| 1. |
Masahiro Kondo, Takehiro Torisu, Tomohiro Nagasue, Hiroki Shibata, Junji Umeno, Keisuke Kawasaki, Shin Fujioka, Yuichi Matsuno, Tomohiko Moriyama, Takanari Kitazono, Duodenal microbiome in chronic kidney disease., Clinical and experimental nephrology, 10.1007/s10157-023-02434-x, 28, 4, 263-272, 2024.04, BACKGROUND: The intestinal microbiome is involved in the pathogenesis of chronic kidney disease (CKD). Despite its importance, the microbiome of the small intestinal mucosa has been little studied due to sampling difficulties, and previous studies have mainly focused on fecal sources for microbiome studies. We aimed to characterize the small intestinal microbiome of CKD patients by studying the microbiome collected from duodenal and fecal samples of CKD patients and healthy controls. METHODS: Overall, 28 stage 5 CKD patients and 21 healthy participants were enrolled. Mucosal samples were collected from the deep duodenum during esophagogastroduodenoscopy and fecal samples were also collected. The 16S ribosomal RNA gene sequencing using Qiime2 was used to investigate and compare the microbial structure and metagenomic function of the duodenal and fecal microbiomes. RESULTS: The duodenal flora of CKD patients had decreased alpha diversity compared with the control group. On the basis of taxonomic composition, Veillonella and Prevotella were significantly reduced in the duodenal flora of CKD patients. The tyrosine and tryptophan metabolic pathways were enhanced in the urea toxin-related metabolic pathways based on the Kyoto Encyclopedia of Genes and Genomes database. CONCLUSION: The small intestinal microbiome in CKD patients is significantly altered, indicating that increased intestinal permeability and production of uremic toxin may occur in the upper small intestine of CKD patients.. |
| 2. |
Sayo Ito, Kinichi Hotta, Masau Sekiguchi, Yoji Takeuchi, Shiro Oka, Hironori Yamamoto, Kensuke Shinmura, Keita Harada, Toshio Uraoka, Takashi Hisabe, Yasushi Sano, Hitoshi Kondo, Takahiro Horimatsu, Hidezumi Kikuchi, Takuji Kawamura, Shinji Nagata, Katsumi Yamamoto, Masahiro Tajika, Shigetsugu Tsuji, Toshihiro Kusaka, Yusuke Okuyama, Naohisa Yoshida, Tomohiko Moriyama, Aki Hasebe, Suketo So, Yutaka Saito, Hiroko Nakahira, Hideki Ishikawa, Takahisa Matsuda, Short-term outcomes of endoscopic resection for colorectal neuroendocrine tumors: Japanese multicenter prospective C-NET STUDY., Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society, 10.1111/den.14728, 2023.11, OBJECTIVES: The incidence of colorectal neuroendocrine tumors (NETs) has increased with colorectal cancer screening programs and increased colonoscopies. The management of colorectal NETs has recently shifted from radical surgery to endoscopic resection. We aimed to evaluate the short-term outcomes of various methods of endoscopic resection for colorectal NETs. METHODS: Among those registered in the C-NET STUDY, patients with colorectal NETs who underwent endoscopic treatment as the initial therapy were included. Short-term outcomes, such as the en bloc resection rate and R0 resection (en bloc resection with tumor-free margin) rate, were analyzed based on treatment modalities. RESULTS: A total of 472 patients with 477 colorectal NETs received endoscopic treatment. Of these, 418 patients with 421 lesions who met the eligibility criteria were included in the analysis. The median age of the patients was 55 years, and 56.9% of them were men. The lower rectum was the most commonly affected site (88.6%), and lesions |
| 3. |
Yuichiro Yoshida, Shin Fujioka, Tomohiko Moriyama, Junji Umeno, Keisuke Kawasaki, Yuta Fuyuno, Yuichi Matsuno, Yutaro Ihara, Takehiro Torisu, Takanari Kitazono, Disease Flares Following COVID-19 Vaccination in Patients with Inflammatory Bowel Disease., Internal medicine (Tokyo, Japan), 10.2169/internalmedicine.2335-23, 2023.09, Objective Flares of inflammatory bowel disease (IBD) can occur infrequently after vaccination for coronavirus disease 2019 (COVID-19), although the details of this phenomenon are poorly understood. To clarify the possibility of an unfavorable response in patients with IBD, we investigated IBD-related symptoms during the COVID-19 vaccination. Methods Between October 2021 and February 2022, we obtained the COVID-19 vaccination status of 411 IBD patients who were being treated at our institution. The disease course of IBD after vaccination was investigated in 188 patients with ulcerative colitis (UC) and 119 patients with Crohn's disease (CD) who had received at least one dose of the vaccine during the clinical remission phase. The baseline characteristics before vaccination were compared between the patients with UC with or without disease flares. Results During the 30-day follow-up period, eight patients with UC (4.3%) and one patient with CD (0.8%) experienced disease flares following vaccination. Disease flares occurred after the first vaccination in six patients and after the second vaccination in three patients. As for the timing of onset of disease flares, eight events (88.9%) occurred within one week of vaccination. Two patients required hospitalization, and one patient with CD required surgery for an intra-abdominal abscess. The baseline characteristics did not significantly differ between patients with UC who experienced flares and those who did not. Conclusions IBD flares following COVID-19 vaccination are rare and vaccination should therefore be recommended for patients with IBD. However, the possibility of disease flares should be considered for approximately one week after each vaccination, especially in patients with UC.. |
| 4. |
Keisuke Kawasaki, Takehiro Torisu, Motohiro Esaki, Makoto Eizuka, Shinichiro Kawatoko, Tomo Kumei, Minami Hirai, Masahiro Kondo, Shin Fujioka, Yuta Fuyuno, Yuichi Matsuno, Junji Umeno, Tomohiko Moriyama, Takanari Kitazono, Tamotsu Sugai, Takayuki Matsumoto, Continuous use of antithrombotic medications during peri-endoscopic submucosal dissection period for colorectal lesions: A propensity score matched study., Journal of gastroenterology and hepatology, 10.1111/jgh.16149, 38, 6, 955-961, 2023.02, BACKGROUND AND AIM: The aim of this study was to elucidate the continuous use of antithrombotic medications during the peri-colorectal endoscopic submucosal dissection (ESD) period. METHODS: This study included 468 patients with colorectal epithelial neoplasms treated by ESD, consisting of 82 under antithrombotic medications and 386 patients without the medications. Among patients taking antithrombotic medications, antithrombotic agents were continued during the peri-ESD period. Clinical characteristics and adverse events were compared after propensity score matching. RESULTS: Before and after propensity score matching, post-colorectal ESD bleeding rate was higher in patients continuing antithrombotic medications (19.5% and 21.6%, respectively) than in those not taking antithrombotic medications (2.9% and 5.4%, respectively). In the Cox regression analysis, continuation of antithrombotic medications was associated with post-ESD bleeding risk (hazard ratio, 3.73; 95% confidence interval, 1.2-11.6; P |
| 5. |
Toshihiro Kita, Shinya Ashizuka, Teruyuki Takeda, Takayuki Matsumoto, Naoki Ohmiya, Hiroshi Nakase, Satoshi Motoya, Hidehisa Ohi, Keiichi Mitsuyama, Tadakazu Hisamatsu, Shuji Kanmura, Naoya Kato, Shunji Ishihara, Masanao Nakamura, Tomohiko Moriyama, Masayuki Saruta, Ryoichi Nozaki, Shojiro Yamamoto, Haruhiko Inatsu, Koji Watanabe, Kazuo Kitamura, Adrenomedullin for biologic-resistant Crohn's disease: A randomized, double-blind, placebo-controlled phase 2a clinical trial., Journal of gastroenterology and hepatology, 10.1111/jgh.15945, 37, 11, 2051-2059, 2022.11, BACKGROUND AND AIM: Adrenomedullin is a bioactive peptide with many pleiotropic effects, including mucosal healing and immunomodulation. Adrenomedullin has shown beneficial effects in rodent models of inflammatory bowel disease and, more importantly, in clinical trials including patients with ulcerative colitis. We performed a successive clinical trial to investigate the efficacy and safety of adrenomedullin in patients with Crohn's disease (CD). METHODS: This was a multicenter, double-blind, placebo-controlled phase 2a trial that evaluated 24 patients with biologic-resistant CD in Japan. Patients were randomly assigned to three groups and were given an infusion of 10 or 15 ng/kg/min of adrenomedullin or placebo for 8 h per day for 7 days. The primary endpoint was the change in the CD activity index (CDAI) at 8 weeks. The main secondary endpoints included changes in CDAI from week 4 to week 24. RESULTS: No differences in the primary or secondary endpoints were observed between the three groups by the 8th week. Changes in CDAI in the placebo group gradually decreased and disappeared at 24 weeks, but those in the adrenomedullin-treated groups (10 or 15 ng/kg/min group) remained at steady levels for 24 weeks. Therefore, a significant difference was observed between the placebo and adrenomedullin-treated groups at 24 weeks (P = 0.043) in the mixed-effects model. We noted mild adverse events caused by the vasodilatory effect of adrenomedullin. CONCLUSION: In this trial, we observed a long-lasting (24 weeks) decrease in CDAI in the adrenomedullin-treated groups. Adrenomedullin might be beneficial for biologic-resistant CD, but further research is needed.. |
| 6. |
Kuriko Kudo, Tatsuro Kudo, Shintaro Ueda, Yasuaki Antoku, Shunta Tomimatsu, Ho Shiaw-Hooi, Yukiko Hisada, Shuji Shimizu, Tomohiko Moriyama, The administrative burden on physicians and technicians for organizing international telemedicine conferences: utility of a shared program management system in an international telemedicine network., Heliyon, 10.1016/j.heliyon.2022.e11297, 8, 11, e11297, 2022.11, Background: The use of international telemedicine conferences for doctor-to-doctor education has increased following the coronavirus disease 2019 pandemic to ensure health and safety. Previous studies have shown that administrative tasks are an obstacle to promoting international telemedicine conferences but have not identified the type of system needed to alleviate this burden. Objective: The Asia-Pacific Advanced Network Medical Working Group (APAN-MWG) is an international telemedicine network that includes 1171 medical institutions and 3653 members as of July 21, 2021. The APAN-MWG has supported international telemedicine conferences since 2005 and implemented a program management system in 2014. The present study explores the conference organizers' tasks and evaluates the APAN-MWG management system through a survey of organizers. Methods: We developed a system called med-hok for managing conference programs, international medical institutions, and their members. We investigated all event programs using the med-hok system from June 3, 2015 to July 21, 2021. The target samples included 64 conference programs in 12 series hosted by 13 program organizers. The effectiveness of the system was evaluated using a four-point Likert scale (very good, good, poor, and very poor). The User Experience Questionnaire (UEQ) was used to assess user experience. Results: The survey response rate of the program organizers, who hosted 11 different program series in 7 Asian countries, was 92% (12/13). The administrative tasks for managing the programs were primarily handled by physicians (67%, 8/12), followed by technicians (17%, 2/12). The average program scope encompassed 7 countries, 10 institutions, and 44 members. The largest program comprised 194 members from 49 institutions in 25 countries and was managed by two physicians and one technician. Most program organizers (8/12, 67%) indicated that verifying member information was the most burdensome aspect of organizing teleconferences. Over 90% of respondents positively evaluated med-hok in the following areas: "Confirmation of institution information," "Confirmation of member information," "Confirmation of technical information," "Maintaining the latest status of the program," "Announcing and publicizing the event," and "Formatting and correcting misspellings." They rated user experience positively for all aspects (attractiveness: 1.22; practical quality: 1.42; and hedonic quality: 1.24). Conclusions: Many tasks of organizing casual international telemedicine conferences are handled by physicians and technicians with no operating funds or staff, unlike those in large academic conferences. The proposed system was found to help program organizers manage participants and communicate information effectively. These findings suggest that international telemedicine networks should implement an administrative support system to conduct program operations efficiently.. |
