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| 1 | Efficacy and safety of over-the-scope clip: Including complications after endoscopic submucosal dissection显示文摘AIM: To retrospectively review the results of over-thescope clip (OTSC) use in our hospital and to examine the feasibility of using the OTSC to treat perforations after endoscopic submucosal dissection (ESD). METHODS: We enrolled 23 patients who presented with gastrointestinal (GI) bleeding, fistulae and perforations and were treated with OTSCs (Ovesco Endoscopy GmbH, Tuebingen, Germany) between November 2011 and September 2012. Maximum lesion size was defined as lesion diameter. The number of OTSCs to be used per patient was not decided until the lesion was completely closed. We used a twin grasper (Ovesco Endoscopy GmbH, Tuebingen, Germany) as a grasping device for all the patients. A 9 mm OTSC was chosen for use in the esophagus and colon, and a 10 mm device was used for the stomach, duodenum and rectum. The overall success rate and complications were evaluated, with a particular emphasis on patients who had undergone ESD due to adenocarcinoma. In technical successful cases we included not only complete closing by using OTSCs, but also partial closing where complete closure with OTSCs is almost difficult. In overall clinical successful cases we included only complete closing by using only OTSCs perfectly. All the OTSCs were placed by 2 experienced endoscopists. The sites closed after ESD included not only the perforation site but also all defective ulcers sites.RESULTS: A total of 23 patients [mean age 77 years (range 64-98 years)] underwent OTSC placement during the study period. The indications for OTSC placement were GI bleeding (n = 9), perforation (n = 10), fistula (n = 4) and the prevention of post-ESD duodenal artificial ulcer perforation (n = 1). One patient had a perforation caused by a glycerin enema, after which a fistula formed. Lesion closure using the OTSC alone was successful in 19 out of 23 patients, and overall success rate was 82.6%. A large lesion size (greater than 20 mm) and a delayed diagnosis (more than 1 wk) were the major contributing factors for the overall unsuccessful clinical cases. The location of the unsuccessful lesion was in the stomach. The median operation time in the successful cases was 18 min, and the average observation time was 67 d. During the observation period, none of the patients experienced any complications associated with OTSC placement. In addition, we successfully used the OTSC to close the perforation site after ESD in 6 patients. This was a single-center, retrospective study with a small sample size. CONCLUSION: The OTSC is effective for treating GI bleeding, fistulae as well as perforations, and the OTSC technique proofed effective treatment for perforation after ESD. | Noriko Nishiyama Hirohito Mori Hideki Kobara Kazi Rafiq Shintarou Fujihara Mitsuyoshi Kobayashi Makoto Oryu Tsutomu Masaki | 2013 | World Journal of Gastroenterology2013，19，18： | 42 |
| 2 | A rare case of hyaline-type Castleman disease in the liver显示文摘Castleman disease often develops in the neck, mediastinum and pulmonary hilum. Its onset in the peritoneal cavity is very rare. The patient, a woman in her 70s, was referred to our department for a detailed examination of an abdominal mass. On abdominal ultrasonography, computed tomography scan, magnetic resonance imaging and positron emission tomography, a mass approximately 15 mm in diameter was noted in the hepatic S6. We attempted radical treatment and conducted a laparoscope-assisted right lobectomy. On the basis of histopathological findings, the patient was diagnosed as having hyaline type Castleman disease in the liver, a very rare condition. | Hisaaki Miyoshi Shima Mimura Takako Nomura Joji Tani Asahiro Morishita Hideki Kobara Hirohito Mori Hirohito Yoneyama Akihiro Deguchi Takashi Himoto Naoki Yamamoto Keiichi Okano Yasuyuki Suzuki Tsutomu Masaki | 2013 | World Journal of Hepatology2013，5，7： | 14 |
