Publications by authors named "Toshihiro Kusaka"

Article Synopsis
  • The study examines the increasing incidence of colorectal neuroendocrine tumors (NETs) due to more frequent cancer screenings and colonoscopies, highlighting a shift in management from radical surgery to endoscopic resection methods.
  • Researchers analyzed short-term outcomes from 418 patients who underwent endoscopic treatments for colorectal NETs, focusing on en bloc resection rates and tumor-free margins.
  • The findings revealed that various endoscopic methods, particularly endoscopic submucosal resection with a ligation device (ESMR-L), were effective and safe for treating tumors smaller than 10 mm, with high R0 resection rates and minimal complications.
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A 77-year-old male patient was referred to our hospital because of jaundice. He was diagnosed with alcoholic liver cirrhosis and was admitted to our hospital because of liver failure. After admission, we observed conservative liver disease, but the liver damage did not improve and gradually worsened.

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Introduction: This study aimed to identify the characteristics of superficial non-ampullary duodenal epithelial tumors (SNADETs) based on the mucin phenotype using magnifying narrow-band imaging with acetic acid spray (MA-NBI) and evaluate the efficacy of MA-NBI in differentiating gastric-type (G-type) from intestinal-type (I-type) lesions.

Methods: We retrospectively identified 59 resected SNADETs in 59 patients who underwent MA-NBI. We evaluated surface patterns using MA-NBI to differentiate G-type from I-type lesions.

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Background: This is the first report from a multicenter prospective cohort study of colorectal neuroendocrine tumor (NET), the C-NET STUDY, conducted to assess the long-term outcomes of the enrolled patients. This report aimed to elucidate the clinicopathological features of the enrolled patients and lesions.

Methods: Colorectal NET patients aged 20-74 years were consecutively enrolled and followed up at 50 institutions.

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A 73-year-old man was initially diagnosed with a 50-mm, depressed-type early gastric cancer on the anterior wall of the angulus, and the lesion was curatively resected en bloc by endoscopic submucosal dissection. Pathology revealed a 54 mm × 43 mm differentiated-type predominant adenocarcinoma with focal undifferentiated-type component that was confined to the mucosa without ulceration. Eleven years after endoscopic submucosal dissection, lymph node metastasis along the lesser curve was incidentally detected on magnetic resonance imaging and diagnosed by endoscopic ultrasound-guided fine-needle aspiration biopsy.

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Background And Aim: A multicenter randomized controlled trial reported a better R0 resection rate for intermediate-sized (10-20 mm) colorectal polyps with underwater endoscopic mucosal resection (UEMR) than conventional endoscopic mucosal resection (CEMR). To clarify whether UEMR removes enough submucosal tissue in the removal of unpredictable invasive cancers, we investigated the cutting plane depth with UEMR versus CEMR.

Methods: This was a post-hoc analysis of a randomized controlled trial in which 210 intermediate-sized colorectal polyps were removed in five Japanese hospitals.

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Background/purpose: The purpose of the present study was to investigate the possibility of reducing clinical impacts of acute necrotic collection (ANC) on patients with acute pancreatitis (AP) using recombinant human soluble thrombomodulin (rTM).

Methods: In this retrospective multicenter study, 233 consecutive AP patients with ANC and acute peripancreatic fluid collection (APFC) from 2012 to 2016 were enrolled. To assess clinical impacts of ANC, severity on admission (JPN score, JPN CT grade, and Modified CT severity index), development of walled-off necrosis (WON), imaging costs for follow-up, and mortality were recorded.

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An 80-year-old woman was found to have a 40-mm depressed-type gastric cancer. Computed tomography showed multiple lymph node enlargement, including paraaortic lymph nodes. The extent of lymph node enlargement was significant compared with the depth of the primary lesion.

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Article Synopsis
  • - A 75-year-old man with a long-term follow-up for mixed-type intraductal papillary mucinous neoplasm (IPMN) in the pancreas was diagnosed with high-risk features after a 5mm nodule was identified.
  • - He underwent a distal pancreatectomy, and the histopathological analysis showed both low-grade IPMN and a Grade 1 pancreatic neuroendocrine neoplasm (PNEN).
  • - This case is notable because it highlights the rare coexistence of PNEN and IPMN, suggesting potential insights into their pathogenic mechanisms.
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  • Langerhans cell histiocytosis (LCH) in the upper gastrointestinal tract is uncommon, with this report detailing two adult cases: one involving the esophagus and another the stomach.
  • In Case 1, a 61-year-old man showed signs of histiocytosis during an endoscopy for epigastric pain, while Case 2 involved a 56-year-old woman whose lesion was found during a follow-up after infection.
  • Both cases exhibited specific cell characteristics upon biopsy and surprisingly revealed that the lesions vanished naturally without treatment, highlighting the need to correctly diagnose LCH to avoid mislabeling it as cancer.
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Objective: The aim of this study was to determine if the difference in serum amylase levels prior to, and two hours following, an endoscopic retrograde cholangiopancreatography (ERCP), or the ratio of the two-hour post-ERCP amylase level to the pre-ERCP amylase level was a better predictor of post-ERCP pancreatitis (PEP).