| 7. |
Ueda Shintaro, Kudo Kuriko, Hisada Yukiko, Tomimatsu Shunta, Shimizu Shuji, Moriyama Tomohiko, Image quality required for online case conferences on minimally invasive surgery(和訳中), 日本遠隔医療学会雑誌, 18, 2, 131-134, 2022.10. |
| 8. |
Masau Sekiguchi, Kinichi Hotta, Yoji Takeuchi, Shinji Tanaka, Hironori Yamamoto, Kensuke Shinmura, Keita Harada, Toshio Uraoka, Takashi Hisabe, Yasushi Sano, Hitoshi Kondo, Takahiro Horimatsu, Hidezumi Kikuchi, Takuji Kawamura, Shinji Nagata, Katsumi Yamamoto, Masahiro Tajika, Shigetsugu Tsuji, Toshihiro Kusaka, Yusuke Okuyama, Naohisa Yoshida, Tomohiko Moriyama, Aki Hasebe, Suketo So, Hideki Kobara, Hiroshi Kashida, Ryoichi Miyanaga, Sosuke Kato, Yoshito Hayashi, Miwa Sada, Masakatsu Fukuzawa, Hiroyuki Kato, Tetsuji Takayama, Jun Konishi, Hiro-O Matsushita, Toshiaki Narasaka, Ken Ohata, Kazutomo Togashi, Hisashi Nakamura, Kentaro Moriichi, Yasushi Oda, Naoki Kanda, Toshio Kuwai, Shuji Terai, Makoto Sanomura, Shinji Kitamura, Hayato Miyamoto, Shinsuke Kiriyama, Chiemi Mizuno, Yutaka Saito, Shigeki Sekine, Sayo Ito, Hiroko Nakahira, Shiro Oka, Yoshikazu Hayashi, Kenichi Yoshimura, Hideki Ishikawa, Takahisa Matsuda, Characteristics of colorectal neuroendocrine tumors in patients prospectively enrolled in a Japanese multicenter study: a first report from the C-NET STUDY., Journal of gastroenterology, 10.1007/s00535-022-01877-5, 57, 8, 547-558, 2022.08, 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. The baseline characteristics and clinicopathological findings at enrollment and treatment were assessed. RESULTS: A total of 495 patients with 500 colorectal NETs were included. The median patient age was 54 years, and 85.3% were asymptomatic. The most frequent lesion location was the lower rectum (88.0%); 99.4% of the lesions were clinically diagnosed to be devoid of metastatic findings, and 95.4% were treated with endoscopic resection. Lesions |
| 9. |
Latorre G, Pizarro M, Ford JS, Gándara V, Muñoz G, Araya JC, Bellolio E, Villaseca MÁ, Fuentes-López E, Cortés P, Rollán A, Bufadel ME, Araya R, Vargas JI, Espino A, Sharp A, Agüero C, Donoso A, Bresky G, Pedrero P, Rueda C, Calvo A, Odagaki T, Moriyama T, Ishida T, Parra-Blanco A, Camargo MC, González R, Corvalán AL, Riquelme A., Evaluation of Trefoil Factor 3 as a Non-Invasive Biomarker of Gastric Intestinal Metaplasia and Gastric Cancer in a High-Risk Population., Gastroenterol Hepatol., doi: 10.1016/j.gastrohep, 2022.05. |
| 10. |
Nagasue T, Hirano A, Torisu T, Umeno J, Shibata H, Moriyama T, Kawasaki K, Fujioka S, Fuyuno Y, Matsuno Y, Esaki M, Kitazono T, The Compositional Structure of the Small Intestinal Microbial Community via Balloon-Assisted Enteroscopy. , Digestion, doi: 10.1159/000524023, 8, 1-11, 2022.04. |
| 11. |
Matsuno Y, Torisu T, Umeno J, Shibata H, Hirano A, Fuyuno Y, Okamoto Y, Fujioka S, Kawasaki K, Moriyama T, Nagasue T, Zeze K, Hirakawa Y, Kawatoko S, Koga Y, Oda Y, Esaki M, Kitazono T, One-year clinical efficacy and safety of indigo naturalis for active ulcerative colitis: a real-world prospective study. , Intest Res., doi: 10.5217/ir.2021.00124, 20, 2, 260-268, 2022.04. |
| 12. |
Yuichi Matsuno, Takehiro Torisu, Junji Umeno, Hiroki Shibata, Atsushi Hirano, Yuta Fuyuno, Yasuharu Okamoto, Shin Fujioka, Keisuke Kawasaki, Tomohiko Moriyama, Tomohiro Nagasue, Keizo Zeze, Yoichiro Hirakawa, Shinichiro Kawatoko, Yutaka Koga, Yoshinao Oda, Motohiro Esaki, Takanari Kitazono, One-year clinical efficacy and safety of indigo naturalis for active ulcerative colitis: a real-world prospective study., Intestinal research, 10.5217/ir.2021.00124, 20, 2, 260-268, 2022.04, BACKGROUND/AIMS: Recent studies suggested a favorable effect of indigo naturalis (IN) in inducing remission for refractory ulcerative colitis (UC), however, the maintenance effect of IN for patients with UC remains unknown. Therefore, we conducted a prospective uncontrolled open-label study to analyze the efficacy and safety of IN for patients with UC. METHODS: Patients with moderate to severe active UC (clinical activity index [CAI] ≥ 8) took 2 g/day of IN for 52 weeks. CAI at weeks 0, 4, 8, and 52 and Mayo endoscopic subscore (MES) and Geboes score (GS) at weeks 0, 4, and 52 were assessed. Clinical remission (CAI ≤ 4), mucosal healing (MES ≤ 1), and histological healing (GS ≤ 1) rates at each assessment were evaluated. Overall adverse events (AEs) during study period were also evaluated. The impact of IN on mucosal microbial composition was assessed using 16S ribosomal RNA gene sequences. RESULTS: Thirty-three patients were enrolled. The rates of clinical remission at weeks 4, 8, and 52 were 67%, 76%, and 73%, respectively. The rates of mucosal healing at weeks 4 and 52 were 48% and 70%, respectively. AEs occurred in 17 patients (51.5%) during follow-up. Four patients (12.1%) showed severe AEs, among whom 3 manifested acute colitis. No significant alteration in the mucosal microbial composition was observed with IN treatment. CONCLUSIONS: One-year treatment of moderate to severe UC with IN was effective. IN might be a promising therapeutic option for maintaining remission in UC, although the relatively high rate of AEs should be considered.. |
| 13. |
Tomohiro Nagasue, Atsushi Hirano, Takehiro Torisu, Junji Umeno, Hiroki Shibata, Tomohiko Moriyama, Keisuke Kawasaki, Shin Fujioka, Yuta Fuyuno, Yuichi Matsuno, Motohiro Esaki, Takanari Kitazono, The Compositional Structure of the Small Intestinal Microbial Community via Balloon-Assisted Enteroscopy., Digestion, 10.1159/000524023, 1-11, 2022.04, INTRODUCTION: An association has been found between human-gut microbiota and various diseases (e.g., metabolic disease) by analyzing fecal or colonic microbiota. Despite the importance of the small intestinal microbiota, sampling difficulties prevent its full analysis. We investigated the composition and metagenomic functions of microbiota along the small intestine and compared them with the microbiota from feces and from other gastrointestinal (GI) sites. METHODS: Mucosal samples from the six GI sites (stomach, duodenum, distal jejunum, proximal ileum, terminal ileum, and rectum) were collected under balloon-assisted enteroscopy. Fecal samples were collected from all participants. The microbial structures and metagenomic functions of the small intestinal mucosal microbiota were compared with those from feces and other GI sites using 16S ribosomal RNA gene sequencing. RESULTS: We analyzed 133 samples from 29 participants. Microbial beta diversity analysis showed that the jejunum and ileum differed significantly from the lower GI tract and the feces (p |
| 14. |
Kudo K, Isobe N, Ueda S, Tomimatsu S, Moriyama T, Shimizu S, Barriers to International Telemedicine Conferencing: A Survey of the National University Hospital Council of Japan, J Telemed E Health, http://doi.org/10.1089/tmj.2021.0046, 28, 3, 433-439, 2022.03. |
| 15. |
Kudo K, Ueda S, Shunta T, Hayata M, Kudo T, Antoku Y, Kimura T, Shimizu S, Moriyama T, Developing Evaluation Criteria for Engineering Training Programs in Remote Medical Education in Asia, IEEE International Conference on Teaching, Assessment and Learning for Engineering (TALE), 1-5, 2021.12. |
| 16. |
Harada A, Torisu T, Fujioka S, Yoshida Y, Okamoto Y, Fuyuno Y, Hirano A, Umeno J, Torisu K, Moriyama T, Esaki M, Kitazono T, Risk of Rebleeding in Patients with Small Bowel Vascular Lesions., Intern Med., doi: 10.2169/internalmedicine.6341-20, 60, 23, 3663-3669, 2021.12. |
| 17. |
Kawasaki K, Torisu T, Nagahata T, Esaki M, Kurahara K, Eizuka M, Tanaka Y, Fujiwara M, Kawatoko S, Oshiro Y, Yamada S, Ikegami K, Fujioka S, Fuyuno Y, Matsuno Y, Umeno J, Moriyama T, Kitazono T, Sugai T, Matsumoto T, Role of barium enema examination for the diagnosis of submucosal invasion depth in T1 colorectal cancers., Cancer Imaging, doi: 10.1186/s40644-021-00437-z, 21, 1, 66, 2021.12. |
| 18. |
Kawasaki K, Nakamura S, Eizuka M, Tanaka Y, Kumei T, Yanai S, Toya Y, Urushikubo J, Torisu T, Moriyama T, Umeno J, Sugai T, Matsumoto T, Is barium enema examination negligible for the management of colorectal cancer? Comparison with conventional colonoscopy and magnifying colonoscopy. , Jpn J Radiol., doi: 10.1007/s11604-021-01157-x, 39, 12, 1159-1167, 2021.12. |
| 19. |
Keisuke Kawasaki, Takehiro Torisu, Takahisa Nagahata, Motohiro Esaki, Koichi Kurahara, Makoto Eizuka, Yoshihito Tanaka, Minako Fujiwara, Shinichiro Kawatoko, Yumi Oshiro, Shun Yamada, Koji Ikegami, Shin Fujioka, Yuta Fuyuno, Yuichi Matsuno, Junji Umeno, Tomohiko Moriyama, Takanari Kitazono, Tamotsu Sugai, Takayuki Matsumoto, Role of barium enema examination for the diagnosis of submucosal invasion depth in T1 colorectal cancers., Cancer imaging : the official publication of the International Cancer Imaging Society, 10.1186/s40644-021-00437-z, 21, 1, 66-66, 2021.12, BACKGROUND: The indication for endoscopic resection for submucosally invasive colorectal cancer (T1-CRC) depends on the preoperative diagnosis of invasion depth. The aim of this investigation was to evaluate the association between barium enema examination (BE) profile views and depth of submucosal (SM) invasion in CRCs. METHODS: We reviewed the radiographic and endoscopic findings of 145 T1-CRCs diagnosed from 2008 to 2019. We measured the widths of horizontal and vertical rigidity under a BE profile view corresponding to CRC and compared the values with SM invasion depth. Horizontal rigidity was defined as the horizontal length and vertical rigidity as the vertical width of the barium defect corresponding to each target lesion. The most appropriate cut-off values for predicting SM invasion ≥1.8 mm were calculated by receiver operating characteristic curve analysis. RESULTS: Values of horizontal rigidity (r = 0.626, P |
| 20. |
Elokla N, Moriyama T, Nakashima N, Approaches for Promoting Telemedicine Utilization in Japan, The Tenth International Conference on Global Health Challenges GLOBAL HEALTH 2021 Proceedings, 34-39, 2021.10. |
| 21. |
上田真太郎, 工藤孔梨子, 富松俊太, 清水周次, 森山智彦, Lecturers’ and Students’ Perspectives Toward the Shift to Online Teaching Owing to COVID 19: A Case at Kyushu University School of Medici, 日本遠隔医療学会雑誌, 17, 2, 108-111, 2021.09. |
| 22. |
Tanaka T, Matsuno Y, Torisu T, Shibata H, Hirano A, Umeno J, Kawasaki K, Fujioka S, Fuyuno Y, Moriyama T, Esaki M, Kitazono T, Gastric microbiota in patients with Helicobacter pylori-negative gastric MALT lymphoma., Medicine (Baltimore), doi: 10.1097/MD.0000000000027287, 100, 38, e27287, 2021.09. |
| 23. |
Zeze K, Hirano A, Torisu T, Esaki M, Moriyama T, Umeno J, Kawasaki K, Fujioka S, Fuyuno Y, Matsuno Y, Kitazono T, Adding Thiopurine After Loss of Response to Infliximab Versus Early Combination in Treating Crohn's Disease: A Retrospective Study., Dig Dis Sci., doi: 10.1007/s10620-020-06600-z, 66, 9, 3124-3131, 2021.09. |
| 24. |
Ueda Shintaro, Kudo Kuriko, Tomimatsu Shunta, Shimizu Shuji, Moriyama Tomohiko, (JTTA 2021 GIFU 第25回 日本遠隔医療学会学術大会), 日本遠隔医療学会雑誌 = Japanese journal of telemedicine and telecare, 17, 2, 108-111, 2021.09. |
| 25. |