| 3 | Management of a large mucosal defect after duodenal endoscopic resection显示文摘Duodenal endoscopic resection is the most difficult type of endoscopic treatment in the gastrointestinal tract(GI) and is technically challenging because of anatomical specificities. In addition to these technical difficulties, this procedure is associated with a significantly higher rate of complication than endoscopic treatment in other parts of the GI tract. Postoperative delayed perforation and bleeding are hazardous complications, and emergency surgical intervention is sometimes required. Therefore, it is urgently necessary to establish a management protocol for preventing serious complications. For instance, the prophylactic closure of large mucosal defects after endoscopic resection may reduce the risk of hazardous complications. However, the size of mucosal defects after endoscopic submucosal dissection(ESD) is relatively large compared with the size after endoscopic mucosal resection, making it impossible to achieve complete closure using only conventional clips. The over-the-scope clip and polyglycolic acid sheets with fibrin gel make it possible to close large mucosal defects after duodenal ESD. In addition to the combination of laparoscopic surgery and endoscopic resection, endoscopic full-thickness resection holds therapeutic potential for difficult duodenal lesions and may overcome the disadvantages of endoscopic resection in the near future. This review aims to summarize the complications and closure techniques of large mucosal defects and to highlight some directions for management after duodenal endoscopic treatment. | Shintaro Fujihara Hirohito Mori Hideki Kobara Noriko Nishiyama Tae Matsunaga Maki Ayaki Tatsuo Yachida Tsutomu Masaki | 2016 | World Journal of Gastroenterology2016，22，29： | 10 |
| 4 | Reduction effect of bacterial counts by preoperative saline lavage of the stomach in performing laparoscopic and endoscopic cooperative surgery显示文摘AIM:To investigate the effects of gastric lavage with2000 mL of saline in laparoscopic and endoscopic cooperative surgery.METHODS:Twenty two patients who were diagnosed with a gastric gastrointestinal stromal tumor were enrolled.In former term,irrigations of the stomach were conducted whenever it was necessary,not systematically(Non systemic lavage group).In latter term,the stomach was thoroughly cleaned with 2000 mL of saline using an endoscope with a water jet,and Duodenal balloon occlusion was conducted to prevent refluxedbile and pancreatic juice(Systemic lavage+balloon occlusion group).The gastric wall was sprayed with 20mL of distilled water,and 20 mL of gastric juice was collected in a sterile tube and submitted for culture.20mL of ascites was also collected from the laparoscopic ports and submitted for culture.We compared WBC,CRP,BT between two groups,and verify the reduction effect of bacterial counts in Systemic lavage+balloon occlusion group.RESULTS:WBC count before,1 d after,and 3 d after laparoscopic and endoscopic cooperative surgery(LECS)were 5060(95%CI:4250-9640),12140(6050-14110),and 6910(5320-12520)in Non systemic lavage group,4400(3660-7620),8910(6480-10980),and 5950(4840-7860)in Systemic lavage+balloon occlusion group.Significant differences between two groups at the day after LECS(P=0.029)and the 3 d after LECS(P=0.042).CRP levels in Non systemic lavage group and in Systemic lavage+balloon occlusion group were significantly different at the day after LECS(P=0.005)and the 3 d after LECS(P=0.028).BTs(℃)in Non systemic lavage group and in Systemic lavage+balloon occlusion group were also significantly different at the day after LECS(P=0.004)and the 3 d after LECS(P=0.006).In a logarithmic comparison,bacterial load before gastric lavage,after lavage,and ascites culture were 6.08(95%CI:4.04-6.97),0.48(0-0.85),and 0.21(0-0.56).The bacterial counts before and after gastric lavage were significantly suppressed(P=0.007),but no significant difference between gastric juice culture after lavage and ascites(P=0.154).CONCLUSION:Pre-LECS lavage with 2000 mL of saline exhibited a bacteria-reducing effect equivalent to disinfectants and obtained favorable results in terms of clinical symptoms and data. | Hirohito Mori Hideki Kobara Takaaki Tsushimi Shintaro Fujihara Noriko Nishiyama Tae Matsunaga Maki Ayaki Tatsuo Yachida Joji Tani Hisaaki Miyoshi Asahiro Morishita Tsutomu Masaki | 2014 | World Journal of Gastroenterology2014，20，42： | 9 |