Methods: This was a retrospective, single-center study of consecutive patients, who underwent ERCP between April 2015 and August 2018. Serum amylase was measured before and two hours following ERCP.

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Background/aims: The aim of the present study was to evaluate the efficacy of magnifying narrow band imaging with acetic acid spray (MA-NBI) in differentiating category 4/5 lesions from category 3 lesions of superficial non-ampullary duodenal epithelial tumors (SNADETs) as per Vienna Classification and to compare the diagnostic performances of both MA-NBI and magnifying narrow band imaging (M-NBI).

Methods: We retrospectively identified 60 resected SNADETs (31 category 3 lesions and 29 category 4/5 lesions) in 60 patients who underwent M-NBI and MA-NBI preoperatively. We evaluated vascular and surface patterns using M-NBI and MA-NBI for characterizing category 3 and 4/5 lesions.

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An 80-year-old woman presented with a 30-mm protruding lesion-like submucosal tumor with a central depression located at the anterior wall of the upper gastric body. The depressed area had a well-demarcated margin, while the other area was covered by a non-neoplastic mucosa. A biopsy specimen revealed neuroendocrine carcinoma.

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Article Synopsis
  • - A 73-year-old man sought medical help for shortness of breath and acid reflux, leading to a diagnosis of anemia and referral for further treatment after blood tests confirmed iron deficiency anemia and prolonged prothrombin time.
  • - Imaging revealed significant expansion of the afferent loop from a previous gastrectomy, which caused nutrient malabsorption and vitamin K deficiency, contributing to his abnormal blood coagulation.
  • - After vitamin K supplementation and surgery to correct the afferent loop obstruction, the man's anemia and nutritional status improved, highlighting the importance of addressing nutrient malabsorption linked to afferent loop issues.
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Background & Aims: Endoscopic mucosal resection (EMR) with submucosal injection is an established method for removing colorectal polyps, although the en bloc resection rate decreases when polyp size exceeds 10 mm. Piecemeal resection increases local recurrence. Underwater EMR (UEMR) is an effective technique for removal of sessile colorectal polyps and we investigated whether it is superior to conventional EMR (CEMR).

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An 80-year-old man was found to have a reddish depressed lesion on the middle thoracic esophagus. The morphology of the lesion had been almost unchanged for 3 years, but it transformed to a 2-cm depressed lesion with elevated margins and an irregular nodular surface. The lesion was resected endoscopically and ultimately diagnosed as a combined neuroendocrine carcinoma and squamous cell carcinoma with submucosal invasion.

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Article Synopsis
  • A 67-year-old man with chronic pancreatitis experienced severe abdominal pain and melena, leading to the discovery of a splenic artery aneurysm affecting the pancreatic duct.
  • He was diagnosed with hemosuccus pancreaticus (HP) after active bleeding was found during an endoscopy, and treatment was carried out using interventional radiology (IVR) since his lung condition prevented major surgery.
  • Although IVR has a high chance of recurrence, it was shown to be an effective and less invasive option for managing relapsing HP, which recurred seven months later but was successfully treated again with IVR.
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Endoscopic treatments, including endoscopic mucosal resection or endoscopic submucosal dissection, are well accepted as standard treatments for early gastric cancers. However, there are few studies evaluating the safety and efficacy of this approach for early gastric cancers in patients aged over 80 years, and the post-treatment prognosis remains unclear. Here, we retrospectively analyzed the medical records and evaluated the safety and efficacy of endoscopic treatment for early gastric cancers in patients aged over 80 years (group A) compared with non-elderly patients aged 65-79 years (group B) and under 65 years (group C).

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Background And Aim: The Japan narrow-band imaging (NBI) Expert Team (JNET) was organized to unify four previous magnifying NBI classifications (the Sano, Hiroshima, Showa, and Jikei classifications). The JNET working group created criteria (referred to as the NBI scale) for evaluation of vessel pattern (VP) and surface pattern (SP). We conducted a multicenter validation study of the NBI scale to develop the JNET classification of colorectal lesions.

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Background And Aims: Patients with ulcerative colitis (UC) are at risk for developing colorectal cancer (CRC), despite the development of new therapeutic agents. Stratification of the individual UC-patient's risk would be helpful to validate the risk factors for CRC. The aim of this study was to evaluate the risk factors for the development of CRC in a large cohort of patients with UC.

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