Takahide Tanaka, Yuichi Matsuno, Takehiro Torisu, Hiroki Shibata, Atsushi Hirano, Junji Umeno, Keisuke Kawasaki, Shin Fujioka, Yuta Fuyuno, Tomohiko Moriyama, Motohiro Esaki, Takanari Kitazono, Gastric microbiota in patients with Helicobacter pylori-negative gastric MALT lymphoma., Medicine, 10.1097/MD.0000000000027287, 100, 38, e27287, 2021.09, ABSTRACT: To investigate the mucosal microbiota in the stomach of patients with Helicobacter pylori-negative mucosa-associated lymphoid tissue (MALT) lymphoma by means of metagenomic analysis.Although some gastric MALT lymphomas are associated with the presence of H. pylori, other gastric MALT lymphomas occur independently of H. pylori infection. The pathogenesis of H. pylori-negative MALT lymphoma remains unclear.Mucosal biopsy specimens were collected from the gastric body from 33 MALT lymphoma patients with gastric lesions, including both H. pylori-infection naïve patients and posteradication patients, as well as 27 control participants without H. pylori infection or cancer. Subsequently, the samples were subjected to 16S rRNA gene sequencing. Quantitative insights into microbial ecology, linear discriminant analysis effect size, and phylogenetic investigation of communities by reconstruction of unobserved states softwares were used to analyze the participants' microbiota.H. pylori-negative MALT lymphoma patients had significantly lower alpha diversity (P = .04), compared with control participants. Significant differences were evident in the microbial composition (P = .04), as determined by comparison of beta diversity between the 2 groups. Taxonomic composition analysis indicated that the genera Burkholderia and Sphingomonas were significantly more abundant in MALT lymphoma patients, while the genera Prevotella and Veillonella were less abundant. Functional microbiota prediction showed that the predicted gene pathways "replication and repair," "translation," and "nucleotide metabolism" were downregulated in MALT lymphoma patients.H. pylori-negative MALT lymphoma patients exhibited altered gastric mucosal microbial compositions, suggesting that altered microbiota might be involved in the pathogenesis of H. pylori-negative MALT lymphoma.. |
| 26. |
Implementation and evaluation of an on-line engineering training program for international remote medical education. |
| 27. |
Evaluation of live endoscopy transmission with HD resolution through web-conferencing software. |
| 28. |
Ihara Y, Torisu T, Miyawaki K, Umeno J, Kawasaki K, Hirano A, Fujioka S, Fuyuno Y, Matsuno Y, Sugio T, Sasaki K, Moriyama T, Akashi K, Kitazono T, Ustekinumab Improves Active Crohn's Disease by Suppressing the T Helper 17 Pathway. , Digestion, doi: 10.1159/000518103., 102, 6, 946-955, 2021.07. |
| 29. |
Tomimatsu S, Kudo K, Shimizu S, Ueda S, Moriyama T, Hirai Y, Development and Evaluation of a Technical Information Sharing System for International Remote Medical Education. , Springer Science and Business Media Deutschland GmbH, 10.1007/978-3-030-80091-8_129, 275, 1090-1098, 2021.07. |
| 30. |
Yutaro Ihara, Takehiro Torisu, Kohta Miyawaki, Junji Umeno, Keisuke Kawasaki, Atsushi Hirano, Shin Fujioka, Yuta Fuyuno, Yuichi Matsuno, Takeshi Sugio, Kensuke Sasaki, Tomohiko Moriyama, Koichi Akashi, Takanari Kitazono, Ustekinumab Improves Active Crohn's Disease by Suppressing the T Helper 17 Pathway., Digestion, 10.1159/000518103, 102, 6, 1-10, 2021.07, BACKGROUND: Ustekinumab (UST), an antibody targeting the p40 subunit of interleukin (IL)-12 and IL-23, is effective in treating Crohn's disease (CD). To clarify the mechanism of UST, we investigated T-cell differentiation in CD patients treated with UST. METHODS: Twenty-seven patients with active CD were enrolled in this study. Seventeen patients were treated with UST, and 10 patients were treated with anti-tumor necrosis factor (TNF)-alpha therapy. The changes in the proportions of T-cell subsets after these therapies were analyzed by flow cytometry. Comprehensive gene expression changes in the colonic mucosa were also evaluated. RESULTS: The frequency of T helper (Th) 17 cells was significantly decreased in the peripheral blood of patients with active CD after UST therapy. Anti-TNF therapy had a minimal effect on Th17 cells but increased the proportion of regulatory T cells. Enrichment analysis showed the expression of genes involved in the Th17 differentiation pathway was downregulated in the colonic mucosa after UST but not anti-TNF therapy. There were no common differentially expressed genes between CD patients treated with UST and anti-TNF therapy, suggesting a clear difference in their mechanism of action. CONCLUSION: In patients with active CD, UST therapy suppressed Th17 cell differentiation both in the peripheral blood and colonic tissues.. |
| 31. |
Keisuke Kawasaki, Shotaro Nakamura, Makoto Eizuka, Yoshihito Tanaka, Tomo Kumei, Shunichi Yanai, Yosuke Toya, Jun Urushikubo, Takehiro Torisu, Tomohiko Moriyama, Junji Umeno, Tamotsu Sugai, Takayuki Matsumoto, Is barium enema examination negligible for the management of colorectal cancer? Comparison with conventional colonoscopy and magnifying colonoscopy., Japanese journal of radiology, 10.1007/s11604-021-01157-x, 39, 12, 1159-1167, 2021.06, PURPOSE: The aim of this investigation was to evaluate the clinical value of barium enema (BE) examination for the management of colorectal epithelial neoplasms. METHODS: We reviewed the colonoscopy records at our institution from 2014 to 2019 and identified cases of endoscopically or surgically resected colorectal epithelial neoplasms evaluated by BE, conventional colonoscopy, magnifying narrow-band imaging colonoscopy (M-NBI), and magnifying chromoendoscopy (MCE). The yield of each modality for the diagnosis of massively submucosal invasive (mSM) colorectal cancer was evaluated by a receiver-operating characteristic analysis including the area under the curve (AUC). RESULTS: We analyzed the records of 105 patients (17 adenomas, 53 high-grade dysplasias (HGDs), and 35 cancers). Smooth surface, irregularity in depression, and eccentric deformity on the profile view with BE were observed more frequently in mSM cancers than adenomas/HGDs/slightly submucosal invasive cancers (p |
| 32. |
Kuriko Kudo, Noriko Isobe, Shintaro Ueda, Shunta Tomimatsu, Tomohiko Moriyama, Shuji Shimizu, Barriers to International Telemedicine Conferencing: A Survey of the National University Hospital Council of Japan., Telemedicine journal and e-health : the official journal of the American Telemedicine Association, 10.1089/tmj.2021.0046, 28, 3, 433-439, 2021.06, Background: Telemedicine conferencing is expected to become commonly used internationally. However, national reports on internationally related telemedicine are limited, and related activities and challenges in each country are unclear. In this study, we aimed to clarify the current status and barriers to international telemedicine conferencing in Japan. Methods: The questionnaire was sent to the Internationalization Project Team (I-PT) representatives in all 43 Japanese National University Hospitals. The total of 167 assigned staff comprised 86 medical staff in charge of internationalization (MI) and 81 technical staff in telemedicine (TT). Results: The response rate was 93% (40/43 universities) from 88 staff (44 MI and 44 TT). Most respondents (75%) stated that they had not been active in international telemedicine conferencing during the past 3 years, although a videoconferencing system was installed in 93% of universities. A total of 65% respondents felt that barriers to promoting telemedicine and conferencing existed. Most (43%) respondents reported staff shortage as the most serious barrier overall. Five TT (19%) felt that the most serious barrier was difficulty with English communication, although no MI selected this as a barrier. More MI than TT felt that technical issues were the most serious barrier (MI: 4/29, TT: 1/27). Conclusions: International telemedicine conferencing was found to be insufficiently active in I-PT of Japan, although the installed equipment and technical expertise of TT seemed adequate. This indicates that merely assigning MI and TT to an I-PT is not enough and that improved cooperation between both MI and TT at each university hospital is needed. Establishment of a structured international telemedicine center in each university hospital is to be suggested to accelerate the activities in Japan.. |
| 33. |
Akira Harada, Takehiro Torisu, Shin Fujioka, Yuichiro Yoshida, Yasuharu Okamoto, Yuta Fuyuno, Atsushi Hirano, Junji Umeno, Kumiko Torisu, Tomohiko Moriyama, Motohiro Esaki, Takanari Kitazono, Risk of Rebleeding in Patients with Small Bowel Vascular Lesions., Internal medicine (Tokyo, Japan), 10.2169/internalmedicine.6341-20, 60, 23, 3663-3669, 2021.06, Background With recent advances in endoscopic modalities, small bowel vascular lesions (SBVLs) are often now detected in patients with gastrointestinal bleeding. Given the high invasiveness of endoscopic treatment, it is important to select patients at high risk for bleeding. Aim To assess the risk of rebleeding in patients with SBVLs as a systemic disease rather than a gastrointestinal disease in relation to their general health. Methods We retrospectively analyzed the clinical data of 55 patients with SBVLs among patients with obscure gastrointestinal bleeding. The possible association between the clinical findings and the updated Charlson comorbidity index with rebleeding was evaluated. Results Gastrointestinal rebleeding occurred in 20 patients (36.4%) during the follow-up period. The presence of multiple comorbidities as indicated by an updated Charlson comorbidity index of ≥4 was a risk factor for rebleeding (hazard ratio, 3.64; P = 0.004). Other risk factors were arteriosclerosis of the superior mesenteric artery and multiple SBVLs. Endoscopic hemostasis and the discontinuation of antithrombotic medications were not significantly associated with rebleeding. Patients with a high updated Charlson comorbidity index had a high risk of death of causes other than gastrointestinal rebleeding. Conclusions Gastrointestinal rebleeding is not a rare condition among patients with SBVLs. Patients with poor general health may therefore have a higher risk of rebleeding.. |
| 34. |
Toshihiro Kita, Sinya Ashizuka, Naoki Ohmiya, Takayuki Yamamoto, Takanori Kanai, Satoshi Motoya, Fumihito Hirai, Hiroshi Nakase, Tomohiko Moriyama, Masanao Nakamura, Yasuo Suzuki, Shuji Kanmura, Taku Kobayashi, Hidehisa Ohi, Ryoichi Nozaki, Keiichi Mitsuyama, Shojiro Yamamoto, Haruhiko Inatsu, Koji Watanabe, Toshifumi Hibi, Kazuo Kitamura, Adrenomedullin for steroid-resistant ulcerative colitis: a randomized, double-blind, placebo-controlled phase-2a clinical trial., Journal of gastroenterology, 10.1007/s00535-020-01741-4, 56, 2, 147-157, 2021.02, BACKGROUND: Adrenomedullin (AM) is a bioactive peptide having many pleiotropic effects, including mucosal healing and immunomodulation. AM has shown beneficial effects in rodent models and in preliminary study for patients with ulcerative colitis (UC). We performed a clinical trial to investigate the efficacy and safety of AM in patients with UC. METHODS: This was a multi-center, double-blind, placebo-controlled phase-2a trial evaluating 28 patients in Japan with steroid-resistant UC. Patients were randomly assigned to four groups and given an infusion of 5, 10, 15 ng/kg/min of AM or placebo for 8 h per day for 14 days. The primary endpoint was the change in Mayo scores at 2 weeks. Main secondary endpoints included the change in Mayo scores and the rate of clinical remission at 8 weeks, defined as a Mayo score 0. RESULTS: No differences in the primary or secondary endpoints were observed among the four groups at 2 weeks. Despite the insufficient tracking rate, the Mayo score at 8 weeks was only significantly decreased in the high-dose AM group (15 ng/kg/min) compared with the placebo group (- 9.3 ± 1.2 vs. - 3.0 ± 2.8, P = 0.035), with its rate of clinical remission at 8 weeks being significantly higher (3/3, 100% vs. 0/2, 0%, P = 0.025). We noted mild but no serious adverse events caused by the vasodilatory effect of AM. CONCLUSIONS: In this double-blind randomized trial, we observed the complete remission at 8 weeks in patients with steroid-resistant UC receiving a high dose of AM. CLINICAL TRIAL REGISTRY: JAPIC clinical trials information; Japic CTI-205255 (200410115290). https://www.clinicaltrials.jp/cti-user/trial/Search.jsp .. |
