Publications by authors named "Hiroyuki Takamaru"
Endoscopic submucosal dissection (ESD) enables en-bloc resection of large lesions more than 20 mm in size. Therefore, the use of ESD has gained broader acceptance for clinical applications globally. Previous reports on long-term outcomes after ESD, when followed by additional surgery, have also reported favorable results, positioning ESD as a crucial tool in providing minimally invasive treatment for T1 colorectal cancer (CRC).
View Article and Find Full Text PDFAdenosquamous carcinoma is an uncommon type of cancer that comprises malignant squamous and glandular components. We present a case of human papillomavirus (HPV)-positive adenosquamous carcinoma of the anorectum, which exhibited extensive pagetoid spread, in a 70-year-old woman. The tumor had spread from the lower rectum to the perianal skin and was removed through a combined endoscopic and transanal surgical procedure.
View Article and Find Full Text PDFBackground: Precision cancer risk stratification for gastric cancer is urgently needed for the growing number of healthy people after eradication. The epimutation burden in non-malignant tissues has been associated with cancer risk in multiple cross-sectional studies.
Objective: To confirm the clinical usefulness of a DNA methylation marker for epimutation burden, and to identify a cut-off methylation level for a super-high-risk population.
Background And Study Aims: The multi-loop traction device (MLTD) facilitates optimal visualization of the submucosa throughout endoscopic submucosal dissection (ESD). This trial aimed to assess the efficacy of MLTD for colorectal ESD.
Patients And Methods: We conducted a multicenter, open-label, randomized controlled trial involving patients with colorectal lesions ≥ 20 mm suspicious for noninvasive carcinoma.
Background & Aims: Colonoscopy is the gold standard for detecting and resecting adenomas and early-stage cancers to reduce colorectal cancer (CRC) incidence and mortality rates. This study aimed to confirm the superiority of texture and color enhancement imaging (TXI) over white light imaging (WLI) in detecting colorectal lesions.
Methods: This randomized controlled trial was conducted at 8 Japanese institutions between March 2023 and October 2023.
Microbiome and Colorectal Cancer in Humans: A Review of Recent Studies.
J Anus Rectum Colon
January 2025
The tumor microenvironment has recently been well-studied in various gastrointestinal cancers, including colorectal cancer (CRC). The gut microbiota, a collection of microorganisms in the human gastrointestinal tract, is one of the microenvironments associated with colon carcinogenesis. It has been challenging to elucidate the mechanisms by which gut microbiota contributes to carcinogenesis and cancer progression due to complex interactions with the host, including its metabolites and immune and inflammatory responses.
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- A new technique called underwater injection EMR (UI-EMR) was developed to improve the removal of submucosal tissue in T1 colorectal cancer (T1-CRC) while ensuring adequate margins.
- A study involving 135 patients showed that UI-EMR achieved a high success rate in resection, with en bloc success in 94.1% of cases and minimal adverse events.
- The method also resulted in sufficient vertical margins for all evaluated T1-CRCs, suggesting it could be a favorable option for treating small non-pedunculated colorectal polyps that are concerning for T1-CRC.
Background And Aim: Colorectal endoscopic submucosal dissection is a technically demanding procedure with a steep learning curve. In Japan, the National Cancer Center Hospital allows overseas doctors to participate in hands-on training. We aimed to assess the colorectal endoscopic submucosal dissection performance and learning curve of an endoscopist who participated in hands-on training.
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- A study compared gene expression in the normal intestines of healthy individuals and colorectal cancer patients using a step biopsy procedure involving 78 participants.
- Significant differences in gene expression were found not only between the healthy intestine regions but also in cancer patients' normal mucosa, indicating concealed alterations due to cancer.
- These findings suggest that seemingly normal tissues in colorectal cancer patients might harbor cancer-predisposing conditions, highlighting potential pathways for new immunotherapy and treatments.
Background And Aim: The risk of colorectal cancer among fecal immunochemistry test-positive individuals who had undergone previous colonoscopies remains unclear. Therefore, this study aimed to determine the differences in the risk of colorectal cancer among fecal immunochemistry test-positive individuals according to the timing of their previous colonoscopies.
Methods: This multicenter, retrospective, observational study was conducted in Japan as a subgroup analysis of the J-SCOUT study (UMIN000040690), which integrated and analyzed a database comprising all colonoscopies performed at participating Japanese institutions between 2010 and 2020.
Article Synopsis
- * A total of 82,005 colonoscopy cases were analyzed, revealing 71 identified colorectal NENs, which corresponds to a detection rate of 0.087%. Most cases were small lesions in the rectum.
- * Findings suggest that the detection rate of colorectal NENs during colonoscopy is higher than previously anticipated, indicating the importance of thorough screening.
Objectives: This study investigated the incidence of lymph node metastasis and long-term outcomes in patients with T1 colorectal cancer where endoscopic submucosal dissection (ESD) resulted in noncurative treatment. It is focused on those with deep submucosal invasion, a factor considered a weak predictor of lymph node metastasis in the absence of other risk factors.
Methods: This nationwide, multicenter, prospective study conducted a post-hoc analysis of 141 patients with T1 colorectal cancer ≥20 mm where ESD of the lesion resulted in noncurative outcomes, characterized by poor differentiation, deep submucosal invasion (≥1000 μm), lymphovascular invasion, high-grade tumor budding, or positive vertical margins.
