Department of Gastroenterology and Endoscopy

Tomonori Yano, Hiroaki Ikematsu, Yasuhiro Oono, Keisuke Hori, Yusuke Yoda, Kensuke Shinmura, Tomohiro Kadota, Kenji Takashima, Youichi Yamamoto, Masayuki Suyama

Introduction

 The Department of Gastroenterology and Endoscopy consists of six staff doctors who specialize in endoscopic diagnosis and treatment for the gastrointestinal tract and head and neck cancer. The mission of our department is to achieve the following tasks related to cancer patients using endoscopy: early detection, less invasive treatment, palliation for painful symptoms.

The Team and What We Do

 The staff members of this department performed more than 15,000 endoscopic procedures in total and 2,000 EMR/ESD procedures in fiscal 2018 (Tables 1, 2). The number of cases are gradually increasing and the total in 2008 was the highest ever. Furthermore, the staff members performed minimally invasive endoscopic treatment including EMR/ ESD for early cancer, salvage treatment such as ESD or photodynamic therapy (PDT) for local failure after radiotherapy for esophageal cancer, and palliative treatments for patients with symptomatic advanced cancer such as stent placement, percutaneous endoscopic gastroscopy and balloon dilatation. In addition, the upper GI group aggressively performed endoscopic treatment for early pharyngeal cancer through collaboration with the department of head and neck surgery (Table 2). And, the colon group concentrates on diagnosis with fine magnified images using image enhanced endoscopy for adenoma or early cancer even in clinical practice. During daily endoscopic examinations, physicians access primary tumors through endoscopy, and easily take by biopsy numerous samples from cancerous lesions. Recently, a lot of molecular target agents are developed and included as practice in the oncology field. Therefore, the position of endoscopy is becoming more important in clinical oncology as an easy access tool for primary tumors.

Research activities

 The major research activities in this department are trance-rational (TR) research, innovation for new imaging and endoscopic equipment through collaboration with academia or companies, and clinical studies. In the TR research field, we collaboratively undertook work with several divisions in the Exploratory Oncology Research and Clinical Trial Center in order to elucidate the microenvironment and immunological status of cancer in digestive tracts and the head and neck using endoscopy taken materials. In 2018, we published the results of several important research projects including TR with the pathology division, which could clarify the endoscopic features of gastric cancers which represents several molecular targets including HER2. And, we also published clinical original articles of the feasibility or risk factors of recurrence related with salvage endoscopic treatment for esophageal cancer patients with local failure after chemoradiotherapy.

Clinical trails

 We are participating in an ongoing clinical trial to evaluate the efficacy and safety of tissue engineered cell sheets to prevent stricture after ESD for wide spreading superficial esophageal cancer. And, we are also participating in trials for a biodegradable stent for refractory benign esophageal stricture for regulatory approval. We conduct the investigator initiated clinical trials using novel imaging as follows: oxygen saturation imaging endoscopy for GI cancer to predict efficacy of chemotherapy or radiotherapy. And, we are planning investigator initiated clinical trials of photoimmunotherapy as an endoscopic procedure for patients with esophageal cancer, who cannot be treated with conventional treatments. Also, we are also conducting clinical trials of 3D luminal endoscopy for gastric ESD. As a member institution of the JCOG-GI endoscopy study group, we participate in several randomized control trials to develop standard endoscopic treatment for GI cancer.

Education

 In our department, there are three senior residents and nine residents. Trainees can carry out services under the training program while being observed by each specialist. And, they are trained not only in endoscopic diagnosis and endoscopic treatment strategy, but also pathological diagnosis, clinical or surgical oncology through conferences with other departments. Furthermore, they actively present their research work at international congresses, and publish papers in international peer reviewed journals. They wrote several study protocols mainly for innovative development in endoscopic imaging and treatment. Residents who want to learn more about regulatory science for medical devices, have a chance to study in PMDA or JCOG after graduation from their residence.

Future prospects

 We want to expand our endoscopic procedure activities in our daily practice using the large endoscopy center. Furthermore, we would like to innovate new endoscopic images or treatments through robust collaboration with companies and academic institutions for cancer patients not only now but also for those of future generations.