| 35. |
Shuji Shimizu, Shunta Tomimatsu, Kuriko Kudo, Shintaro Ueda, Aria Kekalih, Dadang Makmun, Riwanti Estiasari, Aqsa Sjunhada Oki, Tomohiko Moriyama, Remote Medical Education in Indonesia: Analysis of 10 Years of Activities, Journal of the International Society for Telemedicine and eHealth, e6, 1-6, 2020.12. |
| 36. |
Shintaro Ueda, Kuriko Kudo, Tomohiko Moriyama, Shunta Tomimatsu, Shuji Shimizu, Barriers against and Improvement Measures of Discussion during Bilateral Video-conferencing in an Early Gastric Cancer Case Stud, Asia-Pacific Association for Medical Informatics (APAMI2020), 71-76, 2020.11. |
| 37. |
Kudo Kuriko, Ueda Shintaro, Shitoh Hidefumi, Narikiyo Tetsuya, Tomimatsu Shunta, Watanabe Sunao, Nakahara Takahiro, Nakashima Naoki, Moriyama Tomohiko, Nakano Toshiaki, Shimizu Shuji, Participants' Evaluation of a Virtual Academic Conference: Report from the 24th Japan Association of Medical Informatics Spring Symposium, Proceedings of APAMI, 2020, 71-76, 2020.11, The COVID-19 pandemic has caused a shift in the style of academic conferences from in-person to virtual. There have been reports about virtual academic conferences; however, the advantages and disadvantages are not readily apparent from the participants' perspective. This study evaluated a virtual academic conference compared with a conventional one from the viewpoint of participants based on the results of the 24th Japan Association of Medical Informatics Spring Symposium; that association held a virtual conference for the first time. The conference was conducted in three parallel virtual venues using Zoom® webinars. All the panelists and audience members participated from their own sites. The operating team acted as host control for the Zoom® webinar, master of ceremonies, and monitoring and responding to online comments. Questionnaires using the Google Form were sent by e-mail to all registrants after the conference. The number of registrants was about twice that in previous years: 2345 in 2020, 1189 in 2019, and 1007 in 2018. The response rate to the questionnaire was 68% (1591/2345). Most respondents said that the virtual conference was better than the conventional one in terms of image quality of presentation slides (75%), being able to concentrate on presentations (77%), session accessibility (59%), and feasibility of asking questions (53%). In contrast, most (63%) respondents stated that the inperson conference was better for communicating with other participants. Finally, 97% (1535/1591) of participants evaluated the virtual academic conference positively. The virtual conference was highly evaluated by participants because of its advantages compared with conventional ones. However, difficulties in human networking should be addressed in the future.. |
| 38. |
Tomimatsu Shunta, Kudo Kuriko, Moriyama Tomohiko, Ueda Shintaro, Hirai Yasuyuki, Shimizu Shuji, Technical Support for Rapid Replacement of Face-to-Face Events with Online Events due to the COVID-19 Pandemic: A Case Study from Kyushu University Hospital, Proceedings of APAMI, 2020, 66-70, 2020.11, There are many studies addressing how to shift events from face-to-face to virtual under a pre-planned schedule. However, because of the COVID-19 pandemic, rapid replacement of face-to-face events with online events was required at Kyushu University Hospital in Japan. There is limited research on how to accomplish this type of shift in events and no specific guidance exists for making necessary changes. This study aimed to fill this gap in knowledge by evaluating the characteristics and technical support needs of 62 administrative and educational events (25 grouped events) organized by 15 university departments between March and May 2020. We also distributed open-ended questionnaires to the departments that received technical support for their events. Technical support services comprised professional support services and equipment/system support. Three of the most frequently required support services were equipment/system support, on-site support, and venue arrangement. More than half (9/16) of administrative events included individuals from outside of the university, while those that were limited to individuals within Kyushu University also included multiple departments. Results also indicated that a physical "headquarters" room was important to many departments, despite the potential risk of disease transmission. Although online events are relatively simple for large numbers of people to access, they require a large amount of technical support, including technical management and direction.. |
| 39. |
Ueda Shintaro, Kudo Kuriko, Moriyama Tomohiko, Tomimatsu Shunta, Shimizu Shuji, Barriers Against and Improvement Measures of Discussion During Bilateral Video-Conferencing in an Early Gastric Cancer Case Study, Proceedings of APAMI, 2020, 77-81, 2020.11, Japan has a high diagnostic rate of early gastric cancer (EGC), and doctors worldwide are eager to learn advanced tips and skills from Japanese experts. The Telemedicine Development Center of Asia has carried out endoscopy-themed teleconferences, to educate overseas doctors about diagnosing EGC, from which video data are analyzed. The number of comments made varied based on the participant's role in the teleconference. The experts and chair made more comments than the audience participants. Because in-depth discussion about each case study with the experts is important in learning advice for EGC diagnosis, in this paper, we further analyzed the reasons why there were so many silent participants and how to activate discussion by them. We learned that most hesitated when the discussion was concentrated between the experts. Live polling was added to the teleconference to increase activation. Although a direct increase in the number of comments was not seen, the proportion of participants who had questions but remained silent decreased by 53%, and 88% of participants stated that the live polling increased the quality of the discussion. We found that live polling provides valuable feedback to the chair so that the discussion could incorporate the participants' opinions, and thus, it increased the quality of the discussion phase.. |
| 40. |
Keizo Zeze, Atsushi Hirano, Takehiro Torisu, Motohiro Esaki, Tomohiko Moriyama, Junji Umeno, Keisuke Kawasaki, Shin Fujioka, Yuta Fuyuno, Yuichi Matsuno, Takanari Kitazono, Adding Thiopurine After Loss of Response to Infliximab Versus Early Combination in Treating Crohn's Disease: A Retrospective Study., Digestive diseases and sciences, 10.1007/s10620-020-06600-z, 66, 9, 3124-3131, 2020.09, BACKGROUND: Although combining thiopurine with infliximab (IFX) is considered to improve the clinical efficacy of IFX when treating Crohn's disease (CD), it also increases the risk of adverse events (AEs). We compared the efficacy and safety of delayed thiopurine addition after loss of response (LOR) to IFX with the efficacy and safety of an earlier combination of thiopurine and IFX. METHODS: This retrospective study analyzed patients with CD who started IFX as a first-line biologic at Kyushu University Hospital between June 2002 and July 2018. Patients were assigned to either the early-combination (EC) group, who started IFX and thiopurine simultaneously, or the late-combination (LC) group, who were treated with IFX alone until they developed LOR. We compared the cumulative IFX continuation rates and AE incidence between the two groups. RESULTS: One hundred seventy-six patients were enrolled in this study; 49 were enrolled in the EC group, and 127 were enrolled in the LC group. Disease activity at baseline did not significantly differ between the groups, nor did the cumulative IFX continuation rates differ between the groups (P = 0.30); however, the AE rate was significantly higher in the EC group than in the LC group (38.7% vs. 21.2%; P = 0.02). The severe AE rate was also higher in the EC group than in the LC group (18.3% vs 3.1%; P = 0.001). CONCLUSION: Considering the risk-benefit balance, delayed addition of thiopurine after LOR to IFX might be an alternative strategy when using IFX to treat CD.. |
| 41. |
Tomimatsu S, Kudo K, Shimizu S, Moriyama T, Ueda S, Hirai Y, An Exploratory Analysis of Technical Issues in Remote Education Between International Medical Institutions, Advances in Usability, User Experience, Wearable and Assistive Technology, 10.1007/978-3-030-51828-8_24, 1217 AISC, 181-188, 2020.07, © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2020. International education programs that use videoconferencing (VC) are common now and many are being implemented in the medical field. Irrespective of the value of the content, the learning process can be disrupted when technical quality of VC is compromised. In this study, a participatory design (PD) was used with focus group discussion between technical support staff to determine and classify the causes of technical issues in international remote medical education by VC. As a result, a quality of experience (QoE) -based framework was developed based on the technical issues raised. User behavior and three factors (context, human and system factors) influence technical errors, either preventing or creating difficulties, and affecting each other. For future prototyping of the PD process, it is suggested to have a flexible and specific operational procedure which considers variables of engineers’ background.. |
| 42. |
Zeze K, Hirano A, Torisu T, Esaki M, Shibata H, Moriyama T, Umeno J, Fujioka S, Okamoto Y, Fuyuno Y, Matsuno Y, Kitazono T, Mucosal dysbiosis in patients with gastrointestinal follicular lymphoma, Hematol Oncol, 10.1002/hon.2717, 38, 2, 181-188, 2020.04, Because the pathogenesis of gastrointestinal follicular lymphoma (GI-FL) remains unclear, no standardized treatment strategy has been established. Of the gastrointestinal lymphomas, gastric mucosa-associated lymphoid tissue lymphomas are strongly associated with Helicobacter pylori; hence, the microbiota may be involved in GI-FL pathogenesis. However, the association between GI-FL and the microbiota remains uninvestigated. Therefore, we compared the mucosal microbiotas of GI-FL patients with those of controls to identify microbiota changes in GI-FL patients. Mucosal biopsy samples were obtained from the second portion of the duodenum from 20 GI-FL patients with duodenal lesions and 20 controls. Subsequent 16S rRNA gene sequencing was performed on these samples. QIIME pipeline and LEfSe software were used to analyze the microbiota. The GI-FL patients had significantly lower alpha diversity (P = .049) than did the controls, with significant differences in the microbial composition (P = .023) evaluated by the beta diversity metrics between the two groups. Comparing the taxonomic compositions indicated that the genera Sporomusa, Rothia, and Prevotella and the family Gemellaceae were significantly less abundant in the GI-FL patients than in the controls. GI-FL patients presented altered duodenal mucosal microbial compositions, suggesting that the microbiota might be involved in the GI-FL pathogenesis.. |
| 43. |
