers (EGCs) based on pathological curability in a multicenter prospective cohort study.

Methods: We analyzed the long-term outcomes of 9054 patients with 10,021 EGCs undergoing ER between July 2010 and June 2012. Primary endpoint was the 5-year overall survival (OS).

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Objectives: Endoscopic submucosal dissection (ESD) has become popular, but complications such as postoperative bleeding remain an issue. Although some methods of closing a mucosal defect with a snare and clips have been reported to be effective and safe, the snare is not a dedicated device, and the procedure is difficult and time-consuming. We aimed to find an alternative method for defect closure after ESD by developing a dedicated device.

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Background And Aims: Tip-in EMR, which includes anchoring the snare tip, has recently shown a favorable en-bloc and R0 resection rate for colorectal neoplasms. Thus, Tip-in EMR may be an alternative to endoscopic submucosal dissection (ESD). We aimed to compare clinical outcomes between Tip-in EMR and ESD for large colorectal neoplasms.

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Background: Metallic stents placed in the descending duodenum can cause compression of the major duodenal papilla, resulting in biliary obstruction and pancreatitis. These are notable early adverse events of duodenal stent placement; however, they have been rarely examined. This study aimed to assess the incidence of and risk factors for biliary obstruction and/or pancreatitis after duodenal stent placement in the descending duodenum.

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Background And Aims: Surgery is recommended in early gastric cancer (EGC) after noncurative endoscopic submucosal dissection (ESD), although observation can be an alternative. We aimed to develop a tailor-made treatment strategy for noncurative EGCs by comparing the lymph node metastasis risk (LNMR) and the surgical risk.

Methods: We retrospectively identified 485 patients with differentiated-type, noncurative EGCs removed by ESD and classified them into two groups: a surgery-preferable group and an observation-preferable group, according to the clinical courses.

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Article Synopsis
  • Patients with early esophageal squamous cell carcinoma (ESCC) may still develop multiple second primary cancers even after receiving curative treatment, leading researchers to study the impact of adding chemoradiotherapy (CRT) after endoscopic resection (ER).
  • In a comparison of 170 patients, those who received only ER showed a similar incidence of new ESCCs and other cancers as those who underwent ER followed by CRT, with no significant differences noted.
  • Key risk factors for multiple ESCCs included high alcohol consumption and severe pre-existing lesions, suggesting that CRT does not effectively reduce the risk of second primary cancers related to lifestyle factors.
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Background And Aims: Multiple developments of squamous dysplasia and squamous cell carcinoma (SCC) in the upper aerodigestive tract have been explained by field cancerization phenomenon and were associated with alcohol and cigarette use. Second primary SCC development after curative treatment impairs patients' quality of life and survival; however, how these consumption and cessation affect field cancerization is still unknown.

Methods: This is a multicenter cohort study including 331 patients with superficial esophageal SCC (ESCC) treated endoscopically and pooled data from 1022 healthy subjects for comparison.

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Background And Aim: Endoscopic submucosal dissection (ESD) is recommended for the treatment of early gastric cancers with an undifferentiated-type component, clinically diagnosed as intramucosal lesions ≤ 2 cm, without ulceration. In the JCOG1009/1010 trial, ESD could be performed with stomach preservation in 70% of such patients whose pathological findings met the curative resection criteria. However, additional gastrectomy was required for the remaining 30%.

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The Japan Gastroenterological Endoscopy Society published the second edition of the "Guidelines for Colorectal Endoscopic Submucosal Dissection/Endoscopic Mucosal Resection" in 2019 to clarify the indications for colorectal endoscopic mucosal resection (EMR) and endoscopic submucosal dissection and to ensure appropriate preoperative diagnoses as well as effective and safe endoscopic treatment in front-line clinical settings. Endoscopic resection with electrocautery, including polypectomy and EMR, is indicated for colorectal polyps. Recently, the number of facilities introducing and implementing cold polypectomy without electrocautery has increased.

