Annual Report 2019
Department of Gastroenterology and Endoscopy
Tomonori Yano, Hiroaki Ikematsu, Yusuke Yoda, Keisuke Hori, Kensuke Shinmura, Tomohiro Kadota, Tatsuro Murano, Keiichiro Nakajo, Youichi Yamamoto, Masayuki Suyama, Daiki Sato, Tatsunori Minamide
Introduction
The Department of Gastroenterology and Endoscopy consists of six staff doctors specialized in endoscopic diagnosis and treatment for gastrointestinal tract and head and neck cancer. The mission of our department is to achieve the following tasks for cancer patients using endoscopy: early detection, less invasive treatment, and palliation for painful symptoms.
The Team and What We Do
The staff members of this department performed more than 15000 endoscopic procedures in total and 2000 EMR/ESD procedures annually in 2019 (Table 1), and the number of cases is gradually increasing and this was the highest record ever. Furthermore, the staff members performed advanced 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 gastrostomy, and balloon dilatation. Also, the upper GI group aggressively performed endoscopic treatment for early pharyngeal cancer through collaboration with the Department of Head and Neck Surgery. In addition, the colon group concentrated on the 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 can easily take numerous biopsy materials from cancerous lesions. Recently, a lot of molecular target agents are being developed and included in practice in oncology fields. 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 at this department are translational (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 performed works 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 tract and head and neck tumors using materials taken using endoscopy. In 2019, we published the results of several important research projects including a prospective multicenter study for improving skills in systemic endoscopic examination techniques using narrow band imaging of the head and neck region of patients with esophageal squamous cell carcinoma, a retrospective multicenter study to evaluate the impact of the Charlson Comorbidity Index on the treatment strategy and survival in elderly patients after non-curative endoscopic submucosal dissection for esophageal squamous cell carcinoma, and an objective evaluation of the visibility of colorectal lesions using eye tracking.
Clinical trials
We are conducting investigator initiated clinical trials using novel imaging for oxygen saturation imaging endoscopy for GI cancer to predict the efficacy of chemotherapy or radiotherapy. We are also conducting investigator initiated clinical trials of photoimmunotherapy as an endoscopic procedure for patients with esophageal cancer or gastric cancer who cannot be treated with conventional treatments. As a member institution of the JCOG-GI endoscopy study group, we are conducting a single-arm confirmatory trial of adjuvant chemoradiation for patients with high-risk rectal submucosal invasive cancer after local resection (JCOG1612), and participate in several randomized control trials to build the standards for endoscopic treatment for GI cancer.
Education
Four senior residents and nine residents belong to our department. Trainees performed duties under the training program with observation by each specialist. Also, they were educated not only in endoscopic diagnosis and endoscopic treatment strategies, but also pathological diagnosis, clinical and surgical oncology through cooperation with other departments. Furthermore, they actively presented their research work at international congresses, and published 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 about regulatory science for medical devices in more detail can study in PMDA or JCOG after graduating from their residence.
Future prospects
We want to expand our endoscopic procedure activity in our daily practice using a large endoscopy center. Furthermore, we would like to innovate new endoscopic imaging or treatment through robust collaboration with companies and academic institutions for cancer patients not only at present but also in the NEXT generation.
List of papers published in 2019
Journal
