Annual Report 2023

Department of Endoscopy, Respiratory Endoscopy Division

Takaaki Tsuchida, Yuji Matsumoto, Hideaki Furuse

Introduction

 More than 1,000 bronchoscopies were performed between April 2023 and March 2024 (Table 1). We are one of the facilities with the highest number of bronchoscopies performed in Japan. Most cases of peripheral pulmonary and endobronchial lesions are diagnosed on an outpatient basis, and sedation is used in combination with bronchoscopy to reduce patient discomfort.

 The special feature of our hospital is the use of endobronchial ultrasound convex-probe EBUS, radial EBUS) for almost all examinations, and for peripheral lesions, virtual bronchoscopy and virtual fluoroscopy using workstations and other instruments are employed to simulate the lesion before the examination. Efforts were made to shorten the length of the procedure.

 Guided biopsies are combined with rapid onsite cytology. Cryobiopsies were used to diagnose ground-glass nodules or to obtain large specimens especially for next generation sequencing.

 Stenting for airway stenosis and tumor ablation were also performed. We actively performed thoracoscopy under local anesthesia for cases with unexplained pleural effusion and pleural thickening.

The Team and What We Do

 EBUS is used not only to evaluate mediastinal or hilar lesions but also to evaluate whether the biopsy devices can be directed to the peripheral pulmonary lesions. A total of 376 cases of EBUS-TBNA (EBUS-guided transbronchial needle aspiration) were performed as a less invasive procedure to improve the diagnosis of patients with mediastinal or hilar lymph node swelling. Transbronchial biopsies with virtual navigation were performed in most of the peripheral pulmonary lesions.

 Patients with endobronchial stenosis were treated with airway stent placement, debulking with a cryoprobe and/or endobronchial electrocautery ablation. Medical thoracoscopy under local anesthesia was performed in the endoscopic examination room on patients with unknown pleural effusion and/or pleural thickening.

Research Activities

1) We conducted a trial of photodynamic therapy for peripheral small lung cancer.

2) We have conducted a randomized controlled trial to evaluate the efficacy of cryobiopsy in the diagnosis of peripheral pulmonary lesions.

Clinical Trials

 The world's first multicenter trial of photodynamic therapy for peripheral lung cancer was performed.

Education

 Since the flexible bronchoscope was developed at our hospital for the first time in the world, many residents and doctors from overseas have wished to receive training at our hospital, and we actively accept them. However, in the first half of this year, due to the spread of COVID-19, the number of overseas doctors was limited. On the other hand, we have given many residents opportunities to write papers and present at conferences.

Future Prospects

1) We will conduct a randomized controlled trial to evaluate the efficacy of cryobiopsy in the diagnosis of peripheral pulmonary lesions.

2) We will develop diagnostic and therapeutic procedures using the minimally invasive technique of bronchoscopy.

3) We will develop a method to nondestructively understand tissue architecture by X-ray phase imaging.

4) We will develop a new method for diagnosing malignant tumors using a desktop electron microscope.

5) We will conduct a research on multidimensional information analysis of lung cancer pathology and examine the potential diagnostic ability of ultra-high-resolution CT images for lung cancer.

6) We will analyze the data of a prospective observational study using a multicenter database on respiratory endoscopy in Japan.

List of papers published in 2023

Journal

1. Suzuki H, Kawata Y, Aokage K, Matsumoto Y, Sugiura T, Tanabe N, Nakano Y, Tsuchida T, Kusumoto M, Marumo K, Kaneko M, Niki N. Aorta and main pulmonary artery segmentation using stacked U-Net and localization on non-contrast-enhanced computed tomography images. Medical physics, 51:1232-1243, 2024

2. Sano Y, Hotta K, Matsuda T, Murakami Y, Fujii T, Kudo SE, Oda Y, Ishikawa H, Saito Y, Kobayashi N, Sekiguchi M, Ikematsu H, Katagiri A, Konishi K, Takeuchi Y, Iishi H, Igarashi M, Kobayashi K, Sada M, Osera S, Shinohara T, Yamaguchi Y, Hasuda K, Morishima T, Miyashiro I, Shimoda T, Taniguchi H, Fujimori T, Ajioka Y, Yoshida S. Endoscopic Removal of Premalignant Lesions Reduces Long-Term Colorectal Cancer Risk: Results From the Japan Polyp Study. Clinical gastroenterology and hepatology, 22:542-551.e3, 2024

3. Repici A, Khalaf K, Troncone E, Subramaniam S, Hassan C, Bhandari P. International Delphi Consensus Study on disposable single-use endoscopy: A path to clinical adoption. Digestive and liver disease, 56:322-329, 2024

