Annual Report 2017

Department of Gastroenterology and Endoscopy

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

Introduction

 The Department of Gastroenterology and Endoscopy consists of six staff doctors who are specialized in endoscopic diagnosis and treatment for digestive tract, and head and neck cancer. The main service of our department is the endoscopic diagnosis and treatment such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) for early cancers of pharyngeal region, esophagus, stomach, and colon. In May 2017, the new endoscopic center which is more than three times larger than the former one and the largest center in Japan opened at the first floor of the Center of New Surgical and Endoscopic Development for Exploratory Technology (NEXT).

Our team and what we do

 The staff members of this department performed more than a total of 18,000 endoscopic procedures, 2,000 EMR/ESD annually in 2017 (Tables 1, 2), and the number of cases was gradually increasing and it was the highest record ever. Furthermore, the staff members performed minimally invasive endoscopic procedures including EMR/ESD for early cancer, salvage treatment such as ESD and photodynamic therapy (PDT) for local failure after radiotherapy for esophageal cancer, or palliative treatments for patients with symptomatic advanced cancer such as stent placement, percutaneous endoscopic gastroscopy, and balloon dilatation. Also, the upper gastrointestinal (GI) group aggressively performed the endoscopic treatment for early pharyngeal cancer through collaboration with the Department of Head and Neck Surgery (Table 2). In addition, the colon group concentrated the diagnosis with fine magnified images using image enhanced endoscopy for adenoma and early cancer even in clinical practices. During the daily endoscopic examination, physicians access primary tumors through endoscopy, and easily take numerous numbers of biopsy material from cancerous lesions. Recently, a lot of molecular target agents are developed and included as practices in the oncology field. Therefore, the position of endoscopy is becoming more important in clinical oncology as an easy access tool for primary tumors.

Table 1. Number of patients examined in 2015-2017*

Table 2. Endoscopic procedures in 2015-2017*

Research activities

 The major research activities at this department are translational research, innovation for new imaging and endoscopic equipment through collaboration with an academia or company, and clinical studies. In the field of translational research, several research works collaborate with the Department of Pathology in order to clarify the elucidation of early cancer in digestive tract and head and neck cancer. In 2017, we published papers about the results of several important clinical trials in the field of gastrointestinal endoscopy or oncology using novel medical device. For example, clinical trials about detection of colon polyp using blue light imaging or biodegradable stent for refractory benign stricture or novel PDT for local failed esophageal cancer became the keystones for approval.

Clinical trails

 We are participating in undergoing clinical trials to evaluate efficacy and safety of tissue engineered cell sheets to prevent stricture after ESD for wide spreading superficial esophageal cancer. And, we are also working on biodegradable stent for refractory benign esophageal stricture for regulatory approval. In addition, we are conducting investigator initiated clinical trials using novel imaging as follows; the imaging using near-

infrared light with a wavelength of over 1,000nm for surgical resected GIST (gastrointestinal stromal tumor) material and oxygen saturation imaging endoscopy for GI cancer to predict efficacy of chemotherapy or radiotherapy. Furthermore, we are conducting clinical trials of 3D luminal endoscopy for gastric ESD. As a member of the Gastrointesinal Endoscopy Study Group (GIESG) of the Japan Clinical Oncology Group (JCOG), we are participating in several randomized controlled trials to build standard endoscopic treatment for GI cancer.

Education

 In our department, three senior residents and ten residents have been enrolled. Trainees could perform services under the training program with observation by each specialist. And, they are educated not only for endoscopic diagnosis and endoscopic treatment strategy, but also pathological diagnosis, clinical or surgical oncology through the conferences with other departments. Furthermore, they actively presented their research works at international conferences, and published papers in international peer reviewed journals. They wrote several study protocols mainly for innovative development in endoscopic imaging and treatment. For residents who want to learn more in detail about regulatory science for medical devices, they can have a chance to study in the Pharmaceuticals and Medical Device Agency (PMDA) or the JCOG after their graduation.

Future prospects

 We want to expand our activity of endoscopic procedures in our daily practice using our large endoscopy center. Moreover, we would like to perform innovative activities for the creation of new endoscopic images or treatment through robust collaboration with companies and academic institutions for cancer patients, and not only now, but also for the future.