List of papers published in 2018

Journal

 1. Takeuchi Y, Sawaya M, Oka S, Tamai N, Kawamura T, Uraoka T, Ikematsu H, Moriyama T, Arao M, Ishikawa H, Ito Y, Matsuda T. Efficacy of autofluorescence imaging for flat neoplasm detection: a multicenter randomized controlled trial (A-FLAT trial). Gastrointest Endosc, 89:460-469, 2019

 2. Takashima K, Oono Y, Kojima M, Ikematsu H, Akimoto T, Yano T. Clinicopathological features and endoscopic characteristics of inverted sessile serrated adenomas/polyps. Endosc Int Open, 7:E330-E336, 2019

 3. Oono Y, Kensuke S, Yoda Y, Hori K, Ikematsu H, Yano T. Cervical esophageal adenocarcinoma arising from heterotopic gastric mucosa, treated with endoscopic submucosal dissection. Endoscopy, 51:E28-E29, 2019

 4. Kumahara K, Ikematsu H, Shinmura K, Murano T, Inaba A, Okumura K, Nishihara K, Sunakawa H, Furue Y, Ito R, Sato D, Minamide T, Okamoto N, Yamamoto Y, Suyama M, Takashima K, Nakajo K, Yoda Y, Hori K, Oono Y, Yano T. Objective evaluation of the visibility of colorectal lesions using eye tracking. Dig Endosc, 2019

 5. Nishihara K, Oono Y, Kuwata T, Ikematsu H, Yano T. Depressed gastric-type adenoma in nonatrophic gastric mucosa without Helicobacter pylori infection. Endoscopy, 51:E138-E140, 2019

 6. Wu H, Minamide T, Yano T. Role of photodynamic therapy in the treatment of esophageal cancer. Dig Endosc, 2019

 7. Oono Y, Shinmura K, Hori K, Yoda Y, Ishii G, Ikematsu H, Yano T. Endoscopic submucosal resection using a ligation device without injection for duodenal neuroendocrine tumors. Surg Endosc, 33:2008-2014, 2019

 8. Kadota T, Seo S, Fuse H, Ishii G, Itoh K, Yano T, Kaneko K, Tsukasaki K. Complications and outcomes in diffuse large B-cell lymphoma with gastric lesions treated with R-CHOP. Cancer Med, 8:982-989, 2019

 9. Suzuki H, Takizawa K, Hirasawa T, Takeuchi Y, Ishido K, Hoteya S, Yano T, Tanaka S, Endo M, Nakagawa M, Toyonaga T, Doyama H, Hirasawa K, Matsuda M, Yamamoto H, Fujishiro M, Hashimoto S, Maeda Y, Oyama T, Takenaka R, Yamamoto Y, Naito Y, Michida T, Kobayashi N, Kawahara Y, Hirano M, Jin M, Hori S, Niwa Y, Hikichi T, Shimazu T, Ono H, Tanabe S, Kondo H, Iishi H, Ninomiya M. Short-term outcomes of multicenter prospective cohort study of gastric endoscopic resection: 'Real-world evidence' in Japan. Dig Endosc, 31:30-39, 2019

10. Oono Y, Kuwata T, Takashima K, Shinmura K, Hori K, Yoda Y, Ikematsu H, Shitara K, Kinoshita T, Yano T. Human epidermal growth factor receptor 2-, epidermal growth factor receptor-, and mesenchymal epithelial transition factor-positive sites of gastric cancer using surgical samples. Gastric Cancer, 22時33分5-343, 2019

11. Nakajo K, Yoda Y, Hori K, Takashima K, Sinmura K, Oono Y, Ikematsu H, Yano T. Technical feasibility of endoscopic submucosal dissection for local failure after chemoradiotherapy or radiotherapy for esophageal squamous cell carcinoma. Gastrointest Endosc, 88:637-646, 2018

12. Yoshida M, Takizawa K, Suzuki S, Koike Y, Nonaka S, Yamasaki Y, Minagawa T, Sato C, Takeuchi C, Watanabe K, Kanzaki H, Morimoto H, Yano T, Sudo K, Mori K, Gotoda T, Ono H. Conventional versus traction-assisted endoscopic submucosal dissection for gastric neoplasms: a multicenter, randomized controlled trial (with video). Gastrointest Endosc, 87:1231-1240, 2018