4. Yoshida N, Hayashi Y, Togo D, Oka S, Takada K, Fukunaga S, Morita Y, Hayashi T, Kozuka K, Tsuji Y, Murakami T, Yamamura T, Komeda Y, Takeuchi Y, Shinmura K, Fukuda H, Yoshii S, Ono S, Katsuki S, Kawashima K, Nemoto D, Yamamoto H, Saito Y, Tamai N, Iwao A, Itoi Y, Tsuji S, Inagaki Y, Inada Y, Soga K, Hasegawa D, Murakami T, Yoriki H, Fukumoto K, Motoyoshi T, Nakatani Y, Sano Y, Iguchi M, Fujii S, Ban H, Harada K, Okamoto K, Nishiyama H, Sasaki F, Mizukami K, Shono T, Shimoda R, Miike T, Yamaguchi N. An Analysis of Delayed Bleeding in Cases of Colorectal Endoscopic Submucosal Dissection Due to Types of Direct Oral Anticoagulants in Japan. Clinical gastroenterology and hepatology, 22:271-282.e3, 2024

5. Minamide T, Ikematsu H, Kajiwara Y, Oka S, Ajioka Y, Ueno H. Impact of Lesion Location on Recurrence After Resection of T1 Colorectal Cancer: Post Hoc Analysis of a Nationwide Multicenter Cohort Study. Gastroenterology, 166:198-201.e3, 2024

6. Kawamura T, Sekiguchi M, Takamaru H, Mizuguchi Y, Horiguchi G, Toyoizumi H, Kato M, Kobayashi K, Sada M, Oda Y, Yokoyama A, Utsumi T, Tsuji Y, Ohki D, Takeuchi Y, Shichijo S, Ikematsu H, Matsuda K, Teramukai S, Kobayashi N, Matsuda T, Saito Y, Tanaka K. Endoscopist-related factors affecting adenoma detection during colonoscopy: Data from the J-SCOUT study. Digestive endoscopy, 36:51-58, 2024

7. Nakai T, Matsumoto Y, Ueda T, Kuwae Y, Tanaka S, Miyamoto A, Matsumoto Y, Sawa K, Sato K, Yamada K, Watanabe T, Asai K, Furuse H, Uchimura K, Imabayashi T, Uenishi R, Fukui M, Tanaka H, Ohsawa M, Kawaguchi T, Tsuchida T. Comparison of the specimen quality of endobronchial ultrasound-guided intranodal forceps biopsy using standard-sized forceps versus mini forceps for lung cancer: A prospective study. Respirology (Carlton, Vic.), 29:396-404, 2024

8. Fujita K, Saito Y. A novel hood with a small-caliber tip and two traction strings for endoscopic submucosal dissection. Endoscopy, 56:E111-E113, 2024

9. Hotta K, Otake Y, Yamaguchi D, Shimodate Y, Hanabata N, Ikematsu H, Yabuuchi Y, Sano Y, Shimoda R, Sugimoto S, Oba M, Takamaru H, Kimura K, Kishida Y, Takada K, Ito S, Imai K, Hosotani K, Murano T, Yamada M, Shinmura K, Takezawa R, Tomonaga M, Saito Y. Comparison of the efficacy and tolerability of elobixibat plus sodium picosulfate with magnesium citrate and split-dose 2-L polyethylene glycol with ascorbic acid for bowel preparation before outpatient colonoscopy: a study protocol for the multicentre, randomised, controlled E-PLUS trial. BMC gastroenterology, 24:61, 2024

10. Takada K, Imai K, Yamada T, Ohata K, Kanesaka T, Nagami Y, Yamasaki Y, Kobara H, Inokuchi Y, Chino A, Yamaguchi S, Ikehara H, Kawamura T, Yabuuchi Y, Mizuguchi Y, Ikematsu H, Yokoi C, Hattori S, Ohno K, Yoshizawa Y, Fukuzawa M, Tsuji Y, Konishi J, Yamamura T, Osawa S, Oka S, Hikichi T, Togashi K, Hirasawa K, Uraoka T, Takeuchi Y, Chiba H, Komeda Y, Doyama H, Oba MS, Saito Y. Efficacy of endoscopic submucosal resection with a ligation device for small rectal neuroendocrine tumor: study protocol of a multicenter open-label randomized control trial (BANDIT trial). BMC gastroenterology, 24:69, 2024

