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Imai K.,Shizuoka Cancer Center | Tanaka M.,Shizuoka Cancer Center | Hasuike N.,Gastrointestinal Center | Kakushima N.,Shizuoka Cancer Center | And 7 more authors.
Gastrointestinal Endoscopy | Year: 2013

Background: After endoscopic resection (ER) for superficial pharyngeal cancer (SPC), additional treatments such as radical surgical resection or radiation therapy may be needed in cases of possible incomplete resection. However, the benefit of prophylactic additional treatment is unclear. Objective: To evaluate the feasibility of a "resect and watch" strategy with ER for SPC. Design: Retrospective, single-center cohort study. Setting: Tertiary cancer center. Patients: A total of 32 patients with 47 SPCs were eligible. Intervention: A "resect and watch" strategy of initial ER and observation until development of secondary diseases, including local recurrence, neck lymph node metastasis (LNM), and metachronous pharyngeal cancer. Main Outcome Measurements: Complications, tumor recurrence, development of metachronous pharyngeal cancer, overall survival, and cause-specific survival. Results: There were no severe complications related to ER. Median length of follow-up was 43 months (range, 7-76 months). Cumulative development of secondary diseases at 5 years was 44% (95% CI, 24.5%-63.8%). Local recurrence (N = 4) and neck LNM (N = 5) were successfully treated by local resection (2 partial surgical resections and 2 additional ERs) and neck dissection, respectively. Metachronous pharyngeal cancers (N = 6) were completely removed by ER. The overall survival and cause-specific survival rates at 5 years were 84.4% (95% CI, 70.0%-98.8%) and 100%, respectively. No patient needed radical surgery as an additional therapy. Thus, the larynx and its function were preserved in all patients. Limitations: Retrospective nature, single-center setting, relatively small sample size. Conclusions: A "resect and watch" strategy with ER for SPC is feasible and rational. © 2013 American Society for Gastrointestinal Endoscopy. Source

Oka S.,Hiroshima University | Tanaka S.,Hiroshima University | Saito Y.,National Cancer Center Hospital | Iishi H.,Japan National Cardiovascular Center Research Institute | And 16 more authors.
American Journal of Gastroenterology | Year: 2015

OBJECTIVES:Conventional endoscopic resection (CER) is a widely accepted treatment for early colorectal neoplasia; however, large colorectal neoplasias remain problematic, as they necessitate piecemeal resection, increasing the risk of local recurrence. Endoscopic submucosal dissection (ESD) can improve the en bloc resection rate. This study aimed to evaluate local recurrence and its associated risk factors after endoscopic resection (ER) for colorectal neoplasias ≥20 mm.METHODS:A multicenter prospective study at 18 medium-and high-volume specialized institutions was conducted in Japan. Follow-up colonoscopy was performed after 12 months in cases of complete resection and after 3-6 months in cases of incomplete resection. Local recurrence was confirmed by endoscopic findings and/or pathological analysis.RESULTS:Follow-up colonoscopy was performed in 1,524 of 1,845 enrolled colorectal neoplasias (mean age, 65 years; 885 men; median tumor size, 32.8 mm). The local recurrence rates were 4.3% (65/1,524), 6.8% (55/808), and 1.4% (10/716) for the entire cohort, for CER, and for ESD, respectively. The relative risks of local recurrence were 0.21 (95% confidence interval, 0.11-0.39) with ESD compared with CER, 0.32 (95% confidence interval, 0.11-0.92) with en bloc ESD compared with en bloc CER, and 0.90 (95% confidence interval, 0.39-2.12) with piecemeal ESD compared with piecemeal CER. Significant factors associated with local recurrence were piecemeal resection, laterally spreading tumors of granular type, tumor size ≥40 mm, no pre-treatment magnification, and ≤10 years of experience in CER, and piecemeal resection only in ESD.CONCLUSIONS:En bloc ESD reduces the local recurrence rate for large colorectal neoplasias. Piecemeal resection is the most important risk factor for local recurrence regardless of the ER method used. © 2015 by the American College of Gastroenterology. Source

Uraoka T.,Okayama University | Saito Y.,National Cancer Center Hospital | Ikematsu H.,National Cancer Center East Hospital | Yamamoto K.,Okayama University of Science | Sano Y.,Gastrointestinal Center
Digestive Endoscopy | Year: 2011