List of papers published in January 2017 - March 2018

Journal

 1. Sunagawa H, Kinoshita T, Kaito A, Shibasaki H, Kaneko K, Ochiai A, Ohtsu A, Nishida T. Additional surgery for non-curative resection after endoscopic submucosal dissection for gastric cancer: a retrospective analysis of 200 cases. Surg Today, 47:202-209, 2017

 2. Morimoto H, Yano T, Yoda Y, Oono Y, Ikematsu H, Hayashi R, Ohtsu A, Kaneko K. Clinical impact of surveillance for head and neck cancer in patients with esophageal squamous cell carcinoma. World journal of gastroenterology, 23:1051-1058, 2017

 3. Kadota T, Yano T, Fujita T, Daiko H, Fujii S. Submucosal Invasive Depth Predicts Lymph Node Metastasis and Poor Prognosis in Submucosal Invasive Esophageal Squamous Cell Carcinoma. Am J Clin Pathol, 148:416-426, 2017

 4. Nakanishi H, Doyama H, Ishikawa H, Uedo N, Gotoda T, Kato M, Nagao S, Nagami Y, Aoyagi H, Imagawa A, Kodaira J, Mitsui S, Kobayashi N, Muto M, Takatori H, Abe T, Tsujii M, Watari J, Ishiyama S, Oda I, Ono H, Kaneko K, Yokoi C, Ueo T, Uchita K, Matsumoto K, Kanesaka T, Morita Y, Katsuki S, Nishikawa J, Inamura K, Kinjo T, Yamamoto K, Yoshimura D, Araki H, Kashida H, Hosokawa A, Mori H, Yamashita H, Motohashi O, Kobayashi K, Hirayama M, Kobayashi H, Endo M, Yamano H, Murakami K, Koike T, Hirasawa K, Miyaoka Y, Hamamoto H, Hikichi T, Hanabata N, Shimoda R, Hori S, Sato T, Kodashima S, Okada H, Mannami T, Yamamoto S, Niwa Y, Yashima K, Tanabe S, Satoh H, Sasaki F, Yamazato T, Ikeda Y, Nishisaki H, Nakagawa M, Matsuda A, Tamura F, Nishiyama H, Arita K, Kawasaki K, Hoppo K, Oka M, Ishihara S, Mukasa M, Minamino H, Yao K. Evaluation of an e-learning system for diagnosis of gastric lesions using magnifying narrow-band imaging: a multicenter randomized controlled study. Endoscopy, 49:957-967, 2017

 5. Nakamura H, Ikematsu H, Osera S, Ito R, Sato D, Minamide T, Okamoto N, Yamamoto Y, Hombu T, Takashima K, Nakajo K, Kadota T, Yoda Y, Hori K, Oono Y, Yano T. Visual assessment of colorectal flat and depressed lesions by using narrow band imaging. Endoscopy international open, 5:E1284-E1288, 2017

 6. Yokoyama A, Katada C, Yokoyama T, Yano T, Kaneko K, Oda I, Shimizu Y, Doyama H, Koike T, Takizawa K, Hirao M, Okada H, Yoshii T, Konishi K, Yamanouchi T, Tsuda T, Omori T, Kobayashi N, Suzuki H, Tanabe S, Hori K, Nakayama N, Kawakubo H, Ishikawa H, Muto M. Alcohol abstinence and risk assessment for second esophageal cancer in Japanese men after mucosectomy for early esophageal cancer. PLoS One, 12:e0175182, 2017

 7. Uedo N, Yoshio T, Yoshinaga S, Takeuchi M, Hatta W, Yano T, Tanuma T, Goto O, Takahashi A, Tong D, Lee YY, Nakayama Y, Ichihara S, Gotoda T. Endoscopic gastric mucosal atrophy distinguishes the characteristics of superficial esophagogastric junction adenocarcinoma. Dig Endosc, 29 Suppl 2:26-36, 2017

 8. Oka S, Uraoka T, Tamai N, Ikematsu H, Chino A, Okamoto K, Takeuchi Y, Imai K, Ohata K, Shiga H, Raftopoulos S, Lee BI, Matsuda T. Standardization of endoscopic resection for colorectal tumors larger than 10 mm in diameter. Dig Endosc, 29 Suppl 2:40-44, 2017

 9. Hotta K, Matsuda T, Kakugawa Y, Ikematsu H, Kobayashi N, Kushima R, Hozawa A, Nakajima T, Sakamoto T, Mori M, Fujii T, Saito Y. Regional colorectal cancer screening program using colonoscopy on an island: a prospective Nii-jima study. Jpn J Clin Oncol, 47:118-122, 2017