| 5 | Bleeding duodenal hemangioma: Morphological changes and endoscopic mucosal resection显示文摘Recently, the development of endoscopic procedures has increased the availability of minimally invasive treatments; however, there have been few case reports of duodenal hemangioma treated by endoscopic mucosal resection. The present report describes a case of duodenal hemangioma that showed various endoscopic changes over time and was treated by endoscopic mucosal resection. An 80-year-old woman presented with tarry stools and a loss of appetite. An examination of her blood revealed severe anemia, and her hemoglobin level was 4.2 g/dL. An emergency upper gastrointestinal endoscopy was performed. A red, protrusive, semipedunculated tumor (approximately 20 mm in diameter) with spontaneous bleeding on its surface was found in the superior duodenal angle. Given the semipedunculated appearance of the tumor, it was suspected to be an epithelial tumor with a differential diagnosis of hyperplastic polyp. The biopsy results suggested a telangiectatic hemangioma. Because this lesion was considered to be responsible for her anemia, endoscopic mucosal resection was performed for diagnostic and treatment purposes after informed consent was obtained. A histopathological examination of the resected specimen revealed dilated and proliferated capillary lumens of various sizes, which confirmed the final diagnosis of duodenal hemangioma. Neither anemia nor tumor recurrence has been observed since the endoscopic mucosal resection (approximately 1 year). Duodenal hemangiomas can be treated endoscopically provided that sufficient consideration is given to all of the possible treatment strategies. Interestingly, duodenal hemangiomas show morphological changes that are influenced by various factors, such as mechanical stimuli. | Noriko Nishiyama Hirohito Mori Hideki Kobara Shintarou Fujihara Takako Nomura Mitsuyoshi Kobayashi Tsutomu Masaki | 2012 | World Journal of Gastroenterology2012，18，22： | 7 |
| 6 | Two rare gastric hamartomatous inverted polyp cases suggest the pathogenesis of growth显示文摘Gastric hamartomatous inverted polyps(GHIP)are difficult to diagnose accurately because of inversion into the submucosal layer.GHIP are diagnosed using the pathological characteristics of the tumor,including the fibroblast cells,smooth muscle,nerve components,glandular hyperplasia,and cystic gland dilatation.Although Peutz-Jeghers syndrome,juvenile polyposis,and Cowden disease are hereditary,it is rare to encounter 2 cases of monostotic and asymptomatic gastric hamartomas.The pathogeneses of hamartomatous inverted polyps and inverted hyperplastic polyps remain controversial because of the paucity of reported cases.There are 3 hypotheses regarding the pathogenesis of complete gastric inverted polyps.Based on our experience with 2 successive,rare GHIP cases,we affirm the hypothesis that after a hamartomatous change occurs in the submucosal layer,some of these components are exposed to the gastric mucosa and,consequently,form a hypertrophic lesion.In Case 1,our hypothesis explains why a tiny hypertrophic change was first detected on the top of the submucosal tumor using a detailed narrow band imaging-magnified endoscopy.There was no confirmation that the milky white mucous and calcification structures were exuding directly from the biopsy site like Case 1,and in Case 2 the presence of this mucous was indirectly confirmed during an endoscopic submucosal dissection(ESD).Regarding the pathogenesis of GHIP,a submucosal hamartomatous change may occur prior to the growth of hypertrophic portions.An en bloc resection using ESD is recommended for treatment. | Hirohito Mori Hideki Kobara Takaaki Tsushimi Shintaro Fujihara Noriko Nishiyama Tae Matsunaga Maki Ayaki Tatsuo Yachida Tsutomu Masaki | 2014 | World Journal of Gastroenterology2014，20，19： | 7 |
| 7 | Rectal perforations and fistulae secondary to a glycerin enema:Closure by over-the-scope-clip显示文摘Rectal perforations due to glycerin enemas(GE) typically occur when the patient is in a seated or lordotic standing position.Once the perforation occurs and peritonitis results,death is usually inevitable.We describe two cases of rectal perforation and fistula caused by a GE.An 88-year-old woman presented with a large rectal perforation and a fistula just after receiving a GE.Her case was further complicated by an abscess in the right rectal wall.The second patient was a 78-year-old woman who suffered from a rectovesical fistula after a GE.In both cases,we performed direct endoscopic abscess lavage with a saline solution and closed the fistula using an over-the-scope-clip(OTSC) procedure.These procedures resulted in dramatic improvement in both patients.Direct endoscopic lavage and OTSC closure are very useful for pararectal abscess lavage and fistula closure,respectively,in elderly patients who are in poor general condition.Our two cases are the first reports of the successful endoscopic closure of fistulae using double OTSCs after endoscopic lavage of the debris and an abscess of the rectum secondary to a GE. | Hirohito Mori Hideki Kobara Shintaro Fujihara Noriko Nishiyama Mitsuyoshi Kobayashi Tsutomu Masaki Kunihiko Izuishi Yasuyuki Suzuki | 2012 | World Journal of Gastroenterology2012，18，24： | 6 |