Koji Shindo, Jaymel Castillo, Kenoki Ohuchida, Taiki Moriyama, Shuntaro Nagai, Tomohiko Moriyama, Takao Ohtsuka, Eishi Nagai, Shuji Shimizu, Masufumi Nakamura, Influence of endoscopic resection on additional laparoscopic distal gastrectomy: a propensity score-matching analysis, Surgery Today, 10.1007/s00595-020-02012-8, 50, 10, 1290-1296, 2020.04, PURPOSE: There is no definite evidence of the feasibility and safety of laparoscopic distal gastrectomy (LDG) for patients who have undergone incomplete endoscopic resection (ER). We investigated the influence of ER prior to LDG by a propensity score matching analysis. METHODS: We retrospectively analyzed the outcomes of gastric cancer patients who underwent LDG with or without prior ER from 2000 to 2014. Propensity score matching was performed to compare the two groups of patients. RESULTS: After matching, 47 patients in the ER group and 94 patients in the non-ER group were selected from a total of 365 patients. A residual tumor was observed in 10 of 47 patients (21.3%). The mean number of dissected lymph nodes in the non-ER group (39.4 ± 14.5) was higher than that in the ER group (31.7 ± 13.5) (P = 0.003). However, other perioperative data, such as the operation time and blood loss volume were similar. The complication rate of the ER group (17.0%) and the non-ER group (9.6%) did not differ to a statistically significant extent (P = 0.2). Among these patients, 6 died during the 5-year follow-up period, but no patients showed signs of recurrence. CONCLUSION: ER prior to surgical resection showed no significant influence on postoperative complications or mortality. LDG can be safely performed to achieve radical resection after incomplete ER.. |
| 44. |
Matsuno Y, Hirano A, Torisu T, Okamoto Y, Fuyuno Y, Fujioka S, Umeno J, Moriyama T, Nagai S, Hori Y, Fujiwara M, Kitazono T, Esaki M, Short-term and long-term outcome of indigo naturalis treatment for inflammatory bowel disease, J Gastroenterol Hepatol, 10.1111/jgh.14823, 315, 3, 412-417, 2020.03, BACKGROUND AND AIM: Indigo naturalis (IN) is a traditional Chinese herbal medicine reported to be effective in inducing remission in ulcerative colitis (UC). We conducted a retrospective observational study to investigate the efficacy and safety of IN for induction and maintenance therapy in patients with inflammatory bowel disease. METHODS: Data were collected from the electric medical records of patients with inflammatory bowel disease who had started IN treatment between March 2015 and April 2017 at Kyushu University Hospital. Clinical response and remission rates were assessed based on the clinical activity index determined by Rachmilewitz index or Crohn's disease (CD) activity index. Cumulative IN continuation rates were estimated using the Kaplan-Meier method. Overall adverse events (AEs) during follow-up were also analyzed. RESULTS: Seventeen UC patients and eight CD patients were enrolled. Clinical response and remission rates at week 8 were 94.1% and 88.2% in UC patients and 37.5% and 25.0% in CD patients, respectively. Clinical remission rates, as assessed through non-responders imputation analyses at weeks 52 and 104, were 76.4% and 70.4% in UC patients and 25.0% and 25.0% in CD patients, respectively. Ten patients (40%) experienced AEs during follow-up. Three patients (12%) experienced severe AEs, including acute colitis requiring hospitalization in two patients and acute colitis with intussusception requiring surgery in one patient. CONCLUSIONS: Indigo naturalis showed favorable therapeutic efficacy in UC, whereas its therapeutic efficacy in CD appeared to be modest. The risk of severe AEs should be recognized for IN treatment.. |
| 45. |
Harada A, Kurahara K, Moriyama T, Tanaka T, Nagata Y, Kawasaki K, Yaita K, Maehata Y, Umeno J, Oshiro Y, Fuchigami T, Kitazono T, Esaki M, Matsumoto T, Risk factors for reflux esophagitis after eradication of Helicobacter pylori, Scand J Gastroenterol, 10.1080/00365521.2019.1671487, 54, 10, 1183-1188, 2019.10, Objective: While there is an association between successful eradication of Helicobacter pylori (HP) and reflux esophagitis (RE), risk factors associated with RE remain obscure. The aim of this study is to determine risk factors associated with the development of RE after HP eradication.Materials and methods: Among all patients treated with successful HP eradication from 2008 to 2016, we retrospectively analyzed those who were free from RE at initial esophagogastroduodenoscopy (EGD) and who were followed up with EGD after eradication. Patients were classified according to the presence or absence of RE at the follow-up EGD. RE was defined as mucosal breaks proximal to the squamous-columnar junction. Demographic data, underlying diseases, medications and endoscopic findings at the initial EGD were compared between patients with and without RE.Results: Among 1575 patients, 142 (9.0%) had RE at the follow-up EGD. The time interval from HP eradication until EGD ranged from 4 to 24 months. The endoscopic grade of RE was higher in males than in females. Multivariate analysis revealed that male sex (odds ratio [OR], 1.51; 95% confidence interval [CI], 1.04-2.24), body mass index ≥25 kg/m2 (OR, 2.91; 95% CI, 2.00-4.22), use of calcium channel blockers (OR, 1.70; 95% CI, 1.12-2.55), and hiatal hernia (OR, 3.46; 95% CI, 2.41-5.00) were associated with the development of RE.Conclusions: Calcium channel blocker use was found to be a risk factor for the development of RE after eradication of HP.. |
| 46. |
Moriyama T, Kudo K, Ueda S, Tomimatsu S, Shimizu S, Remote education of early gastric cancer in Central Asia and Russia, News of the Academy of Sciences of the Republic of Tajikistan, 257, 105-111, 2019.10. |
| 47. |
Maehata Y, Nagata Y, Moriyama T, Matsuno Y, Hirano A, Umeno J, Torisu T, Manabe T, Kitazono T, Esaki M, Risk of surgery in patients with structuring type of Crohn’s disease at the initial diagnosis: a single center experience, Intest Res, 10.5217/ir.2018.00107, 17, 3, 357-364, 2019.07, BACKGROUND/AIMS: It remains uncertain which patients with stricturing-type Crohn's disease (CD) require early small bowel surgery after the initial diagnosis. We aimed to clarify clinical characteristics associated with the intervention in such condition of CD. METHODS: We retrospectively evaluated the clinical course of 53 patients with CD and small bowel strictures who were initially treated with medications after the initial diagnosis. We investigated possible associations between small bowel surgery and the following: clinical factors and radiologic findings at initial diagnosis and the types of medications administered during follow-up. RESULTS: Twenty-eight patients (53%) required small bowel resection during a median follow-up period of 5.0 years (range, 0.5-14.3 years). The cumulative incidence rates of small bowel surgery at 2, 5, and 10 years were 26.4%, 41.0%, and 63.2%, respectively. Univariate analysis indicated that obstructive symptoms (P=0.036), long-segment stricture (P |
| 48. |
Ihara Y, Torisu T, Moriyama T, Umeno J, Hirano A, Okamoto Y, Hori Y, Yamamoto H, Kitazono T, Esaki M, Endoscopic features of gastrointestinal stromal tumor in the small intestine, Intest Res, 10.5217/ir.2018.00161, 17, 3, 398-403, 2019.07, BACKGROUND/AIMS: Gastrointestinal stromal tumor (GIST) is one of the most common types of submucosal tumors (SMTs). Because of GIST's malignant potential, it is crucial to differentiate it from other SMTs. The present study aimed to identify characteristic endoscopic findings of GISTs in the small intestine. METHODS: We reviewed the clinicopathological and endoscopic findings of 38 patients with endoscopically or surgically resected SMTs in the small intestine. SMTs were classified into GIST and non-GIST groups, and clinicopathological and endoscopic findings were compared between the 2 groups. RESULTS: Fifteen patients had GIST and 23 patients had other types of SMTs in the small intestine. Comparison of the endoscopic findings between the 2 groups revealed that dilated vessels in the surrounding mucosa were significantly more in number in the GIST group than in the non-GIST group (P |
| 49. |
Yutaka Nagata, Motohiro Esaki, Moriyama Tomohiko, Atsushi Hirano, Junji Umeno, Yuji Maehata, takehiro torisu, Takayuki Matsumoto, Takanari Kitazono, Anti-tumor necrosis factor therapy decreases the risk of initial intestinal surgery after diagnosis of Crohn’s disease of inflammatory type, Journal of gastroenterology, 10.1007/s00535-018-1511-x, 54, 4, 330-338, 2019.04, Background: Anti-tumor necrosis factor (TNF) therapy induces and maintains clinical remission in patients with Crohn’s disease (CD). However, the effect of anti-TNF therapy on the natural course of CD remains controversial. We aimed to investigate the effect of anti-TNF therapy on the initial intestinal surgery for CD. Methods: In this single-center retrospective cohort study, clinical course of 199 CD patients of inflammatory type at the initial diagnosis (the period between 1973 and 2014) was precisely reviewed until the end of 2016. Patients were divided into TNF and non-TNF groups based on anti-TNF agent use. After comparisons of clinical characteristics and medical treatments, propensity scores were calculated for covariates. Risk of intestinal surgery was compared by a Cox proportional hazards model using the propensity scores. The effect of immunomodulators on initial intestinal surgery was assessed in the TNF group. Results: During the study period, 108 patients received anti-TNF therapy. The patients in the TNF group were diagnosed more recently, and more frequently had isolated colonic involvement, and perianal disease. Immunomodulators were more frequently used in the TNF group. Cumulative probability of initial intestinal surgery was significantly lower in the TNF group (P |
| 50. |
Nagata Y, Esaki M, Moriyama T, Hirano A, Umeno J, Maehata Y, Torisu T, Matsumoto T, Kitazono T, Anti-tumor necrosis factor therapy decreases the risk of initial intestinal surgery after diagnosis of Crohn’s disease of inflammatory type, J Gastroenterol, 10.1007/s00535-018-1511-x, 54, 4, 330-338, 2019.04, BACKGROUND: Anti-tumor necrosis factor (TNF) therapy induces and maintains clinical remission in patients with Crohn's disease (CD). However, the effect of anti-TNF therapy on the natural course of CD remains controversial. We aimed to investigate the effect of anti-TNF therapy on the initial intestinal surgery for CD. METHODS: In this single-center retrospective cohort study, clinical course of 199 CD patients of inflammatory type at the initial diagnosis (the period between 1973 and 2014) was precisely reviewed until the end of 2016. Patients were divided into TNF and non-TNF groups based on anti-TNF agent use. After comparisons of clinical characteristics and medical treatments, propensity scores were calculated for covariates. Risk of intestinal surgery was compared by a Cox proportional hazards model using the propensity scores. The effect of immunomodulators on initial intestinal surgery was assessed in the TNF group. RESULTS: During the study period, 108 patients received anti-TNF therapy. The patients in the TNF group were diagnosed more recently, and more frequently had isolated colonic involvement, and perianal disease. Immunomodulators were more frequently used in the TNF group. Cumulative probability of initial intestinal surgery was significantly lower in the TNF group (P |
| 51. |
Kudo K, Moriyama T, Tomimatsu S, Ueda S, Shimizu S, A train-the trainer program for engineers for hosting multiparty international clinical teleconferences, J Int Soc Telemed eHealth, 7, e16, 1-8, 2019.03. |
| 52. |
Yasuharu Okamoto, Ryu Nakadate, Shotaro Nakamura, Jumpei Arata, Susumu Oguri, Moriyama Tomohiko, Motohiro Esaki, tsutomu iwasa, Kenoki Ouchida, Tomohiko Akahoshi, Tetsuo Ikeda, Takanari Kitazono, Makoto Hashizume, Colorectal endoscopic submucosal dissection using novel articulating devices a comparative study in a live porcine model, Surgical endoscopy, 10.1007/s00464-018-6408-5, 33, 2, 651-657, 2019.02, Background and aims: Colonic endoscopic submucosal dissection (ESD) is time-consuming and bears a high risk of perforation. The aim of the present study was to compare the safety and efficacy between novel articulating devices and conventional ESD in live porcine colon models. Methods: Thirty ESDs in ten pigs were carried out at three different locations (15, 25, and 35 cm from the anus) by the conventional method (n = 15) and by the new method (n = 15). Procedure times, adverse events (perforation, bleeding), and damage to the muscular layer were recorded, and the ESD time per unit area of the specimens was calculated. Results: The perforation rate using the conventional method was 6.7% (1/15), whereas that using the new method was 0.0%. The number of sites of muscular damage was significantly lower in the new than conventional method (6 vs. 37, respectively; P = 0.024). The mean procedure time was significantly shorter in the new than conventional method (4.6 ± 2.0 vs. 7.0 ± 4.1 min/cm