13. Sakai Y, Takemoto S, Hori K, Nishimura M, Ikematsu H, Yano T, Yokota H. Automatic detection of early gastric cancer in endoscopic images using a transferring convolutional neural network. Conf Proc IEEE Eng Med Biol Soc, 2018時41分38-4141, 2018

14. Hombu T, Yano T, Hatogai K, Kojima T, Kadota T, Onozawa M, Yoda Y, Hori K, Oono Y, Ikematsu H, Fujii S. Salvage endoscopic resection (ER) after chemoradiotherapy for esophageal squamous cell carcinoma: What are the risk factors for recurrence after salvage ER? Dig Endosc, 30:338-346, 2018

15. Kadota T, Hatogai K, Yano T, Fujita T, Kojima T, Daiko H, Fujii S. Pathological tumor regression grade of metastatic tumors in lymph node predicts prognosis in esophageal cancer patients. Cancer Sci, 19時20分46-2055, 2018

16. Abe S, Saito Y, Oono Y, Tanaka Y, Sakamoto T, Yamada M, Nakajima T, Matsuda T, Ikematsu H, Yano T, Sekine S, Kojima M, Yamagishi H, Kato H. Pilot study on probe-based confocal laser endomicroscopy for colorectal neoplasms: an initial experience in Japan. Int J Colorectal Dis, 33:1071-1078, 2018

17. Iwatate M, Sano Y, Tanaka S, Kudo SE, Saito S, Matsuda T, Wada Y, Fujii T, Ikematsu H, Uraoka T, Kobayashi N, Nakamura H, Hotta K, Horimatsu T, Sakamoto N, Fu KI, Tsuruta O, Kawano H, Kashida H, Takeuchi Y, Machida H, Kusaka T, Yoshida N, Hirata I, Terai T, Yamano HO, Nakajima T, Sakamoto T, Yamaguchi Y, Tamai N, Nakano N, Hayashi N, Oka S, Ishikawa H, Murakami Y, Yoshida S, Saito Y. Validation study for development of the Japan NBI Expert Team classification of colorectal lesions. Dig Endosc, 30:642-651, 2018

18. Mori Y, Kudo SE, Misawa M, Saito Y, Ikematsu H, Hotta K, Ohtsuka K, Urushibara F, Kataoka S, Ogawa Y, Maeda Y, Takeda K, Nakamura H, Ichimasa K, Kudo T, Hayashi T, Wakamura K, Ishida F, Inoue H, Itoh H, Oda M, Mori K. Real-Time Use of Artificial Intelligence in Identification of Diminutive Polyps During Colonoscopy: A Prospective Study. Ann Intern Med, 169:357-366, 2018

19. Kudo T, Saito Y, Ikematsu H, Hotta K, Takeuchi Y, Shimatani M, Kawakami K, Tamai N, Mori Y, Maeda Y, Yamada M, Sakamoto T, Matsuda T, Imai K, Ito S, Hamada K, Fukata N, Inoue T, Tajiri H, Yoshimura K, Ishikawa H, Kudo SE. New-generation full-spectrum endoscopy versus standard forward-viewing colonoscopy: a multicenter, randomized, tandem colonoscopy trial (J-FUSE Study). Gastrointest Endosc, 88:854-864, 2018

20. Hashimoto T, Tanaka Y, Ogawa R, Mori T, Yoshida H, Taniguchi H, Hiraoka N, Kojima M, Oono Y, Saito Y, Sekine S. Superficially serrated adenoma: a proposal for a novel subtype of colorectal serrated lesion. Mod Pathol, 31:1588-1598, 2018

21. Oono Y, Kuwata T, Takashima K, Yoda Y, Ikematsu H, Shitara K, Kinoshita T, Yano T. Clinicopathological features and endoscopic findings of HER2-positive gastric cancer. Surg Endosc, 32:3964- 3971, 2018

22. Nakajo K, Oono Y, Kuwata T, Yano T. A case of a protruded lesion formed by a poorly differentiated intramucosal adenocarcinoma of the stomach: an immunohistochemical analysis. Clin J Gastroenterol, 11時12分7-132, 2018

23. Nakajo K, Oono Y, Kuwata T. Case of pyloric gland adenoma accompanied by a component of foveolar epithelial-type adenoma within the lesion. Dig Endosc, 30:673, 2018