| 8 | Development of biological soil disinfestations in Japan显示文摘 | Noriaki Momma Yuso Kobara Seiji Uematsu Nobuhiro Kita Akinori Shinmura | 2013 | Applied Microbiology and Biotechnology2013，，9： | 3 |
| 9 | Establishment of pure NOTES procedure using a conventional flexible endoscope: review of six cases of gastric gastrointestinal stromal tumors显示文摘 | H. Mori H. Kobara M. Kobayashi A. Muramatsu T. Nomura M. Hagiike K. Izuishi Y. Suzuki T. Masaki | 2011 | Endoscopy2011，，07： | 3 |
| 10 | Effect of the anti-diabetic drug metformin in hepatocellular carcinomain vitro and in vivo显示文摘 | Hisaaki Miyoshi Kiyohito Kato Hisakazu Iwama Emiko Maeda Teppei Sakamoto Koji Fujita Yuka Toyota Joji Tani Takako Nomura Shima Mimura Mitsuyoshi Kobayashi Asahiro Morishita Hideki Kobara Hirohito Mori Hirohito Yoneyama Akihiro Deguchi Takashi Himoto Kazut | 2014 | International Journal of Oncology2014，，1： | 3 |
| 11 | Successful closing of duodenal ulcer after endoscopic submucosal dissection with over‐the‐scope clip to prevent delayed perforation显示文摘 | Hirohito Mori Fujihara Shintaro Hideki Kobara Noriko Nishiyama Kazi Rafiq Mitsuyoshi Kobayashi Toshiaki Nakatsu Noboru Miichi Yasuyuki Suzuki Tsutomu Masaki | 2013 | Digestive Endoscopy2013，，4： | 3 |
| 12 | Outcomes of gastrointestinal defect closure with an overthe-scope clip system in a multicenter experience: An analysis of a successful suction method显示文摘AIM To demonstrate the clinical outcomes of a multicenter experience and to suggest guidelines for choosing a suction method. METHODS This retrospective study at 5 medical centers involved 58 consecutive patients undergoing over-the-scope clips(OTSCs) placement. The overall rates of technical success (TSR), clinical success (CSR), complications, and procedure time were analyzed as major outcomes. Subsequently, 56 patients, excluding two cases that used the Anchor device, were divided into two groups: 14 cases of simple suction (SS-group) and 42 cases using the Twin Grasper (TG-group). Secondary evaluation was performed to clarify the predictors of OTSC success.RESULTS The TSR, CSR, complication rate, and median procedure time were 89.7%, 84.5%, 1.8%, and 8 (range 1-36) min, respectively, demonstrating good outcomes. However, significant differences were observed between the two groups in terms of the mean procedure time (5.9 min vs 14.1 min). The CSR of the SS- and TG-groups among cases with a maximum defect size ≤ 10 mm and immediate or acute refractory bleeding was 100%, which suggests that SS is a better method than TG in terms of time efficacy. The CSR in the SS-group (78.6%), despite the technical success of the SS method (TSR, 100%), tended to decrease due to delayed leakage compared to that in the TG-group (TSR, CSR; 88.1%), indicating that TG may be desirable for leaks and fistulae with defects of the entire layer. CONCLUSION OTSC system is a safe and effective therapeutic option for gastrointestinal defects. Individualized selection of the suction method based on particular clinical conditions may contribute to the improvement of OTSC success. | Hideki Kobara Hirohito Mori Shintaro Fujihara Noriko Nishiyama Taiga Chiyo Takayoshi Yamada Masao Fujiwara Keiichi Okano Yasuyuki Suzuki Masayuki Murota Yoshitaka Ikeda Makoto Oryu Mohamed Abo Ellail Tsutomu Masaki | 2017 | World Journal of Gastroenterology2017，23，9： | 3 |
| 13 | Endoscopic management of a rare granulation polyp in a colonic diverticulum显示文摘There are many case reports on colon diverticula that cause irritable bowel syndrome,constipation,bleeding,diverticulitis,stricture due to multiple recurrences of diverticulitis,and perforation.However,few articles have examined neoplasms that arise from a diverticulum,such as adenoma and adenocarcinoma,and there have been no reports of granulation polyps that arise from a colon diverticulum after recurrent diverticulitis.We observed a rare granulation polyp that arose from a diverticulum as a result of repeated episodes of local diverticulitis.Narrow band imaging magnified colonoscopy was very useful to diagnose the polyp as a granulation polyp because of the absence of a pit pattern on the surface of the polyp.We successfully resected the polyp using endoscopic mucosal resection.We inverted the diverticulum,and the resected stalk of the polyp was used to close the diverticulum with an over-thescope clip.If a granulomatous polyp could arise from a diverticulum,differential diagnosis between a colon neoplasm and a granulomatous polyp would not only be difficult but also necessary for suitable endoscopic treatment. | Hirohito Mori Takaaki Tsushimi Hideki Kobara Noriko Nishiyama Shintaro Fujihara Tae Matsunaga Maki Ayagi Tatsuo Yachida Tsutomu Masaki | 2013 | World Journal of Gastroenterology2013，19，48： | 3 |