2
, respectively; P = 0.042). Conclusions: Use of the new ESD method allows for reduced adverse events and a shortened resection time.. |
| 53. |
Yoji Takeuchi, Manabu Sawaya, Shiro Oka, Naoto Tamai, Takuji Kawamura, Toshio Uraoka, Hiroaki Ikematsu, Moriyama Tomohiko, Masamichi Arao, Hideki Ishikawa, Yuri Ito, Takahisa Matsuda, Efficacy of autofluorescence imaging for flat neoplasm detection a multicenter randomized controlled trial (A-FLAT trial), Gastrointestinal Endoscopy, 10.1016/j.gie.2018.11.012, 89, 3, 460-469, 2019.01, Background and Aims: Colorectal flat (nonpolypoid) lesions can be overlooked during colonoscopy. This study evaluated the efficacy of updated autofluorescence imaging (AFI) for detecting colorectal flat neoplasms. Methods: This was a prospective, multicenter, randomized controlled trial in 9 Japanese tertiary institutions. Patients undergoing colonoscopy because of positive fecal immunochemical tests, surveillance after polypectomy, or investigation of minor symptoms were enrolled and randomly assigned to either the white-light imaging (WLI) or the AFI group. Primary outcome measurement was number of flat neoplasms per patient. Results: From November 2015 to June 2017, 817 patients were enrolled. After excluding 15 patients, 802 were finally analyzed (404, WLI; 398, AFI). Patients’ backgrounds (sex, age, indication of colonoscopy, experience of endoscopists) and quality of colonoscopy (bowel preparation, sedative use, cecal insertion rate, insertion and withdrawal time) were not different between groups. Number of flat neoplasms in each patient was significantly higher in the AFI than in the WLI group (.87 [95% confidence interval [CI],.78-.97] vs.53 [95% CI,.46-.61]), whereas overall and polypoid neoplasm detection was not significantly different between the groups (1.33 [95% CI, 1.22-1.45] vs 1.14 [95% CI, 1.03-1.24],.46 [95% CI,.40-.53] vs.60 [95% CI,.53-.68]). Flat neoplasms were more frequently detected in the right-sided colon with AFI (.61 [95% CI,.54-.70] vs.30 [95% CI,.25-.36]) but not in the left-sided colon and rectum (.26 [95% CI,.21-.32] vs.23 [95% CI,.19-.28]). Conclusions: Updated AFI improves the detection of flat colorectal neoplasms in the right-sided colon compared with WLI. (Clinical trial registration number: UMIN000019355.). |
| 54. |
Akira Harada, Takehiro Torisu, Yasuharu Okamoto, Atsushi Hirano, Junji Umeno, Moriyama Tomohiko, Ema Washio, Yuta Fuyuno, Shin Fujioka, Takanari Kitazono, Motohiro Esaki, Predictive Factors for Rebleeding after Negative Capsule Endoscopy among Patients with Overt Obscure Gastrointestinal Bleeding, Digestion, 10.1159/000496826, 101, 2, 129-136, 2019.01, Background: Although capsule endoscopy (CE) is useful to evaluate obscure gastrointestinal bleeding (OGIB), CE does not always identify the responsible lesions in patients with overt OGIB. Objectives: To identify factors predictive of rebleeding after negative CE in patients with overt OGIB. Methods: We retrospectively analyzed the clinical data of 221 patients who underwent CE for overt OGIB. Among 120 patients with negative CE findings, clinical course of 112 patients after CE was followed-up. Clinical factors associated with rebleeding after negative CE and lesions responsible for rebleeding were investigated. Results: Rebleeding was identified in 37 patients (33.0%) during follow-up after negative CE, and 36 patients (32.1%) developed rebleeding within 24 months after negative CE. Multivariate analyses showed that ongoing overt OGIB (OR 2.67; 95% CI 1.07-5.80; p = 0.036) and severe anemia at the initial CE examination (OR 2.54; 95% CI 1.33-4.96; p = 0.005) were independent factors -associated with rebleeding. Rebleeding source was detected in 13 patients. Conclusions: Rebleeding is not a rare condition among patients with overt OGIB after negative CE. Patients with ongoing overt OGIB or severe anemia at the initial CE examination seem to have a higher risk of rebleeding.. |
| 55. |
Tomimatsu S, Kudo K, Moriyama T, Moriyama T, Taguchi T, Shimizu S, How to prevent technical issues in large multiparty medical videoconferencing., J Int Soc Telemed eHealth, 2018.11. |
| 56. |
Technical agenda considering QoE in large multiparty videoconferencing for clinical case study. |
| 57. |
Ueda S, Kudo K, Moriyama T, Suyama Y, Shimizu S, A step forward in sharing images during telemedicine conference (JTTA 2018 FUKUOKA 第22回日本遠隔医療学会学術大会), 日本遠隔医療学会雑誌 = Japanese journal of telemedicine and telecare, 14, 2, 151-154, 2018.10. |
| 58. |
Atsushi Hirano, Junji Umeno, Yasuharu Okamoto, Hiroki Shibata, Yoshitoshi Ogura, Moriyama Tomohiko, takehiro torisu, Shin Fujioka, Yuta Fuyuno, Yutaka Kawarabayasi, Takayuki Matsumoto, Takanari Kitazono, Motohiro Esaki, Comparison of the microbial community structure between inflamed and non-inflamed sites in patients with ulcerative colitis, Journal of Gastroenterology and Hepatology (Australia), 10.1111/jgh.14129, 33, 9, 1590-1597, 2018.09, Background and Aim: The gut microbiota is suggested to play an important role in the pathogenesis of ulcerative colitis (UC). However, interindividual and spatial variations hamper the identification of UC-related changes. We thus investigated paired mucosa-associated microbiota obtained from both inflamed and non-inflamed sites of UC patients and corresponding sites of non-inflammatory bowel disease (IBD) controls. Methods: Mucosal biopsies of both inflamed and non-inflamed sites were obtained from 14 patients with active UC of the left-sided or proctitis type. Paired mucosal biopsies of the corresponding sites were obtained from 14 non-IBD controls. The microbial community structure was investigated using 16S ribosomal RNA gene sequences, followed by data analysis using qiime and LEfSe softwares. Results: Microbial alpha diversity in both inflamed and non-inflamed sites was significantly lower in UC patients compared with non-IBD controls. There were more microbes of the genus Cloacibacterium and the Tissierellaceae family, and there were less microbes of the genus Neisseria at the inflamed site when compared with the non-inflamed site in UC patients. Decreased abundance of the genera Prevotella, Eubacterium, Neisseria, Leptotrichia, Bilophila, Desulfovibrio, and Butyricimonas was evident at the inflamed site of UC patients compared with the corresponding site of non-IBD controls. Among these taxa, the genera Prevotella and Butyricimonas were also less abundant at the non-inflamed site of UC patients compared with the corresponding site in non-IBD controls. Conclusions: Mucosal microbial dysbiosis occurs at both inflamed and non-inflamed sites in UC patients. The taxa showing altered abundance in UC patients might mediate colonic inflammation.. |
| 59. |
Maehata Y, Nakamura S, Esaki M, Ikeda F, Moriyama T, Hida R, Washio E, Umeno J, Hirahashi M, Kitazono T, Matsumoto T, Characteristics of primary and metachronous gastric cancers discovered after Helicobacter pylori eradication: A multicenter propensity score-matched study., Gut Liver, 2017.11. |
| 60. |
Kudo K, Tomimatsu S, Moriyama T, Tanimoto MA, Jalife SLV, Shimizu S, Remote Medical Education in Latin America, 267-276, 2017.07. |
| 61. |
Youichiro Nuki, Moriyama Tomohiko, Comparison of the therapeutic efficacy and safety between tacrolimus and infliximab for moderate-to-severe ulcerative colitis: a single center experience., Scandinavian journal of gastroenterology, 10.3109/00365521.2016.1138239, 51, 6, 700-5, 2016.06, OBJECTIVE: Both tacrolimus (Tac) and infliximab (IFX) are effective for moderate-to-severe ulcerative colitis (UC). The aim of this study was to compare the therapeutic efficacy and safety of both drugs. MATERIALS AND METHODS: We performed a retrospective analysis of 46 patients with moderate-to-severe UC who were treated either by Tac (n = 21) or IFX (n = 25). We compared the remission and response rates for 10 weeks between the two groups. In patients who achieved a clinical response, the subsequent relapse rate was compared. The overall adverse events were also compared between the two groups. RESULTS: The remission and response rates at week 10 did not differ between patients treated with Tac (67% and 86%, respectively) and patients treated with IFX (76% and 92%, respectively). Among 41 patients showing a clinical response, eight of 23 patients treated with IFX and eight of 18 patients treated with Tac showed a subsequent relapse. The risk of relapse was not different between the two groups. While no serious adverse events were observed, the incidence of adverse events was higher in patients treated with Tac than in those treated with IFX. CONCLUSION: Tac and IFX may be equally efficacious for the induction and maintenance of remission in patients with UC while minor adverse events are more frequent with the former treatment.. |
| 62. |
Asano Kouichi, Moriyama Tomohiko, Contribution of susceptibility variants at FCGR2A and 13q12 to the risk of relapse among Japanese patients with ulcerative colitis., Journal of Gastroenterology, 10.1007/s00535-015-1062-3, 50, 11, 1094-102, 2015.11, BACKGROUND: Recent genome-wide association studies have identified nearly 100 susceptibility genes for ulcerative colitis (UC). However, the contribution of susceptibility variants for UC to clinical outcome has scarcely been reported. The aim of this study was to investigate whether UC-associated genetic variants confer a risk of clinical relapse. METHODS: One hundred and nine consecutive Japanese subjects with quiescent UC were recruited. Four genetic variants of HLA-DRB1*1502, rs6671847 at FCGR2A, rs17085007 at 13q12, and rs2108225 at SLC26A3 were genotyped by Invader assay. The clinical courses were followed after blood sampling, and the risk of relapse according to these genotypes was calculated by Cox proportional hazard model. RESULTS: During the mean follow-up period of 35 months (range 1-81 months), 49 of 109 subjects (45 %) relapsed. Carriers of the G allele of rs6671847 showed an increased risk of relapse compared with non-carriers [adjusted hazard ratio (HR), 2.27; 95 % confidence interval (CI), 1.20-4.32; p = 0.01]. Patients with the CT or TT genotypes of rs17085007 also had an increased risk of relapse compared to subjects with the CC genotype (for CT: adjusted HR, 2.16; 95 % CI, 1.10-4.23; p = 0.03; for TT: adjusted HR, 3.25; 95 % CI, 1.18-8.95; p = 0.02). These two risk variants multiplied the risk of relapse by 2.74 times (95 % CI, 1.10-4.23; p = 0.01) in patients with one risk genotype and 5.40 times (95 % CI, 2.06-14.13; p = 0.0006) in patients with both risk genotypes. CONCLUSIONS: Genetic variants of rs6671847 at FCGR2A and rs17085007 at 13q12 conferred a risk of relapse in patients with UC.. |
| 63. |
Nagata Y, Esaki M, Umeno J, Fuyuno Y, Ikegami K, Maehata Y, Asano K, Moriyama T, Nakamura S, Kitazono T, Matsumoto T, Therapeutic strategy for Crohn's disease with a loss of response to infliximab: a single-center retrospective study, Digestion, 10.1159/000368815, 91, 1, 50-6, 2015.11, BACKGROUND/AIMS: Infliximab (IFX) is an effective treatment for maintaining clinical remission in patients with initially moderate-to-severe Crohn's disease (CD). However, a certain number of patients become unresponsive to IFX, subsequently requiring intensified therapy. The aim of this study was to compare the short- and long-term therapeutic efficacy of intensified regimens in CD patients who fail to respond to IFX. METHODS: The clinical courses of 33 CD patients who failed to respond to treatment with IFX were investigated retrospectively. An intensified regimen involving doubling the dose of IFX was chosen in 13 patients (DD group) versus shortening the IFX interval in 13 patients (SI group) and switching to adalimumab (ADA) in 7 patients (SA group). RESULTS: The clinical response and rate of clinical remission at 4 weeks were 62 and 54% in the DD group, 77 and 62% in the SI group and 57 and 43% in the SA group, respectively (p = 0.59 for clinical response, p = 0.90 for clinical remission). The rate of sustained remission at 48 weeks was 44% in the DD group, 54% in the SI group and 33% in the SA group (p = 0.88). CONCLUSION: The short- and long-term efficacy of doubling the dose of IFX, shortening the interval of IFX or switching to ADA is similar for CD patients who no longer respond to IFX.. |
