Publications by authors named "Akiko Toshimori"

Article Synopsis
  • The MANTIS Clip is a new medical device designed to improve tissue grasping and close defects in the gastrointestinal tract, specifically after colorectal endoscopic submucosal dissection (C-ESD).
  • A study at a single center from May 2023 to April 2024 involved 52 patients, showing a very high complete closure success rate of 98.1% and a sustained closure rate of 96.1% for mucosal defects.
  • The procedure had minimal complications, with only one instance each of bleeding and coagulation syndrome, indicating the MANTIS Clip's effectiveness and practicality, but further multicenter trials are recommended for more comprehensive evaluation.
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Mucosal defect closure after colorectal endoscopic submucosal dissection (ESD) has the potential to reduce the occurrence of delayed adverse events (AEs) such as bleeding and perforation. This study aimed to assess the feasibility and effectiveness of the Loop9 method for closing mucosal defects following colorectal ESD. A retrospective single-center study was conducted using prospectively collected data from May 2020 to March 2023.

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Objectives: The endoscopic pressure study integrated system (EPSIS) is an endoscopic diagnostic system utilized for evaluation of lower esophageal sphincter function. Although previous studies have determined that EPSIS was effective as a tool for the diagnosis of achalasia, it remains uncertain if EPSIS can detect significant changes before and after peroral endoscopic myotomy (POEM), which is the premier treatment for achalasia. This study aimed to evaluate the effectiveness of EPSIS as an objective diagnostic tool for assessing the clinical effect of POEM.

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Background And Study Aim: Magnifying endoscopy enables the diagnosis of advanced neoplasia throughout the gastrointestinal tract. The unified magnifying endoscopic classification (UMEC) framework unifies optical diagnosis criteria in the esophagus, stomach, and colon, dividing lesions into three categories: non-neoplastic, intramucosal neoplasia, and deep submucosal invasive cancer. This study aims to ascertain the performance of North American endoscopists when using the UMEC.

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Article Synopsis
  • The endoscopic pressure study integrated system (EPSIS) is a new tool that measures lower esophageal sphincter (LES) function by recording intragastric pressure during esophagogastroduodenoscopy (EGD), aimed at helping diagnose achalasia.
  • A case-control study involved 35 achalasia patients and 34 control patients, comparing EPSIS findings like pressure waveform patterns and maximum intragastric pressure (IGP-Max) between the two groups.
  • Results showed that all achalasia patients had an uphill pressure pattern, with IGP-Max providing high diagnostic accuracy (100% sensitivity, 58.8% specificity) at a cut-off of 15.8 mmHg, indicating EPS
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Article Synopsis
  • - The study assessed the effectiveness of the endoscopic pressure study integrated system (EPSIS) to evaluate anorectal function in older and younger patients, hypothesizing that it could help diagnose lower gastrointestinal disorders.
  • - A retrospective analysis of 30 patients showed significant differences in maximum rectal pressure measurements, with older patients (≥80 years) exhibiting lower pressure compared to younger patients (<80 years), indicating a decline in anorectal function with age.
  • - The findings suggest that EPSIS could be a useful tool for understanding age-related changes in anorectal physiology, recommending that future research explores its potential in routine screenings and diagnosing anorectal issues.
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With the advent of endoscopic submucosal dissection, a variety of endoscopic devices including knives and high-frequency electrosurgical unit have become available. In addition, the concept of natural orifice transluminal endoscopic surgery pushed flexible endoscopic surgery ahead. In this review, the birth of peroral endoscopic myotomy and its expansion into the field of submucosal endoscopy are reviewed.

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Article Synopsis
  • The study aimed to determine how many cases of peroral endoscopic myotomy (POEM) are needed for proficiency among nonexperts compared to endoscopic submucosal dissection (ESD) experts.
  • Analysis of 1,121 POEM cases showed nonexperts needed 41-60 cases to reach proficiency, while experts needed only 21-40 cases, with operation times significantly decreasing as experience increased in both groups.
  • There were high clinical success rates for both groups (96.2-100%), but nonexperts experienced slightly higher adverse events and rates of gastroesophageal reflux disease (GERD), highlighting the need for tailored training programs.
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Article Synopsis
  • The endoscopic pressure study integrated system (EPSIS) is a new diagnostic tool for assessing gastroesophageal reflux disease (GERD) by measuring intragastric pressure during endoscopy.
  • A study investigated the link between EPSIS results and lower esophageal sphincter (LES) function, comparing EPSIS with high-resolution manometry (HRM).
  • The findings revealed that EPSIS parameters, such as pressure difference and pressure gradient, are significantly correlated with LES pressures, supporting its effectiveness as a diagnostic tool for GERD.
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Article Synopsis
  • This study investigates the relationship between the lower esophageal sphincter (LES) and a new endoscopic sign called the scope holding sign (SHS) in patients with gastroesophageal reflux disease (GERD).
  • Researchers performed high-resolution manometry (HRM) and endoscopy on GERD patients to measure resting LES pressure while observing SHS, comparing pressures when the lower esophagus held or released the endoscope.
  • Results showed that LES pressure was significantly higher when SHS was positive, suggesting the sphincter can be visualized during endoscopy, paving the way for better evaluation of LES function in GERD patients.
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Endoscopic technologies have been continuously advancing throughout the years to facilitate improvement in the detection and diagnosis of gastric lesions. With the development of different endoscopic diagnostic modalities for EGC, several classifications have been advocated for the evaluation of gastric lesions, aiming for an early detection and diagnosis. Sufficient knowledge on the appearance of EGC on white light endoscopy is fundamental for early detection and management.