Article Synopsis
- Recent research shows a link between gut microbiota and sporadic colorectal cancer (CRC), but its relationship with hereditary Lynch Syndrome (LS) is not well understood.
- A study examined the gut microbiota and metabolites in 71 Japanese LS patients compared to 437 non-LS controls, revealing that LS patients have lower microbial diversity and specific metabolite profiles.
- The findings indicate that gut microbiota may be more actively involved in tumor formation in LS patients than in those with sporadic CRC.
Endoscopic hand suturing using a modified through-the-scope needle holder for mucosal closure after colorectal endoscopic submucosal dissection: Prospective multicenter study (with video).
Dig Endosc
November 2024
Article Synopsis
- Endoscopic hand suturing (EHS) is a new method for closing mucosal defects after endoscopic submucosal dissection (ESD), and this study aimed to evaluate its technical feasibility in colorectal procedures using a modified needle holder.
- Conducted at two referral centers, the study included 20 patients with colorectal neoplasms, revealing a high complete closure rate of 90% and an average suturing time of 49 minutes.
- The results indicated an 85% sustained closure rate on follow-up endoscopy, with no delayed adverse events, highlighting EHS's effectiveness but suggesting it may be best suited for high-risk cases due to its complexity and time requirements.
Article Synopsis
- * A randomized trial involved 901 patients undergoing endoscopies, where 3G-NBI showed a higher detection rate for GNs (7.3%) compared to TXI (5.0%) and WLI (5.6%).
- * The findings suggest that 3G-NBI is superior in detecting GNs, leading to better outcomes, thereby highlighting its potential in clinical practices for early diagnosis.
Chronological Trend of Opportunistic Endoscopic Screening for Gastric Cancer and Atrophic Gastritis.
Asian Pac J Cancer Prev
April 2024
Background: Opportunistic endoscopic screening for gastric cancer was initiated in 2004 at our institute. We investigated chronological trends in gastric cancer detection rates based on individual characteristics and atrophic gastritis prevalence.
Methods: Overall, 15,081 asymptomatic individuals aged ≥40 years without a medical history of gastric cancer underwent first-time esophagogastroduodenoscopy in our institute between February 2004 and December 2017.
Article Synopsis
- The study examined 354 patients with primary small bowel adenocarcinoma (PSBA) in Japan, revealing a median age of 67 years and a majority being male (61.6%).
- The majority of tumors were located in the jejunum (66.2%) and ileum (30.4%), with over 76% of patients presenting symptoms at diagnosis, often at an advanced stage.
- The research found that clinical stage was the main predictor of disease-specific survival, emphasizing the importance of early detection for better patient outcomes.
Article Synopsis
- This study explored the characteristics and outcomes of stage IV small bowel adenocarcinoma (SBA) in Japan, analyzing data from 128 patients to determine the effectiveness of different treatment strategies.
- The treatments included chemotherapy alone, surgery alone, surgery combined with chemotherapy, and best supportive care, revealing a median overall survival of 16 months, with the best outcomes seen in those receiving surgery and chemotherapy.
- Results indicated that patients who underwent surgery or chemotherapy had better survival rates compared to those with best supportive care, and survival did not significantly vary among different chemotherapy regimens.
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 Gastroenterol
February 2024
Article Synopsis
- The study compares two bowel cleansing methods for colonoscopy preparation: Sodium picosulfate/magnesium citrate (SP/MC) and polyethylene glycol (PEG) with ascorbic acid, with a focus on patient acceptability and effectiveness.
- The trial includes 540 participants aged 40-69 and evaluates bowel cleansing quality using the Boston Bowel Preparation Scale, along with other factors like patient satisfaction and detection of polyps.
- Researchers aim to demonstrate that SP/MC is not only more acceptable due to its smaller dosage and better taste but also as effective as PEG for ensuring thorough bowel cleansing in outpatient settings.
Article Synopsis
- The study investigates how colonoscopy insertion and withdrawal times affect the adenoma detection rate (ADR), which is important for cancer screening effectiveness.
- Using data from a large sample of colonoscopies performed by various endoscopists in Japan, researchers found that longer cecal insertion times were linked to lower ADRs, while longer withdrawal times were associated with higher ADRs.
- The findings suggest that both insertion and withdrawal times should be considered as quality indicators for colonoscopy procedures.
Article Synopsis
- Chronic inflammation is linked to the growth and worsening of colorectal cancer (CRC), prompting research on the underlying molecular mechanisms.
- In vivo screening revealed 142 frequently mutated genes in inflammation-associated colon tumors, highlighting the role of senescence and TGFβ-activin signaling pathways.
- The study identifies potential therapeutic targets, such as the Cdk4/6 inhibitor and tumor suppressor genes Arhgap5 and Mecom, emphasizing the significance of senescence pathway inactivation in CRC within inflammatory environments.
Article Synopsis
- Patients with ulcerative colitis (UC) are at an increased risk of colorectal cancer, and this study explores the feasibility of endoscopic resection (ER) as a treatment for UC-associated neoplasms.
- In a retrospective analysis of 336 patients who underwent ER or surgery for colorectal issues, the study found a low perforation rate and local recurrence after treatment, indicating that ER may be a safer option compared to traditional surgery.
- The results suggest that while ER can be effective for certain cases of colorectal neoplasms in UC patients, ongoing monitoring for new lesions is essential, and ER shows better overall survival compared to surgical interventions.