1. Kobayashi K, Tanaka S, Murakami Y, Ishikawa H, Sada M, Oka S, Saito Y, Iishi H, Kudo SE, Ikematsu H, Igarashi M, Saitoh Y, Inoue Y, Hisabe T, Tsuruta O, Sano Y, Yamano H, Shimizu S, Yahagi N, Matsuda K, Nakamura H, Fujii T, Sugihara K. Predictors of invasive cancer of large laterally spreading colorectal tumors: A multicenter study in Japan. JGH Open, 4:83-89, 2020
2. Kadota T, Abe S, Yoda Y, Yoshinaga S, Oda I, Kojima T, Kato K, Daiko H, Yano T. Clinical outcomes according to the modified endoscopic criteria for neoadjuvant chemotherapy in resectable esophageal squamous cell carcinoma. Dig Endosc, 32:337-345, 2020
3. Sasaki A, Nakamura Y, Togashi Y, Kuno H, Hojo H, Kageyama S, Nakamura N, Takashima K, Kadota T, Yoda Y, Mishima S, Sawada K, Kotani D, Kawazoe A, Kuboki Y, Taniguchi H, Kojima T, Doi T, Yoshino T, Yano T, Kobayashi T, Akimoto T, Nishikawa H, Shitara K. Enhanced tumor response to radiotherapy after PD-1 blockade in metastatic gastric cancer. Gastric Cancer, 2020
4. Takashima K, Fujii S, Komatsuzaki R, Komatsu M, Takahashi M, Kojima T, Daiko H, Minashi K, Chiwaki F, Muto M, Sasaki H, Yano T. CD24 and CK4 are upregulated by SIM2, and are predictive biomarkers for chemoradiotherapy and surgery in esophageal cancer. Int J Oncol, 56:835-847, 2020
5. Shinmura K, Ikematsu H, Kojima M, Nakamura H, Osera S, Yoda Y, Hori K, Oono Y, Ochiai A, Yano T. Safety of endoscopic procedures with monopolar versus bipolar instruments in an ex vivo porcine model. BMC Gastroenterol, 20:27, 2020
6. Yano T, Hasuike N, Ono H, Boku N, Ogawa G, Kadota T, Oda I, Doyama H, Hori S, Iishi H, Takahashi A, Takizawa K, Muto M. Factors associated with technical difficulty of endoscopic submucosal dissection for early gastric cancer that met the expanded indication criteria: post hoc analysis of a multi-institutional prospective confirmatory trial (JCOG0607). Gastric Cancer, 23:168-174, 2020
7. Minamide T, Yoda Y, Hori K, Shinmura K, Oono Y, Ikematsu H, Yano T. Advantages of salvage photodynamic therapy using talaporfin sodium for local failure after chemoradiotherapy or radiotherapy for esophageal cancer. Surg Endosc, 34:899-906, 2020
8. Yano T, Wang KK. Photodynamic Therapy for Gastrointestinal Cancer. Photochem Photobiol, 96:517-523, 2020
9. Sato D, Motegi A, Kadota T, Kojima T, Bando H, Shinmura K, Hori K, Yoda Y, Oono Y, Zenda S, Ikematsu H, Akimoto T, Yano T. Therapeutic results of proton beam therapy with concurrent chemotherapy for cT1 esophageal cancer and salvage endoscopic therapy for local recurrence. Esophagus, 17:305-311, 2020
10. Yamamoto Y, Kadota T, Yoda Y, Hori K, Hatogai K, Kojima T, Fujii S, Akimoto T, Yano T. Review of early endoscopic findings in patients with local recurrence after definitive chemoradiotherapy for esophageal squamous cell carcinoma. Esophagus, 2020
11. Kadota T, Yoda Y, Hori K, Shinmura K, Oono Y, Ikematsu H, Yano T. Prophylactic steroid administration against strictures is not enough for mucosal defects involving the entire circumference of the esophageal lumen after esophageal endoscopic submucosal dissection (ESD). Esophagus, 2020
12. Kudo SE, Misawa M, Mori Y, Hotta K, Ohtsuka K, Ikematsu H, Saito Y, Takeda K, Nakamura H, Ichimasa K, Ishigaki T, Toyoshima N, Kudo T, Hayashi T, Wakamura K, Baba T, Ishida F, Inoue H, Itoh H, Oda M, Mori K. Artificial Intelligence-assisted System Improves Endoscopic Identification of Colorectal Neoplasms. Clin Gastroenterol Hepatol, 18:1874-1881.e2, 2020
13. Yoshida N, Hisabe T, Ikematsu H, Ishihara H, Terasawa M, Inaba A, Sato D, Cho H, Ego M, Tanaka Y, Yasuda R, Inoue K, Murakami T, Inada Y, Itoh Y, Saito Y. Comparison Between Linked Color Imaging and Blue Laser Imaging for Improving the Visibility of Flat Colorectal Polyps: A Multicenter Pilot Study. Dig Dis Sci, 65:2054-2062, 2020
14. Yokoyama A, Katada C, Yokoyama T, Takizawa K, Yano T, Oda I, Shimizu Y, Nakanishi H, Koike T, Hirao M, Okada H, Yoshii T, Katagiri A, Yamanouchi T, Matsuo Y, Kawakubo H, Kobayashi N, Ishikawa H, Muto M. The Alcohol Use Disorders Identification Test and the risk of metachronous cancer after endoscopic resection of esophageal cancer. Carcinogenesis, 2020