11. Kang SJ, Tae CH, Bang CS, Shin CM, Jeong YH, Choi M, Hwang JH, Saito Y, Chiu PWY, Rerknimitr R, Khor C, Khien VV, Choi KD, Shim KN, Song GA, Lee OY. International Digestive Endoscopy Network consensus on the management of antithrombotic agents in patients undergoing gastrointestinal endoscopy. Clinical endoscopy, 57:141-157, 2024

12. Adachi M, Matsumoto Y, Furuse H, Uchimura K, Imabayashi T, Yotsukura M, Yoshida Y, Nakagawa K, Igaki H, Watanabe SI, Tsuchida T. Utility of the endobronchial Watanabe spigot for intractable cancer-related pneumothorax: a retrospective observational study. Japanese journal of clinical oncology, 53:829-836, 2023

13. Nishimatsu K, Matsumoto Y, Kashima J, Imabayashi T, Uchimura K, Furuse H, Masuda K, Shinno Y, Okuma Y, Yoshida T, Goto Y, Horinouchi H, Yamamoto N, Tsuchida T, Ohe Y, Yatabe Y. Concordance between cryobiopsy and forceps biopsy specimens in assessment of immunohistochemistry staining for non-small cell lung carcinoma. Translational lung cancer research, 12:1245-1255, 2023

14. Suzuki H, Nonaka S, Maetani I, Matsuda T, Abe S, Yoshinaga S, Oda I, Yamagata Y, Yoshikawa T, Saito Y. Clinical and endoscopic features of metachronous gastric cancer with possible lymph node metastasis after endoscopic submucosal dissection and Helicobacter pylori eradication. Gastric cancer, 26:743-754, 2023

15. Hayashi T, Takasawa K, Yoshikawa T, Hashimoto T, Sekine S, Wada T, Yamagata Y, Suzuki H, Abe S, Yoshinaga S, Saito Y, Kouno N, Hamamoto R. A discrimination model by machine learning to avoid gastrectomy for early gastric cancer. Annals of gastroenterological surgery, 7:913-921, 2023

16. Kajiwara Y, Oka S, Tanaka S, Nakamura T, Saito S, Fukunaga Y, Takamatsu M, Kawachi H, Hotta K, Ikematsu H, Kojima M, Saito Y, Yamada M, Kanemitsu Y, Sekine S, Nagata S, Yamada K, Kobayashi N, Ishihara S, Saitoh Y, Matsuda K, Togashi K, Komori K, Ishiguro M, Kuwai T, Okuyama T, Ohuchi A, Ohnuma S, Sakamoto K, Sugai T, Katsumata K, Matsushita HO, Yamano HO, Eda H, Uraoka T, Akimoto N, Kobayashi H, Ajioka Y, Sugihara K, Ueno H. Nomogram as a novel predictive tool for lymph node metastasis in T1 colorectal cancer treated with endoscopic resection: a nationwide, multicenter study. Gastrointestinal endoscopy, 97:1119-1128.e5, 2023

17. Mori Y, Wang P, Løberg M, Misawa M, Repici A, Spadaccini M, Correale L, Antonelli G, Yu H, Gong D, Ishiyama M, Kudo SE, Kamba S, Sumiyama K, Saito Y, Nishino H, Liu P, Glissen Brown JR, Mansour NM, Gross SA, Kalager M, Bretthauer M, Rex DK, Sharma P, Berzin TM, Hassan C. Impact of Artificial Intelligence on Colonoscopy Surveillance After Polyp Removal: A Pooled Analysis of Randomized Trials. Clinical gastroenterology and hepatology, 21:949-959.e2, 2023

18. Hijioka S, Sakamoto Y, Nagashio Y, Maruki Y, Okusaka T, Saito Y. Novel and safe plastic stent exchange method after endoscopic ultrasound-guided hepaticogastrostomy with incomplete fistula (side hole method). Endoscopy, 55:E24-E25, 2023

19. Hijioka S, Sakamoto Y, Nagashio Y, Maruki Y, Okusaka T, Saito Y. Troubleshooting for endoscopic ultrasound-guided hepaticogastrostomy stent migration: Additional stenting by the partial stent-in-stent method. Endoscopy, 55:E122-E124, 2023

20. Maehara K, Hijioka S, Kawasaki Y, Tamada K, Okusaka T, Saito Y. A novel triple stenting in the treatment of post-choledochojejunostomy reflux cholangitis. Endoscopy, 55:E191-E193, 2023

21. Takeshita K, Hijioka S, Maehara K, Maruki Y, Nagashio Y, Okusaka T, Saito Y. Bile duct radiofrequency ablation for a residual adenoma after endoscopic papillectomy. Endoscopy, 55:E185-E188, 2023