| 14 | Fe 2+ and Mn 2+ , potential agents to induce suppression of Fusarium oxysporum for biological soil disinfestation显示文摘 | Noriaki Momma Yuso Kobara Mari Momma | 2011 | Journal of General Plant Pathology2011，，6： | 2 |
| 15 | Biological soil disinfestation using ethanol: effect on Fusarium oxysporum f. sp. lycopersici and soil microorganisms显示文摘 | Noriaki Momma Mari Momma Yuso Kobara | 2010 | Journal of General Plant Pathology2010，，5： | 2 |
| 16 | Feasibility of pure EFTR using an innovative new endoscopic suturing device: the Double-arm-bar Suturing System (with video)显示文摘 | Hirohito Mori Hideki Kobara Shintaro Fujihara Noriko Nishiyama Kazi Rafiq Makoto Oryu Masao Fujiwara Yasuyuki Suzuki Tsutomu Masaki | 2014 | Surgical Endoscopy2014，，2： | 2 |
| 17 | Local steroid injection into the artificial ulcer created by endoscopic submucosal dissection for gastric cancer: prevention of gastric deformity显示文摘 | H. Mori K. Rafiq H. Kobara S. Fujihara N. Nishiyama M. Kobayashi T. Himoto R. Haba M. Hagiike K. Izuishi K. Okano Y. Suzuki T. Masaki | 2012 | Endoscopy2012，，07： | 2 |
| 18 | Current Innovations in Endoscopic Therapy for the Management of Colorectal Cancer: From Endoscopic Submucosal Dissection to Endoscopic Full-Thickness Resection显示文摘 | Shintaro Fujihara Hirohito Mori Hideki Kobara Noriko Nishiyama Tae Matsunaga Maki Ayaki Tatsuo Yachida Asahiro Morishita Kunihiko Izuishi Tsutomu Masaki Hirotoshi Kobayashi | 2014 | BioMed Research International2014，，： | 2 |
| 19 | Balloon-Armed Mechanical Counter Traction and Double-Armed Bar Suturing Systems for Pure Endoscopic Full-Thickness Resection显示文摘 | Hirohito Mori Hideki Kobara Rafiq Kazi Shintaro Fujihara Noriko Nishiyama Tsutomu Masaki | 2014 | Gastroenterology2014，，2： | 2 |
| 20 | Difficulty in differentiating two cases of sigmoid stenosis by diverticulitis from cancer显示文摘The incidence of colonic diverticulosis with or without diverticulitis has increased in the Japanese population due to the modernization of food and aging.The rate of diverticulitis in colon diverticulosis ranges from 8.1% to 9.6%.However,few cases of stenosis due to diverticulitis have been reported.These reports suggest that the differentiation between sigmoid diverticulitis and colon cancer is difficult.This report describes two cases of colon stenosis due to diverticulitis that were difficult to differentiate from colon cancer.Case 1 was a 70-year-old woman with narrowed stools for 1 month who underwent colonofiberscopy (CFS).CFS revealed a diverticulum and circumferential stenosis in the sigmoid colon.Barium enema revealed a marked,hourglassshaped,2-cm circumferential stenosis in the sigmoid colon.Fluorodeoxyglucose (FDG)-positron emission tomography computed tomography (CT) revealed an increased FDG uptake at the affected portion of the sigmoid colon.Sigmoid colon cancer was suspected,and laparoscopic sigmoidectomy was performed.Pathological examination demonstrated active inflammation with no evidence of malignancy.Case 2 was a 50-yearold man who presented to a nearby clinic with reduced stool output despite the urge to defecate.CFS detected severe stenosis in the sigmoid colon approximately 25 cm from the dentate line.Contrast-enhanced abdominal CT revealed multiple diverticula,wall thickening,and swelling of the lymph nodes around the peritoneal aorta and the inferior mesenteric artery.A partial sigmoidectomy was performed.Pathological examination of the resected specimen revealed no changes in the mucosal epithelial surface,but a marked infiltration of inflammatory cells was observed. | Noriko Nishiyama Hirohito Mori Hideki Kobara Kazi Rafiq Shintarou Fujihara Mitsuyoshi Kobayashi Tsutomu Masaki | 2012 | World Journal of Gastroenterology2012，18，27： | 2 |
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