Narrow-band imaging enhances visualization of the mucosal surface structure and vascular network and helps to increase the visibility of neoplasia by improving contrast. Sano and his colleagues first reported its efficacy for endoscopic use in the gastrointestinal tract and later proposed a sequential classification of the mucosal vascular network patterns according to histopathological categories. Sano's 'capillary pattern classification' was established to facilitate diagnosis of early colorectal lesions on a step-by-step basis. This review focuses on the utility and effectiveness of Sano's capillary pattern classification when examining early colorectal lesions using narrow-band imaging. © 2011 The Authors Digestive Endoscopy © 2011 Japan Gastroenterological Endoscopy Society. Source

Ikematsu H.,National Cancer Center Hospital East | Saito Y.,National Cancer Center Hospital | Tanaka S.,Hiroshima University | Uraoka T.,Okayama University | And 7 more authors.
Journal of Gastroenterology | Year: 2012

Background: Previous studies have yielded conflicting results on the adenoma detection rate with narrow band imaging (NBI) compared with white light imaging (WLI). To overcome the confounding factors of these studies, we aimed to evaluate the colonic adenoma detection rate with primary NBI versus that with primary WLI by using consistent NBI system, endoscope, and imaging settings, and experienced colonoscopists. Methods: In this multicenter prospective trial, 813 patients were randomized to undergo high-definition, tandem colonoscopy in the right colon with either NBI followed by WLI (NBI-WLI group) or WLI followed by NBI (WLI-NBI group). The NBI settings were fixed at surface structure enhancement level A-5 and adaptive index of hemoglobin color enhancement level 3. All detected polyps were resected or biopsied for histopathological analysis. The primary and secondary outcome measures were the adenoma detection rates and miss rates, respectively, with primary imaging. Results: The NBI-WLI and WLI-NBI groups comprised 389 and 393 patients, respectively, who met the inclusion criteria. The groups did not differ significantly in age, gender, institution, indication for colonoscopy, bowel preparation, or observation time. The adenoma detection rates of primary NBI and WLI were 42.3 and 42.5 %, respectively [difference not significant (NS)]. The adenoma miss rate was significantly less with primary NBI than with primary WLI (21.3 vs. 27.8 %; p = 0.03). Conclusions: NBI does not improve the adenoma detection rate during primary colonoscopy; however, it has a lower miss rate for adenoma lesions in the proximal colon than WLI. © 2012 Springer. Source

Dai J.,Shanghai JiaoTong University | Shen Y.-F.,Shanghai JiaoTong University | Sano Y.,Gastrointestinal Center | Li X.-B.,Shanghai JiaoTong University | And 5 more authors.
Digestive Endoscopy | Year: 2013

Background The usefulness of endoscopy narrow-band imaging (NBI) in differentiating colorectal lesions has been demonstrated. However, the learning curve associated with this technique is a concern for endoscopists. Methods Prior to carrying out these colonoscopies, four endoscopists attended a training course designed to teach the principles of NBI and application of the Sano Capillary Pattern (CP) classification criteria. Following a pre-test, endoscopists used NBI with magnification and CP analysis for real-time colonoscopy exams to predict lesion histology. Three sets of 15 lesions were imaged. These three sets included both lesions requiring endoscopic treatment (e.g. target lesions) and lesions that were not, or could not be, treated by endoscopy (e.g. non-target lesions). The diagnostic accuracy of each endoscopist for each set of lesions was evaluated to assess the learning curve associated with the application of NBI. Results Overall accuracy, sensitivity, and specificity for differentiating neoplastic and non-neoplastic lesions were 95.4%, 98.0%, and 92.0%, respectively. For target lesions versus non-target lesions, the diagnostic accuracy associated with the second set of lesions was better than that achieved with the first set of lesions (78.3% vs 96.7% (P = 0.02) and 70.0% vs 96.7% (P < 0.01), respectively in each case). In contrast, the difference in diagnostic accuracy between the second and third sets of lesions was not significant. Conclusion NBI with magnification is a useful tool for the diagnosis of colorectal lesions. Moreover, following a short training program and with minimal clinic practice, less experienced endoscopists were able to become competent in the method. © 2012 The Authors. Digestive Endoscopy © 2012 Japan Gastroenterological Endoscopy Society. Source

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