15. Ishihara R, Arima M, Iizuka T, Oyama T, Katada C, Kato M, Goda K, Goto O, Tanaka K, Yano T, Yoshinaga S, Muto M, Kawakubo H, Fujishiro M, Yoshida M, Fujimoto K, Tajiri H, Inoue H. Endoscopic submucosal dissection/endoscopic mucosal resection guidelines for esophageal cancer. Dig Endosc, 32:452-493, 2020
16. Katada C, Yokoyama T, Yano T, Oda I, Shimizu Y, Takemura K, Koike T, Takizawa K, Hirao M, Okada H, Nakayama N, Kubota Y, Matsuo Y, Kawakubo H, Ishikawa H, Yokoyama A, Muto M. Association between the findings of metachronous secondary primary malignancies and the number of Lugol-voiding lesions. Dis Esophagus, 2020
17. Mori Y, Kudo SE, East JE, Rastogi A, Bretthauer M, Misawa M, Sekiguchi M, Matsuda T, Saito Y, Ikematsu H, Hotta K, Ohtsuka K, Kudo T, Mori K. Cost savings in colonoscopy with artificial intelligence-aided polyp diagnosis: an add-on analysis of a clinical trial (with video). Gastrointest Endosc, 2020
18. Jimenez-Garcia VA, Yamada M, Ikematsu H, Takamaru H, Abe S, Sakamoto T, Nakajima T, Matsuda T, Saito Y. Endoscopic submucosal dissection in management of colorectal tumors near or involving a diverticulum: a retrospective case series. Endosc Int Open, 7:E664-E671, 2019
19. Atkinson NSS, Ket S, Bassett P, Aponte D, De Aguiar S, Gupta N, Horimatsu T, Ikematsu H, Inoue T, Kaltenbach T, Leung WK, Matsuda T, Paggi S, Radaelli F, Rastogi A, Rex DK, Sabbagh LC, Saito Y, Sano Y, Saracco GM, Saunders BP, Senore C, Soetikno R, Vemulapalli KC, Jairath V, East JE. Narrow-Band Imaging for Detection of Neoplasia at Colonoscopy: A Meta-analysis of Data From Individual Patients in Randomized Controlled Trials. Gastroenterology, 157:462-471, 2019
20. 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
21. Okamoto N, Morimoto H, Yamamoto Y, Kanda K, Nankinzan R, Kasamatsu S, Yoshimura S, Kan M, Nakano A, Hosaka S, Watanabe Y, Arahata K, Toyama Y, Okamura A, Yamaguchi T, Yano T. Skill-up study of systemic endoscopic examination technique using narrow band imaging of the head and neck region of patients with esophageal squamous cell carcinoma: Prospective multicenter study. Dig Endosc, 31:653-661, 2019
22. Minamide T, Shinmura K, Ikematsu H, Yano T. Early-stage primary signet ring cell carcinoma of the colon with magnifying endoscopic findings. Gastrointest Endosc, 90:529-531, 2019
23. Nakajo K, Abe S, Oda I, Ishihara R, Tanaka M, Yoshio T, Katada C, Yano T. Impact of the Charlson Comorbidity Index on the treatment strategy and survival in elderly patients after non-curative endoscopic submucosal dissection for esophageal squamous cell carcinoma: a multicenter retrospective study. J Gastroenterol, 54:871-880, 2019
24. 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
25. 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, 31:552-557, 2019
26. Wu H, Minamide T, Yano T. Role of photodynamic therapy in the treatment of esophageal cancer. Dig Endosc, 31:508-516, 2019 27. Yamamoto Y, Shinmura K, Yano T. Two cases of early gastric and esophageal cancers treated by endoscopic submucosal dissection in three-dimensional endoscopy. Dig Endosc, 31:e120-e121, 2019
28. Murano T, Ikematsu H, Shinmura K, Ito R, Minamide T, Sato D, Yamamoto Y, Takashima K, Kadota T, Yoda Y, Hori K, Oono Y, Yano T. Endoscopic prediction of advanced histology in colorectal lesions sized <10 mm using the Japan Narrow-band imaging Expert Team classification. Dig Endosc, 2019
29. Minashi K, Nihei K, Mizusawa J, Takizawa K, Yano T, Ezoe Y, Tsuchida T, Ono H, Iizuka T, Hanaoka N, Oda I, Morita Y, Tajika M, Fujiwara J, Yamamoto Y, Katada C, Hori S, Doyama H, Oyama T, Nebiki H, Amagai K, Kubota Y, Nishimura K, Kobayashi N, Suzuki T, Hirasawa K, Takeuchi T, Fukuda H, Muto M. Efficacy of Endoscopic Resection and Selective Chemoradiotherapy for Stage I Esophageal Squamous Cell Carcinoma. Gastroenterology, 157:382-390.e3, 2019
30. Zimmermann-Fraedrich K, Sehner S, Rex DK, Kaltenbach T, Soetikno R, Wallace M, Leung WK, Guo C, Gralnek IM, Brand EC, Groth S, Schachschal G, Ikematsu H, Siersema PD, Rösch T. Right-Sided Location Not Associated With Missed Colorectal Adenomas in an Individual-Level Reanalysis of Tandem Colonoscopy Studies. Gastroenterology, 157:660-671.e2, 2019