10. Ikematsu H, Sakamoto T, Togashi K, Yoshida N, Hisabe T, Kiriyama S, Matsuda K, Hayashi Y, Matsuda T, Osera S, Kaneko K, Utano K, Naito Y, Ishihara H, Kato M, Yoshimura K, Ishikawa H, Yamamoto H, Saito Y. Detectability of colorectal neoplastic lesions using a novel endoscopic system with blue laser imaging: a multicenter randomized controlled trial. Gastrointest Endosc, 86:386-394, 2017

11. Niwa A, Kuwano S, Tomita H, Kimura K, Orihara Y, Kanayama T, Noguchi K, Hisamatsu K, Nakashima T, Hatano Y, Hirata A, Miyazaki T, Kaneko K, Tanaka T, Hara A. The different pathogeneses of sporadic adenoma and adenocarcinoma in non-ampullary lesions of the proximal and distal duodenum. Oncotarget, 8:41078-41090, 2017

12. Yano T, Yoda Y, Nomura S, Toyosaki K, Hasegawa H, Ono H, Tanaka M, Morimoto H, Horimatsu T, Nonaka S, Kaneko K, Sato A. Prospective trial of biodegradable stents for refractory benign esophageal strictures after curative treatment of esophageal cancer. Gastrointest Endosc, 86:492-499, 2017

13. Osera S, Ikematsu H, Fujii S, Hori K, Oono Y, Yano T, Kaneko K. Endoscopic treatment outcomes of laterally spreading tumors with a skirt (with video). Gastrointest Endosc, 86:533-541, 2017

14. Sekine S, Ogawa R, Hashimoto T, Motohiro K, Yoshida H, Taniguchi H, Saito Y, Yasuhiro O, Ochiai A, Hiraoka N. Comprehensive characterization of RSPO fusions in colorectal traditional serrated adenomas. Histopathology, 71:601-609, 2017

15. Noguchi M, Yano T, Kato T, Kadota T, Imajoh M, Morimoto H, Osera S, Yagishita A, Odagaki T, Yoda Y, Oono Y, Ikematsu H, Kaneko K. Risk factors for intraoperative perforation during endoscopic submucosal dissection of superficial esophageal squamous cell carcinoma. World journal of gastroenterology, 23:478-485, 2017

16. Yano T, Kasai H, Horimatsu T, Yoshimura K, Teramukai S, Morita S, Tada H, Yamamoto Y, Kataoka H, Kakushima N, Ishihara R, Isomoto H, Muto M. A multicenter phase II study of salvage photodynamic therapy using talaporfin sodium (ME2906) and a diode laser (PNL6405EPG) for local failure after chemoradiotherapy or radiotherapy for esophageal cancer. Oncotarget, 8:22135-22144, 2017

17. Kanesaka T, Uedo N, Yao K, Ezoe Y, Doyama H, Oda I, Kaneko K, Kawahara Y, Yokoi C, Sugiura Y, Ishikawa H, Takeuchi Y, Arao M, Iwatsubo T, Iwagami H, Matsuno K, Muto M, Saito Y, Tomita Y. Multiple convex demarcation line for prediction of benign depressed gastric lesions in magnifying narrow-band imaging. Endosc Int Open, 6:E145-E155, 2018

18. Niwa A, Kuwano S, Tomita H, Kimura K, Orihara Y, Kanayama T, Noguchi K, Hisamatsu K, Nakashima T, Hatano Y, Hirata A, Miyazaki T, Kaneko K, Tanaka T, Hara A. Correction: The different pathogenesis of sporadic adenoma and adenocarcinoma in non-ampullary lesions of the proximal and distal duodenum. Oncotarget, 9:11427, 2018

19. Hasuike N, Ono H, Boku N, Mizusawa J, Takizawa K, Fukuda H, Oda I, Doyama H, Kaneko K, Hori S, Iishi H, Kurokawa Y, Muto M. A non-randomized confirmatory trial of an expanded indication for endoscopic submucosal dissection for intestinal-type gastric cancer (cT1a): the Japan Clinical Oncology Group study (JCOG0607). Gastric Cancer, 21:114-123, 2018

20. Murakami H, Horiba R, Iwata T, Miki Y, Uno B, Sakai T, Kaneko K, Ishihama Y, Teshima N, Esaka Y. Progress in a selective method for the determination of the acetaldehyde-derived DNA adducts by using HILIC-ESI-MS/MS. Talanta, 177:12-17, 2018