| 64. |
Shiro Oka, Moriyama Tomohiko, Improved visibility of colorectal flat tumors using image-enhanced endoscopy, Digestive Endoscopy, 10.1111/den.12445, 27 Suppl 1, 35-9, 2015.04, Colonoscopy is considered the gold standard for detecting colorectal tumors; however, conventional colonoscopy can miss flat tumors. We aimed to determine whether visualization of colorectal flat lesions was improved by autofluorescence imaging and narrow-band imaging image analysis in conjunction with a new endoscopy system. Eight physicians compared autofluorescent, narrow-band, and chromoendoscopy images to 30 corresponding white-light images of flat tumors. Physicians rated tumor visibility from each image set as follows: +2 (improved), +1 (somewhat improved), 0 (equivalent to white light), -1 (somewhat decreased), and -2 (decreased). The eight scores for each image were totalled and evaluated. Interobserver agreement was also examined. Autofluorescent, narrow-band, and chromoendoscopy images showed improvements of 63.3% (19/30), 6.7% (2/30), and 73.3% (22/30), respectively, with no instances of decreased visibility. Autofluorescence scores were generally greater than narrow-band scores. Interobserver agreement was 0.65 for autofluorescence, 0.80 for narrow-band imaging, and 0.70 for chromoendoscopy. In conclusion, using a new endoscopy system in conjunction with autofluorescent imaging improved visibility of colorectal flat tumors, equivalent to the visibility achieved using chromoendoscopy.. |
| 65. |
Toshio Uraoka, Moriyama Tomohiko, Feasibility of a novel colonoscope with extra-wide angle of view: a clinical study, Endoscopy, 2015.03. |
| 66. |
Ryu Nakadate, Moriyama Tomohiko, Gastric endoscopic submucosal dissection using novel 2.6-mm articulating devices: an ex vivo comparative and in vivo feasibility study, Endoscopy, 2015.02. |
| 67. |
Yutaka Nagata, motohiro esaki, Moriyama Tomohiko, Therapeutic strategy for Crohn’s disease with a loss of response to infliximab: a single-center retrospective study, Digestion, 10.1159/000368815, 91, 1, 50-6, 2015.01, BACKGROUND/AIMS: Infliximab (IFX) is an effective treatment for maintaining clinical remission in patients with initially moderate-to-severe Crohn's disease (CD). However, a certain number of patients become unresponsive to IFX, subsequently requiring intensified therapy. The aim of this study was to compare the short- and long-term therapeutic efficacy of intensified regimens in CD patients who fail to respond to IFX. METHODS: The clinical courses of 33 CD patients who failed to respond to treatment with IFX were investigated retrospectively. An intensified regimen involving doubling the dose of IFX was chosen in 13 patients (DD group) versus shortening the IFX interval in 13 patients (SI group) and switching to adalimumab (ADA) in 7 patients (SA group). RESULTS: The clinical response and rate of clinical remission at 4 weeks were 62 and 54% in the DD group, 77 and 62% in the SI group and 57 and 43% in the SA group, respectively (p = 0.59 for clinical response, p = 0.90 for clinical remission). The rate of sustained remission at 48 weeks was 44% in the DD group, 54% in the SI group and 33% in the SA group (p = 0.88). CONCLUSION: The short- and long-term efficacy of doubling the dose of IFX, shortening the interval of IFX or switching to ADA is similar for CD patients who no longer respond to IFX.. |
| 68. |
Moriyama Tomohiko, Takayuki Matsumoto, motohiro esaki, Shotaro Nakamura, Hiroshi Kimura, Topical anesthesia for transnasal esophagogastroduodenoscopy: spray, applicator, or both?, Digestive Endoscopy, 25, 20-24, 2013.03, 経鼻内視鏡検査の前処置方法について、スプレー法、スティック法、併用法で比較検討を行った。. |
| 69. |
Atsushi Hirano, Motohiro Esaki, Tomohiko Moriyama, Kouhei Fujita, Minako Hirahashi, Takayuki Matsumoto, Comparison of capsule endoscopy and double balloon endoscopy for the diagnosis of submucosal tumor of the small bowel, DIGESTIVE ENDOSCOPY, 10.1111/j.1443-1661.2011.01223.x, 24, 4, 287-287, 2012.07. |
| 70. |
Maehata Y, Nakamura S, Fujisawa K, Esaki M, Moriyama T, Asano K, Fuyuno Y, Yamaguchi K, Egashira I, Kim H, Kanda M, Hirahashi M, Matsumoto T., Long-term effect of Helicobacter pylori eradication on the development of metachronous gastric cancer after endoscopic resection of early gastric cancer., Gastrointestinal endoscopy, 75, 39-46, 2012.01. |
| 71. |
T. Matsumoto, S. Nakamura, T. Moriyama, M. Hirahashi, M. Iida, Autofluorescence imaging colonoscopy for the detection of dysplastic lesions in ulcerative colitis: a pilot study, COLORECTAL DISEASE, 10.1111/j.1463-1318.2009.02181.x, 12, 10, E291-E297, 2010.10, Aim Autofluorescence imaging (AFI) is a novel technology for endoscopy, which enhances neoplastic lesions of the gastrointestinal tract. The aim of this investigation was to examine whether AFI colonoscopy can identify dysplasia in ulcerative colitis.
Method We examined 48 patients with ulcerative colitis by AFI colonoscopy. Apparently flat, coarse granular mucosa and visible protruding lesions under conventional colonoscopy were observed by AFI. Those target areas were classified into low AF and high AF according to the colour under AFI colonoscopy. The grade of dysplasia was determined in the specimens obtained from the target areas.
Results About 126 sites (35 protruding lesions and 91 flat areas) were examined by AFI colonoscopy. AF was determined to be high in 42 areas and to be low in 84 areas. The positive rate of dysplasia was higher in protrusions (31%) than in flat mucosa (3.3%, P Conclusions Autofluorescence imaging colonoscopy seems to have a role for the detection of dysplaia in ulcerative colitis.. |
| 72. |
Moriyama T, Matsumoto T, Hirakawa K, Ikeda H, Tsuruya K, Hirakata H, Iida M, Helicobacter pylori status and esophagogastroduodenal mucosal lesions in patients with end-stage renal failure on maintenance hemodialysis., Journal of gastroenterology, 2010.03. |
| 73. |
Matsumoto T, Nakamura S, Esaki M, Yada S, Moriyama T, Yanai S, Hirahashi M, Yao T, Iida M, Double-balloon endoscopy depicts diminutive small bowel lesions in gastrointestinal lymphoma, Digestive Disease and Science, 55, 158-165, 2010.01. |
| 74. |
Takayuki Matsumoto, Shotaro Nakamura, Motohiro Esaki, Shinichiro Yada, Tomohiko Moriyama, Shunichi Yanai, Minako Hirahashi, Takashi Yao, Mitsuo Iida, Double-balloon endoscopy depicts diminutive small bowel lesions in gastrointestinal lymphoma., Digestive diseases and sciences, 10.1007/s10620-009-0713-8, 55, 1, 158-65, 2010.01, The aim was to determine the prevalence of small bowel involvement in patients with gastrointestinal (GI) lymphoma by double-balloon endoscopy (DBE). We examined 29 patients with primary GI lymphoma by oral and anal DBEs. Clinicopathologic features related to the prevalence of diminutive small bowel involvement and the clinical outcome were retrospectively investigated. Diminutive small bowel lesions were found in 14 patients. The prevalence of the lesions was not different between patients with primary small bowel lymphoma and those with primary extra-small bowel lymphoma (50% versus 47%, P = 0.6). However, clinical stage was more advanced in patients with the lesions than in those without (P |
| 75. |
Takayuki Matsumoto, Motohiro Esaki, Ritsuko Yanaru-Fujisawa, Tomohiko Moriyama, Shinichiro Yada, Shotaro Nakamura, Takashi Yao, Mitsuo Iida, Small-intestinal involvement in familial adenomatous polyposis: evaluation by double-balloon endoscopy and intraoperative enteroscopy., Gastrointestinal endoscopy, 10.1016/j.gie.2008.02.067, 68, 5, 911-9, 2008.11, BACKGROUND: Small-intestinal adenoma occurs in patients with familial adenomatous polyposis (FAP). OBJECTIVES: The aim was to analyze the diagnostic yield of a double-balloon endoscopy (DBE) and an intraoperative enteroscopy (IOE) for small-intestinal involvement in FAP. PATIENTS: Forty-one patients with FAP. INTERVENTIONS: We examined 12 patients with FAP by using oral DBE before a colectomy and 29 patients with FAP by using IOE. The incidence and the endoscopic findings of adenoma were compared between the 2 procedures. Phenotypes of FAP and genotypes of adenomatous polyposis coli (APC) were then compared between patients with small-intestinal adenomas and those without. The genotype was classified into a 5' mutation (exons 1-14), a 3' mutation (exon 15), and a negative mutation of APC. MAIN OUTCOME MEASUREMENT: The prevalence of adenoma. RESULTS: A DBE detected small-intestinal adenomas in 9 of 12 patients (75%), as did an IOE in 15 of 29 patients (52%, P > .05). The adenomas occurred predominantly in the jejunum, with a configuration of diminutive polyps in 22 patients. In addition, a DBE detected nonpolypoid adenoma in a patient, and nodular, broad-based protrusion (advanced lesions) in 3 patients, whereas an IOE detected advanced lesions in a patient. Patients with small-intestinal adenoma had more severe duodenal adenomatosis than those patients without small-intestinal adenoma (P |
| 76. |
Takayuki Matsumoto, Motohiro Esaki, Shinichiro Yada, Yukihiko Jo, Tomohiko Moriyama, Mitsuo Iida, Is small-bowel radiography necessary before double-balloon endoscopy?, AJR. American journal of roentgenology, 10.2214/AJR.07.3155, 191, 1, 175-81, 2008.07, OBJECTIVE: Small-bowel radiography may be replaced by enteroscopy in the diagnosis of small-intestine lesions. We retrospectively elucidated the diagnostic yield of small-bowel radiography performed before double-balloon endoscopy. MATERIALS AND METHODS: One hundred twenty-four patients who underwent double-balloon endoscopy during the period 2004-2006 were classified into those with abnormal radiographic findings (n = 45), normal radiographic findings (n = 31), and no small-bowl radiographs (n = 48). The classification was based on the use of small-bowel radiography and the diagnosis before double-balloon endoscopy. The indications for, approaches to, and diagnostic yields of double-balloon endoscopy were compared for the three groups. The diagnostic yield of small-bowel radiography was considered positive when any sign of pathologic change in the small bowel was identified. The diagnostic yield of double-balloon endoscopy was considered positive when endoscopic or biopsy findings explained the clinical manifestations. RESULTS: The group with abnormal findings on small-bowel radiography was younger (15-86 years) and less frequently had obscure bleeding (8.9%) than the group with normal findings on small-bowel radiography (age, 17-84 years; frequency of obscure bleeding, 45.2%) (p = 0.01) or the group without small-bowel radiographs (age, 15-91 years; frequency of obscure bleeding, 64.6%) (p 0.1). CONCLUSION: The diagnostic accuracy of double-balloon endoscopy seems to improve if the procedure is preceded by small-bowel radiography.. |
| 77. |
Matsumoto T, Esaki M, Yada S, Jo Y, Moriyama T, Iida M, Is small-bowel radiography necessary before double-balloon endoscopy?, America Journal of Roentgenology, 191: 175-181, 2008, 2008.06. |
| 78. |
Matsumoto T, Esaki M, Yanaru-Fujisawa R, Moriyama T, Yada S, Nakamura S, Yao T, Iida M, Small-intestinal involvement in familial adenomatous polyposis: evaluation by double-balloon endoscopy and intraoperative enteroscopy, Gastrointestinal Endoscopy, 68: 911-919, 2008, 2008.06. |
| 79. |