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Background And Aims: Endoscopic resection (ER) for early gastric cancer (EGC) can preserve the stomach; however, the remaining stomach can develop second gastric cancer. Few reports have prospectively investigated the incidence and treatment outcomes of second gastric cancer.

Methods: This post-hoc analysis used the dataset of the single-arm confirmatory trial, JCOG0607.

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Backgound: Cold snare polypectomy (CSP) can minimize the risk of adverse events and has become a standard treatment for small colorectal polyps. CSP might also be suitable for small superficial non-ampullary duodenal epithelial tumors (SNADETs). This study aimed to evaluate the safety of CSP for SNADETs.

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Background And Aim: Preoperative determination of the invasion depth of superficial adenocarcinoma of the esophagogastric junction is important for appropriate endoscopic or surgical resection. There are no objective criteria regarding this; therefore, we investigated the factors associated with the invasion depth of superficial adenocarcinoma of the esophagogastric junction.

Methods: This retrospective study evaluated patients with superficial adenocarcinoma of the esophagogastric junction who had undergone endoscopic or surgical resection at a Japanese tertiary cancer center between April 2004 and December 2017.

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Article Synopsis
  • Gastrointestinal (GI) perforations can occur during endoscopic procedures, prompting a study to evaluate the effectiveness of polyglycolic acid (PGA) sheets combined with fibrin glue for closure.
  • The study reviewed medical records from 18 Japanese institutions between 2013 and 2018, analyzing cases of both intraoperative and delayed GI perforations treated with PGA sheeting.
  • Results showed that 91% of intraoperative cases and all delayed cases achieved successful closure, with median diet resumption times of 6 and 10 days respectively, indicating that PGA sheeting is a viable treatment option for GI perforations.
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Background: Endoscopic submucosal dissection (ESD) is a widely accepted and minimally invasive treatment for early gastric cancer (EGC) without the risk of lymph node metastasis (LNM). However, undifferentiated-type EGC (UD-EGC) is considered to have a relatively high risk of LNM. Recently, the Japan Clinical Oncology Group conducted a nonrandomized confirmatory trial (JCOG1009/1010) to evaluate the efficacy and safety of ESD for UD-EGC.

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Objectives: Magnifying endoscopy with narrow-band imaging (M-NBI) is useful for the optical diagnosis of gastrointestinal neoplasms. However, the utility of M-NBI in screening esophagogastroduodenoscopy (EGD) is unclear. We aimed to evaluate the diagnostic ability of the magnification endoscope (ME) in screening EGD for a population with a low prevalence of upper gastrointestinal cancers.

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Endoscopic submucosal dissection (ESD) is the standard treatment method for esophageal, gastric, and colorectal cancers. However, it has not been standardized for duodenal lesions because of its high complication rates. Recently, minimally invasive and simple methods such as cold snare polypectomy and underwater endoscopic mucosal resection have been utilized more for superficial nonampullary duodenal epithelial tumors (SNADETs).

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Article Synopsis
  • Distinguishing the invasion depth of esophageal squamous cell carcinoma (ESCC) is crucial for appropriate treatment, but effective diagnostic methods are not yet established.
  • This study aimed to assess the diagnostic effectiveness of endoscopic ultrasonography (EUS) alongside conventional endoscopy in evaluating ESCC invasion depth, involving 372 patients across various hospitals in Japan.
  • The research included two registration phases with different endoscopic techniques, ultimately comparing the findings to pathological results from resected tumors to determine overdiagnosis of submucosal cancer.
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Objectives: Given the high risk of bleeding in post-endoscopic submucosal dissection (ESD) patients receiving antithrombotic therapy, a new effective method is needed to prevent delayed bleeding among such patients. The aim of this study was to assess the efficacy of endoloop closure, using an endoloop and clips, after gastric ESD to prevent bleeding among patients receiving antithrombotic therapy.

Methods: This retrospective study enrolled patients taking antithrombotic agents who underwent ESD for early gastric cancer between March 2016 and January 2019.

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