22. Sakamoto T, Ikematsu H, Tamai N, Mizuguchi Y, Takamaru H, Murano T, Shinmura K, Sasabe M, Furuhashi H, Sumiyama K, Saito Y. Detection of colorectal adenomas with texture and color enhancement imaging: Multicenter observational study. Digestive endoscopy, 35:529-537, 2023

23. Kawasaki Y, Hijioka S, Takeshita K, Tamada K, Okusaka T, Saito Y. Endoscopic ultrasound-guided choledochojejunostomy using a forward-viewing echoendoscopic saddle-cross technique. Endoscopy, 55:E233-E235, 2023

24. Kawamura T, Sekiguchi M, Takamaru H, Mizuguchi Y, Horiguchi G, Kato M, Kobayashi K, Sada M, Oda Y, Yokoyama A, Utsumi T, Tsuji Y, Ohki D, Takeuchi Y, Shichijo S, Ikematsu H, Matsuda K, Teramukai S, Kobayashi N, Matsuda T, Saito Y, Tanaka K. "Endoscopic" adenoma detection rate as a quality indicator of colonoscopy: First report from the J-SCOUT study. Digestive endoscopy, 35:615-624, 2023

25. Bak MTJ, Albéniz E, East JE, Coelho-Prabhu N, Suzuki N, Saito Y, Matsumoto T, Banerjee R, Kaminski MF, Kiesslich R, Coron E, de Vries AC, van der Woude CJ, Bisschops R, Hart AL, Itzkowitz SH, Pioche M, Moons LMG, Oldenburg B. Endoscopic management of patients with high-risk colorectal colitis-associated neoplasia: a Delphi study. Gastrointestinal endoscopy, 97:767-779.e6, 2023

26. Takeshita K, Hijioka S, Kawasaki Y, Maruki Y, Nagashio Y, Okusaka T, Saito Y. Endoscopic ultrasound-guided hepaticojejunostomy for drainage of the right posterior hepatic duct enabled total liver drainage. Endoscopy, 55:E346-E348, 2023

27. Ken O, Kobayashi N, Saito Y. Reply. Gastroenterology, 164:1342-1343, 2023

28. Oguma J, Ishiyama K, Kurita D, Kanematsu K, Kubo K, Utsunomiya D, Abe S, Makiguchi M, Nonaka S, Suzuki H, Yoshinaga S, Oda I, Saito Y, Daiko H. Oncologic significance of lymphovascular invasion in patients with superficial esophageal squamous cell carcinoma reaching the muscularis mucosae or with slight invasion of the submucosa. Surgery, 173:1162-1168, 2023

29. Djinbachian R, Saito Y, von Renteln D. Thermal ablation of the margin defect after EMR: the need for randomized controlled trials with standardized outcome assessment. Gastrointestinal endoscopy, 97:808-809, 2023

30. Ngamruengphong S, Saito Y. Commentary. Endoscopy, 55:393, 2023

31. Chan FKL, Wong MCS, Chan AT, East JE, Chiu HM, Makharia GK, Weller D, Ooi CJ, Limsrivilai J, Saito Y, Hang DV, Emery JD, Makmun D, Wu K, Ali RAR, Ng SC. Joint Asian Pacific Association of Gastroenterology (APAGE)-Asian Pacific Society of Digestive Endoscopy (APSDE) clinical practice guidelines on the use of non-invasive biomarkers for diagnosis of colorectal neoplasia. Gut, 72:1240-1254, 2023

32. Yamamoto H, Sakamoto H, Kumagai H, Abe T, Ishiguro S, Uchida K, Kawasaki Y, Saida Y, Sano Y, Takeuchi Y, Tajika M, Nakajima T, Banno K, Funasaka Y, Hori S, Yamaguchi T, Yoshida T, Ishikawa H, Iwama T, Okazaki Y, Saito Y, Matsuura N, Mutoh M, Tomita N, Akiyama T, Yamamoto T, Ishida H, Nakayama Y. Clinical Guidelines for Diagnosis and Management of Peutz-Jeghers Syndrome in Children and Adults. Digestion, 104:335-347, 2023

33. Hihara D, Takamaru H, Sekiguchi M, Yamada M, Sakamoto T, Matsuda T, Saito Y. Factors associated with increased duration of endoscopic submucosal dissection for rectal tumors: a 22-year retrospective analysis. Gastrointestinal endoscopy, 98:420-427.e1, 2023