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Article Synopsis
  • Endoscopic balloon dilatation is a recognized method for treating benign gastrointestinal strictures, but it's challenging to safely achieve widths over 30 mm with current commercial products.
  • Two new methods have been developed: the single-barrel method uses one balloon for precise dilatation, while the double-barrel method employs two balloons for larger dilation over 30 mm.
  • These techniques can help treat strictures like esophageal achalasia or those resulting from surgeries like Nissen fundoplication, allowing for safe and controlled dilatation under direct visualization.
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Article Synopsis
  • Image-enhanced magnifying endoscopy improves the detection and diagnosis of gastrointestinal lesions, but existing classifications can confuse general gastroenterologists.
  • The Unified Magnifying Endoscopic Classification (UMEC) was developed to be a simpler, organ-agnostic system that categorizes lesions into non-neoplasia, intramucosal neoplasia, and deep submucosal invasive cancer.
  • In a feasibility pilot study, two experienced endoscopists evaluated 303 lesions using UMEC, achieving high diagnostic accuracy (approximately 84-89%) and good agreement between observers, suggesting UMEC's practicality and effectiveness for general use.
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Article Synopsis
  • Congenital esophageal stenosis (CES) in adults can be mistaken for achalasia and typically presents with symptoms like dysphagia, requiring a careful evaluation to identify the condition correctly.
  • A study of 6 patients misdiagnosed with achalasia revealed specific features of CES, and 4 of them successfully underwent a procedure called peroral endoscopic myotomy (POEM) that improved their symptoms.
  • While the short-term outcomes of POEM for CES appear positive, caution is advised for inexperienced practitioners due to potential technical challenges in the procedure.
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Since per-oral endoscopic myotomy (POEM) was introduced in 2010, it has become accepted as one of the standard treatments for esophageal achalasia worldwide. This study aimed to present long-term clinical results of POEM over 10 years and evaluate the technique and outcomes at the institution where it was first used in clinical settings. Questionnaire-based surveys were sent to patients who received POEM in our institution from September 2008 to May 2010.

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Article Synopsis
  • EPSIS is a new diagnostic tool for gastroesophageal reflux disease that monitors intragastric pressure during endoscopy, allowing for accurate assessment of the lower esophageal sphincter function.
  • The study presents an updated EPSIS method that simplifies the procedure by eliminating the need for catheter insertion, thus reducing costs and complexity.
  • Results from a pilot study on 20 patients showed a strong consistency between the traditional and updated EPSIS methods, indicating the updated version is a reliable alternative for measuring intragastric pressure.
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Article Synopsis
  • - This study tested the new loop 9 method for closing gastrointestinal defects in 20 patients, evaluating its effectiveness and practicality.
  • - Complete closure of defects was achieved in all cases, with an average closure time of 14 minutes and a sustained closure rate of 90%, with no complications reported.
  • - The findings suggest that loop 9 is a promising technique for successful closure of GI defects during therapeutic endoscopy procedures.
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Article Synopsis
  • Endocytoscopy (EC) is an advanced endoscopy technique aimed at providing detailed histological assessments of esophageal lesions.
  • A study analyzed 2548 EC images from targeted areas to evaluate the diagnostic yield of a new fourth-generation EC using a modified classification system, with both expert and non-expert endoscopists reviewing the images.
  • Results showed high sensitivity and specificity for diagnosing squamous cell cancer (SCC) and other lesions, indicating that fourth-generation EC is reliable for both experts and non-experts in detecting esophageal lesions.
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Objectives: Endoscopic pressure study integrated system (EPSIS) is a novel diagnostic tool for gastroesophageal reflux disease (GERD). EPSIS has been developed to evaluate lower esophageal sphincter function by monitoring the intragastric pressure (IGP) while insufflating the stomach during gastroscopy. Based on previous data, EPSIS could diagnose GERD with good accuracy by assessing IGP waveform pattern.

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Objectives: Per-oral endoscopic myotomy (POEM) is a safe and effective treatment for achalasia and esophageal motility disorders. The role of second-look endoscopy (SE) on postoperative day 1 has not been examined. This study aimed to evaluate the findings and need of SE after POEM.

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Patients with end-stage renal disease who are undergoing dialysis may be at high risk of developing hepatocellular carcinoma (HCC). We investigated the characteristics and prognosis of HCC in patients undergoing dialysis in Japan. Patients characteristics, progression of HCC at diagnosis, and survival rates after diagnosis were compared between 108 HCC patients undergoing dialysis and 526 non-dialysis patients followed up at liver center.

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There is no consensus regarding which therapeutic option is better and/or safer for treating hemodialysis (HD) patients with hepatocellular carcinoma (HCC). The present study compared surgical resection (Hx) and radiofrequency ablation (RFA) with regard to therapeutic efficacy in HD patients with HCC. Of 108 HD patients with naïve HCC treated at 15 institutions between 1988 and 2014 enrolled in the present study, 58 fulfilled the up-to-7 criteria [7 as the sum of the size of the largest tumor (cm) and the number of tumors] and were treated with Hx (n=23) or RFA (n=35); their clinical features, complications and prognosis were assessed.

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A 63-year-old Japanese man whose white blood cell count and total-bilirubin and aminotransferase levels were elevated was referred to our hospital. Computed tomography did not reveal any abnormalities, and there was no evidence of gastritis or colitis on esophagogastroduodenoscopy. Although the patient had no history of drug use or allergies, a high concentration of eosinophils (80%) was noted.

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