Tomohiko Moriyama, Takayuki Matsumoto, Shotaro Nakamura, Yukihiko Jo, Ryuichi Mibu, Takashi Yao, Mitsuo Iida, Hypermethylation of p14 (ARF) may be predictive of colitic cancer in patients with ulcerative colitis., Diseases of the colon and rectum, 50, 9, 1384-92, 2007.09, PURPOSE: The microsatellite instability and CpG island hypermethylation of p14 ( ARF ) and p16 ( INK4a ) are related to the pathogenesis of neoplasia in ulcerative colitis. This study was designed to assess the significance of those genetic or epigenetic alterations for cancer surveillance in ulcerative colitis. METHODS: During surveillance colonoscopy in 39 patients with ulcerative colitis, biopsy specimens were obtained from the cecum and the rectum as well as from any other areas suspected of being neoplasia by chromoscopy. Using DNA extracts, the methylation status of p14 ( ARF ) and p16 ( INK4a ) and the microsatellite status were determined. RESULTS: Microsatellite instability was positive in one of five dysplasias, but it was negative in the cecum and the rectum. The incidence of hypermethylation of p14 ( ARF ) was 0 percent in the cecum, 26 percent in the rectum, and 100 percent in dysplasia, whereas that of p16 ( INK4a ) was 10, 10, and 0 percent, respectively. Patients who were positive for the hypermethylation of p14 ( ARF )in the rectum had a longer duration of ulcerative colitis than those who were negative for such hypermethylation. Two of 10 patients who were positive for p14 ( ARF ) hypermethylation in the rectum and 1 of 29 patients who were negative for the hypermethylation had dysplasia. During the subsequent surveillance of 36 patients, dysplasia was detected in 2 of 8 patients with p14 ( ARF ) hypermethylation and in none of 28 patients without hypermethylation (P = 0.044). CONCLUSIONS: In patients with ulcerative colitis, hypermethylation of p14 ( ARF ) seems to be associated with an early stage of dysplasia. The hypermethylation may be one of candidates for potential biomarker to identify patients at a high risk of dysplasia.. |
| 80. |
Takayuki Matsumoto, Tomohiko Moriyama, Takashi Yao, Ryuichi Mibu, Mitsuo Iida, Autofluorescence imaging colonoscopy for the diagnosis of dysplasia in ulcerative colitis., Inflammatory bowel diseases, 13, 5, 640-1, 2007.05. |
| 81. |
Moriyama T, Matsumoto T, Nakamura S, Jo Y, Mibu R, Yao T, Iida M, Hypermethylation of p14(ARF) may be predictive of colitic cancer in patients with ulcerative colitis., Dis Colon Rectum, 50: 1384-1392, 2007.01. |
| 82. |
Motohiro Esaki, Takayuki Matsumoto, Tomohiko Moriyama, Kazuoki Hizawa, Yutaka Ohji, Shotaro Nakamura, Katsuya Hirakawa, Minako Hirahashi, Takashi Yao, Mitsuo Iida, Probe EUS for the diagnosis of invasion depth in superficial esophageal cancer: a comparison between a jelly-filled method and a water-filled balloon method., Gastrointestinal endoscopy, 63, 3, 389-95, 2006.03, BACKGROUND AND OBJECTIVE: Diagnostic accuracy of probe EUS depends on the constant maintenance of luminal medium for acoustic coupling. This study compared the accuracy of probe EUS by a jelly-filled method (EUS-J) and by a water-filled balloon method (EUS-W) for the assessment of invasion depth in superficial esophageal cancer. DESIGN AND SETTING: A prospective, single-center study. PATIENTS: Forty superficial esophageal cancers in 38 patients. INTERVENTIONS: Patients were alternately assigned to EUS-J or EUS-W. The depth of invasion was classified into epithelium or lamina propria mucosae (D1), muscularis mucosae or superficial layer of the submucosa (D2), and deep portion of the submucosa (D3). Depiction rate, interobserver variation between 2 observers, and accuracy for the determination of invasion depth were compared between EUS-J and EUS-W. MAIN OUTCOME MEASUREMENTS AND RESULTS: Eighteen cancers were examined by EUS-J, and 22 cancers were examined by EUS-W. The actual depth of invasion was D1 in 21 cancers, D2 in 9 cancers, and D3 in 10 cancers. Depiction rate (94.4% vs 77.2%, P = .14) and interobserver agreement of EUS determination (82.3% vs 58.8%, P = .13) was higher in EUS-J than in EUS-W. The overall accuracy for the diagnosis of invasion depth was 77.8% in EUS-J and 59.1% in EUS-W (P = .18). The sensitivity for the diagnosis of D1 cancer was significantly higher in EUS-J than in EUS-W (100% vs 50%, P = .03), while the specificity was not different between the 2 procedures (81.8% vs 87.5%). CONCLUSIONS: EUS-J is superior to EUS-W for the assessment of invasion depth in superficial esophageal cancer, especially for intramucosal cancer.. |
| 83. |
Takayuki Matsumoto, Tomohiko Moriyama, Motohiro Esaki, Shotaro Nakamura, Mitsuo Iida, Performance of antegrade double-balloon enteroscopy: comparison with push enteroscopy., Gastrointestinal endoscopy, 62, 3, 392-8, 2005.09, BACKGROUND: Double-balloon enteroscopy (DBE) is a novel procedure for the diagnosis of small-bowel pathology. The aim of this retrospective study was to compare the performance and the diagnostic value of antegrade DBE with those of push enteroscopy (PE). METHODS: We reviewed endoscopic and histologic findings in 118 patients examined by PE or antegrade DBE during a period 1980 to 2004. The maximal length of insertion under plain radiograph was compared between patients examined by PE and those examined by antegrade DBE. Diagnostic yield was compared among patients stratified by indication for enteroscopy and the duodenal pathology. RESULTS: Ninety-one patients were examined by PE and 27 patients by antegrade DBE. Length of insertion from the ligament of Treitz was significantly greater in antegrade DBE (median, 92 cm; range, 40-144 cm) than in PE (median, 22 cm; range, 0-98 cm; p |
| 84. |
T Matsumoto, M Esaki, T Moriyama, S Nakamura, M Iida, Comparison of capsule endoscopy and enteroscopy with the double-balloon method in patients with obscure bleeding and polyposis, ENDOSCOPY, 10.1055/s-870207, 37, 9, 827-832, 2005.09, Background and Study Aims: Video capsule endoscopy and double-balloon enteroscopy (DBE) are novel methods of enteroscopy. The aim of this investigation was to compare the value of CE and DBE in the diagnosis of small-intestinal pathology.
Patients and Methods: Thirteen patients with gastrointestinal bleeding of obscure origin and nine patients with known gastrointestinal polyposis were examined using antegrade or retrograde DBE, and the most distal or proximal site in the explored small intestine was marked by submucosal injection of sterilized ink. The patients were then evaluated by CE. Video images obtained by CE were reviewed by an observer who was blinded to the DBE findings.
Results: DBE identified positive findings in 12 patients (54.5%). CE identified positive findings in the area explored by DBE in eight patients (36.4%), and in the unexplored area in 11 patients (50.0%). The overall diagnostic yield in the area explored by DBE did not differ between the two procedures. The enteroscopic findings in the area explored by DBE were concordant in 12 of 13 patients with gastrointestinal bleeding of obscure origin. In patients with polyposis, the diagnoses were discordant in three patients, in whom CE failed to detect any polyp. In two of three polyposis patients with concordant positive findings, DBE detected a larger number of polyps than CE did.
Conclusions: DBE appears to be superior to CE in the diagnosis of small-intestinal polyps, whereas the value for diagnosing gastrointestinal bleeding of obscure origin is similar in the two procedures.. |
| 85. |
T Moriyama, T Matsumoto, Y Jo, S Yada, M Hirahashi, T Yao, M Iida, Mucosal proinflammatory cytokine and chemokine expression of gastroduodenal lesions in Crohn's disease, ALIMENTARY PHARMACOLOGY & THERAPEUTICS, 21, 85-91, 2005.06, Background: The stomach and the duodenum are frequent sites of involvement by diminutive lesions in Crohn's disease (CD).
Aim: To assess mucosal proinflammatory cytokines and chemokines in gastroduodenat lesions of CD.
Methods: C-13-Urea breath test and upper endoscopy were performed in 29 CD patients and seven control subjects, and biopsy specimens were obtained from the gastric cardia and the duodenum. Histology and mucosal levels of IL-1 beta, IL-8/CXCL8 and RANTES/ CCL5 were assessed and compared according to the presence of gastric cardial lesion [bamboo joint-like appearance (BJA)] and duodenal lesion (notched appearance, aphthous erosion and polypoid lesion). In 11 CD patients, these procedures were repeatedly performed after administration of famotidine.
Results: H. pylori was less frequently positive in CD patients than in controls (10% vs. 71%, P = 0.003). Prevalence of cardial and duodenal lesion was significantly higher in CD than in controls (59% vs. 0%, P = 0.008 for gastric lesion; 45% vs. 0%, P = 0.034 for duodenal lesion). There were no differences in IL-1 beta, IL-8 and RANTES between CD and controls. Duodenal mucosal IL-1 beta and IL-8 were significantly higher in positive duodenal lesion than in negative duodenal lesion. However, there were no such differences with respect to cardial lesions. Endoscopic findings remained unchanged after administration of famotidine, while there was a trend towards decreases in IL-1 beta and IL-8 in the gastric cardia.
Conclusions: The pathogenesis of diminutive lesions of CD may be different between the stomach and the duodenum. Famotidine may not have a therapeutic effect on duodenal lesion in CD.. |
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Moriyama T, Matsumoto T, Jo Y, Yada S, Hirahashi M, Yao T, Iida M, Mucosal proinflammatory cytokine and chemokine expression of gastroduodenal lesions in Crohn’s disease., Aliment Pharmacol Ther, 10.1111/j.1365-2036.2005.02480.x, 21, 85-91, 21 Suppl 2: 85-91, 2005.01. |
| 87. |
T Moriyama, T Matsumoto, T Fuchigami, S Nakamura, N Ishikawa, N Takubo, S Yamamoto, Y Oshiro, M Nakanishi, K Tomioka, M Iida, Changes in Helicobacter pylori status in patients with rheumatoid arthritis under non-steroidal anti-inflammatory drugs, SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY, 10.1080/00365520310008089, 39, 2, 111-118, 2004.02, Background: The role of Helicobacter pylori infection in rheumatoid arthritis (RA) patients during treatment with non-steroidal anti-inflammatory drugs (NSAID) is still unclear. Methods: By means of endoscopy and biopsy, gastroduodenal lesions and H. pylori status were repeatedly examined in 88 RA patients at intervals ranging from 26 to 49 months. Histology and culture were applied to determine H. pylori status. Serial changes in gastroduodenal lesions and histologic score for mucosal atrophy were compared among groups classified by initial and second H. pylori status. Results: There were 28 patients with continuously positive H. pylori infection (CP group), 33 patients with continuously negative H. pylori infection (CN group), 7 patients in whom H. pylori status became negative (PN group), and 20 patients in whom H. pylori status could not be determined (UD group). Age, duration and species of NSAID, disease activity of RA, gastroprotective drugs applied and the prevalence of gastroduodenal mucosal lesions were not different among the groups at either the initial or the second examination. In the PN group, the score for mucosal atrophy at the second examination was significantly lower than at the initial examination, whereas no difference was found for the CP, CN and UD groups. Overall, histologic score for mucosal atrophy was higher in H. pylori-positive patients than in H. pylori-negative patients at both initial and second examination. Conclusions: In RA patients using NSAIDs, H. pylori infection may not affect the course of gastroduodenal lesions and activity of RA, but the infection contributes to mucosal atrophy.. |
| 88. |
Moriyama T, Matsumoto T, Fuchigami T, Nakamura S, Ishikawa N, Takubo N, Yamamoto S, Oshiro Y, Nakanishi M, Tomioka K, Iida M, Changes in Helicobacter pylori status in patients with rheumatoid arthritis under non-steroidal anti-inflammatory drugs., Scand J Gastroenterol, 10.1080/00365520310008089, 39, 2, 111-118, 39: 111-118, 2004.01. |
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Moriyama T, Matsumoto T, Hizawa K, Tada S, Fuchigami T, Iwai K, Yao T, Iida M, Inflammatory myoglandular polyps: a case series of nine patients., Endoscopy, 10.1055/s-2003-38138, 35, 4, 363-365, 35: 363-365, 2003.01. |