34. Matsumoto T, Umeno J, Jimbo K, Arai M, Iwama I, Kashida H, Kudo T, Koizumi K, Sato Y, Sekine S, Tanaka S, Tanakaya K, Tamura K, Hirata K, Fukahori S, Esaki M, Ishikawa H, Iwama T, Okazaki Y, Saito Y, Matsuura N, Mutoh M, Tomita N, Akiyama T, Yamamoto T, Ishida H, Nakayama Y. Clinical Guidelines for Diagnosis and Management of Juvenile Polyposis Syndrome in Children and Adults-Secondary Publication. Journal of the anus, rectum and colon, 7:115-125, 2023

35. Toyoshima O, Nishizawa T, Yoshida S, Matsuno T, Miyoshi K, Naito E, Shiomi C, Uozumi T, Fujishiro M, Saito Y. Hemorrhoids as a risk factor for colorectal adenomas on colonoscopy. Endoscopy international open, 11:E497-E503, 2023

36. Hirai M, Yanai S, Kunisaki R, Nishio M, Watanabe K, Sato T, Ishihara S, Anzai H, Hisabe T, Yasukawa S, Maeda Y, Takishima K, Ohno A, Shiga H, Uraoka T, Itoi Y, Ogata H, Takabayashi K, Yoshida N, Saito Y, Takamaru H, Kawasaki K, Esaki M, Tsuruoka N, Hisamatsu T, Matsumoto T. Effectiveness of endoscopic resection for colorectal neoplasms in ulcerative colitis: a multicenter registration study. Gastrointestinal endoscopy, 98:806-812, 2023

37. Koyama Y, Fukuzawa M, Aikawa H, Nemoto D, Muramatsu T, Matsumoto T, Uchida K, Madarame A, Morise T, Yamaguchi H, Kono S, Nagata N, Sugimoto M, Kawai T, Saito Y, Itoi T. Underwater endoscopic submucosal dissection for colorectal tumors decreases the incidence of post-electrocoagulation syndrome. Journal of gastroenterology and hepatology, 38:1566-1575, 2023

38. Mizuguchi Y, Saito Y. Colorectal cancer invasion calculation, a colorectal tumor depth diagnostic artificial intelligence, is promising, but its diagnostic accuracy remains a challenge. Digestive endoscopy, 35:636-637, 2023

39. Nakai T, Watanabe T, Kaimi Y, Shiomi K, Ando K, Miyamoto A, Ogawa K, Matsumoto Y, Sawa K, Sato K, Asai K, Matsumoto Y, Mikami Y, Ohsawa M, Kawaguchi T. Diagnostic Utility and Safety of Non-Intubated Cryobiopsy Technique Using a Novel Ultrathin Cryoprobe in Addition to Conventional Biopsy Techniques for Peripheral Pulmonary Lesions. Respiration; international review of thoracic diseases, 102:503-514, 2023

40. Uozumi T, Abe S, Makiguchi ME, Nonaka S, Suzuki H, Yoshinaga S, Saito Y. Complications of endoscopic resection in the upper gastrointestinal tract. Clinical endoscopy, 56:409-422, 2023

41. Takahashi Y, Taniguchi H, Haruhi F, Hattori D, Sasaki H, Makita S, Iwaki N, Fukuhara S, Munakata W, Saito Y, Izutsu K, Maeshima AM. Pathogenesis of Gastrointestinal Follicular Lymphomas: Consideration Based on Histopathology and Endoscopic Findings. The American journal of surgical pathology, 47:1134-1143, 2023

42. Saito Y. Reply to Santos-Antunes et al. Endoscopy, 55:883, 2023

43. Fujimoto K, Matsumoto Y, Imabayashi T, Uchimura K, Furuse H, Tsuchida T. Suitability of respiratory endoscopy for sampling malignant thoracic tumors for comprehensive genomic profiling. Cancer science, 114:4401-4412, 2023

44. Hihara D, Takamaru H, Matsuda T, Saito Y. Response. Gastrointestinal endoscopy, 98:683, 2023

45. Kunimasa K, Matsumoto S, Honma K, Tamiya M, Inoue T, Kawamura T, Tanada S, Miyazaki A, Kanzaki R, Maniwa T, Okami J, Matsumoto Y, Goto K, Nishino K. Utility of needle biopsy in centrally located lung cancer for genome analysis: a retrospective cohort study. BMC pulmonary medicine, 23:484, 2023

46. So C, Matsumoto Y, Imabayashi T, Uchimura K, Ohe Y, Furuse H, Tsuchida T. Identifying factors causing failure of nodal staging by endobronchial ultrasound-guided transbronchial needle aspiration in non-small cell lung cancer. Translational lung cancer research, 12:2169-2180, 2023